An assessment of gait and balance deficits after traumatic brain injury

Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

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The primary vascular dysregulation syndrome: implications for eye diseases

### 3.1 - General Principles of Glaucoma Treatment

The purpose of this chapter is to give a summary overview and it is not meant to be an all-inclusive text



Figure 3.1. 
THE WHOM -TO -TREAT GRAPH The rate of ganglion cell loss and resulting functional decay is very different among different glaucoma eyes. Quality of life is clearly reduced when visual field defects become severe, cf. the severe functional impairment. Line A represents the effect of aging alone. In glaucoma loss of visual function is often much more rapid. An older patient, diagnosed late in life, with a moderate rate of progression (B) has a much lower risk of developing severe functional impairment than a younger patient with the same amount of field loss at diagnosis and rate of progression (C). A very slow rate of progression may be tolerated by the patient and treatment left unchanged (D), while a rapid rate of progression (E) needs a considerably lower target pressure .

It needs to be remembered that it is the extent of binocular visual field or the field of the better eye that largely determines the patient’s quality of life, while the rates of progression of each eye separately are needed to determine treatment .



To assess the likely Rate of Progression (RoP) is an important part of patient management and the measured rate is a very important factor that should determine target pressure and treatment intensity (See Ch. Introduction) [I.D]. Many studies have found that progression is usually linear1-4, but the goal of intensifying treatment is to decrease rate of progression.

Please observe that perimetric printouts of progression using the MD or VFI indices are age-corrected, so that a normal eye would not show any age-related deterioration over time.

The goal of glaucoma treatment is to maintain the patient’s visual function and related quality of life, …

/pdf/european-glaucoma-society-terminology-and-guidelines-for-35j13md8bp.pdf

European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and optionsSupported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options

This literature review looks at the current status of multifocal intraocular lenses (IOLs) in cataract surgery. The results of implantation of multifocal IOLs of diffractive, refractive, and hybrid diffractive–refractive design are described with regard to uncorrected near and distance visual acuity and spectacle independence. The occurrence of photic phenomena and contrast sensitivity loss with multifocal IOLs are also addressed. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects.

Multifocal Intraocular Lenses: An Overview

The key to identifying the type of diabetic maculopathy is determining the status of posterior vitreous adhesion. In the pathological state, the breakdown of the internal and external blood-retina barrier is evident, however the mechanism is usually complex. The common denominator for these disorders are Muller glial cells, which mediate in maintaining the blood-retina barrier by linking the vessels, neurons and the vitreous in anatomical network and into functional dependence. The breakdown of the blood-retina barrier results in proliferation of Muller cells. Molecular changes in these cells increase endothelial barrier properties, but also induce pathological processes on the vitreo-retinal junction, resulting in increased adhesiveness of the collagen fibers of vitreous to retinal internal limiting membrane. The ability of Muller cells to reactive gliosis is influenced by the healthy functioning of the retinal pigment epithelium, which is a source of trophic factors necessary for appropriate Muller cells morphogenesis. Vitrectomy with the removal of ILM eliminates the vitreofoveal interface pathology, additionally provoking reactive gliosis within the macula. Intraoperative use of anti-VEGF supports short-term tightness of the blood-retina barrier in the perioperative neuralgic period. In the future, supplying astrocytes may be a strategy that will allow not only the inhibition of pathological neovascularization but also the restoration of the physiological network of capillaries in avascular retina areas. The delivery of recombinant PEDF allows for the recovery of Muller cells, and thus creates the conditions favourable for the survival of nerve cells in loss of retinal homeostasis.

Müller glial cells--the mediators of vascular disorders with vitreomacular interface pathology in diabetic maculopathy.

Background
The aim of this paper was to evaluate functional and anatomical results of intravitreal ranibizumab injections and the course of exudative age-related macular degeneration (AMD) treatment over a 12-month observation period.

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Effectiveness of ranibizumab intravitreal injections for exudative age-related macular degeneration treatment: 12-month outcomes.

PURPOSE Myopia is the second most frequent cause of CNV after AMD. Since the introduction verteporfin photodynamic therapy and anti-angiogenic drugs into clinical practice, major changes occurred in the treatment of subfoveal exudative maculopathy associated with myopia.The aim of the paper is to present the effect of intravitreal injections ranibizumab (Lucentis) for myopic choroidal neovascularization. MATERIAL AND METHODS The study included two patients (25 and 55 years old women) with high myopia. Diagnosis and monitoring of the treatment were based on fluorescein angiography and optical coherence tomography. RESULTS In 55-years old woman after two injections central retinal leakage decreased in fluorescein angiography and optical coherence tomography and visual acuity improved of two lines (10 letters). After 9 months follow-up in 25 years old woman's after three injections of Lucentis, visual acuity improved of three lines on ETDRS chart (15 letters). The leakage in fluorescein angiography was closed. CONCLUSIONS Intravitreal injections therapy of ranibizumab may be a therapeutic option for CNV associated with myopia. It causes chance for decreased central retinal thickness and increased visual acuity, particularly in view of the young patients. One must take note of the other illness associated with CNV in myopic eyes like as epiretinal membranes or vitreoretinal tractions.

[Anty-VEGF therapy in the treatment of myopic macular choroidal neovascularization--cases report].

BACKGROUND The aim of this study was to evaluate the visual acuity and structural outcomes of combined phacovitrectomy with ILM peeling, retinal endophotocoagulation and use of bevacizumab in patients with diffuse diabetic macular edema (DDME). MATERIAL/METHODS In this prospective, nonrandomized, interventional study we included 29 eyes of 26 patients with DDME. The best-corrected visual acuity (BCVA) and central retinal thickness and volume (CRT and CRV) were recorded at 4, 8, 12, and 16 months after surgery. RESULTS The mean preoperative BCVA was 0.74±0.36 logMAR (0.3-1.5) and improved finally to 0.4±0.24 logMAR (-0.1-1.0) p=0.000006. The mean preoperative CRT in the 1mm zone was 516±184 microm (256-950) and decreased postoperatively at the last control to 237±75 microm (117-489) p=0.000003. The mean preoperative CRV in the 1mm zone was 0.39±0.14 microL (0.19-0.74) and decreased postoperatively at the last control to 0.17±0.06 microL (0.09-0.36) p=0.000003. The mean preoperative CRT in the 6 mm zone was 407±105 microm (279-640) and decreased postoperatively at the last control to 282±40 µm (212-380) p=0.000004. The mean preoperative CRV in the 6 mm zone was 11.4±2.9 microL (7.85-17.93) and decreased postoperatively at the last control to 7.92±1.0 microL (5.62-10.97) p=0.000003. The 23 (79.3%) eyes showed improvement in BCVA ≥0.2 logMAR, 5 (17.2%) eyes improvement or stabilization of BCVA and 1(3.5%) eye deterioration. Preoperative BCVA was a positive factor for prognosis of BCVA at 12th month follow-up (b=0.42; p=0.006), while the negative factors were: previous panretinal photocoagulation (b=-0.24; p=0.04), presence of vitreomacular traction (b=-0.29; p=0.02) and preoperative CRT in the 1000 microm zone (b=-0.24; p=0.07). A greater visual acuity improvement occurred in eyes with worse baseline visual acuity (b=-1.01; p=0.00001). The presentation of vitreomacular traction (b=-0.38; p=0.02), previous panretinal photocoagulation (b=-0.31, p=0.04) and greater preoperative CRT in the 1000 µm zone (b=-0.31; p=0.07) were negative factors for visual improvement. CONCLUSIONS This combined treatment resulted in improvement or stabilization of BCVA and decrease of CRT and CRV. Larger comparative studies are necessary to establish the real impact of this therapeutic approach.

Triple therapy: Phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of Bevacizumab for diffuse diabetic macular edema

Objective:To compare the efficacy and safety of phacoemulsification – deep sclerectomy (PDS) with absorbable SK-gel or non-absorbable T-flux implantation.Research design and method:The study involved eyes after PDS with SK-gel (32 eyes) and T-flux (20 eyes). Primary open angle glaucoma without satisfying intraocular pressure (IOP) control (≥21 mmHg) despite maximally tolerated medication or with progression of the visual field and cataract was the indication for surgery. For statistical analyses, the Mann–Whitney U test, Student’s t-test, pair sequence Wilcoxon test, and analysis of variance were used. Survival analysis was done using the Kaplan–Meier method.Main outcome measures:The best corrected visual acuity (BCVA), IOP, anterior and posterior segments of the eye, and number of antiglaucoma medications were examined. Follow-up examinations were performed on days 1 and 7, and at 1, 3, 6, 12, 18 and 24 months. A complete success rate was defined as IOP ≤18 mmHg without and qualified success as I...

Combined surgery for cataract and glaucoma: PDS with absorbable SK-gel implant compared with PDS with non-absorbable T-flux implant - medium-term results.

Andrzej Stankiewicz

Papers

Müller glial cells--the mediators of vascular disorders with vitreomacular interface pathology in diabetic maculopathy.

Effectiveness of ranibizumab intravitreal injections for exudative age-related macular degeneration treatment: 12-month outcomes.

[Anty-VEGF therapy in the treatment of myopic macular choroidal neovascularization--cases report].

Triple therapy: Phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of Bevacizumab for diffuse diabetic macular edema

Combined surgery for cataract and glaucoma: PDS with absorbable SK-gel implant compared with PDS with non-absorbable T-flux implant - medium-term results.