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

PURPOSE To evaluate cathepsin A activity in the subretinal fluid in the primary retinal detachment. MATERIALS AND METHODS The studies were performed on subretinal fluids taken from 38 patients operated for the primary retinal detachment. Duration of the detachment was contained between 1 week and 6 months. Cathepsin A activity was determined by the ninhydrin method with synthetic substrate (N-Cbz-Phe-Ala) at its optimum pH 5.0. RESULTS Cathepsin A activity was demonstrated in all investigated fluids. The highest activity was found at about the 4th week of the detachment and then it decreased. No differences of enzyme activity according to sex and refraction error were found. CONCLUSION The increasing proteolytic activity in the subretinal fluid could be an important factor in gradual degrading of the structure and function of the detached retina, because cathepsins are involved in digestion of outer segment proteins of rods and cones and degradation of mucopolysaccharide interphotoreceptor matrix. Retinal degradation during detachment is probably induced by both insufficient nutrition and the effect of increasing lysosomal enzymes.

Activity of cathepsin a in subretinal fluid in primary retinal detachment

Purpose Retrospective analysis of the incidence and risk factors of senile and pre-senile cataract in patients from North-East Region of Poland, operated on cataract in the years 1986-1995. Material and methods In the analysed decade, 6038 patients were operated on cataract in the Ophthalmology Department of the Clinical Hospital and Ophthalmology Department of the District Hospital in Bialystok. There were 2603 males and 3435 females, mean age amounted to 69 +/- 11 years. 44% of the patients came from rural communities (560.000 inhabitants in the region), whereas 56% of the patients were of urban province (796.000 inhabitants). Statistical analysis was performed on such variables like age, gender, place of residence, cataract history and presence of concomitant diseases: arterial hypertension, diabetes, lung and joints disorders, intestinal diseases. Results and conclusions Residence in rural communities increases the risk of cataract, although the condition in this environment tends to develop in older age. Gender distribution of the patients does not differ from male/female ratio in the population of the region, so both genders are exposed to similar risk of cataract. Females contract cataract in older age, on average about 3 years later than males. Age is the most important risk factor of cataract; 52% of the patients are older than 70, 43% are in the age of 51-70 years. Mean value of duration of cataract history before operation decreased during the analysed 10 years from 3.8 years in 1986 to 2.2 years in 1995. In 14% of patients cataract coexisted with arterial hypertension, in 8% with diabetes, and in 15% with other diseases. During the analysed 10 years period the number of patients with cataract increased in the same degree in all examined communities. The mean age of patients operated on cataract decreased in this period by 2 years in spite of increasing number of patients older than 75 years. This result can be explained by the fact that the disease tends now to develop earlier and by concomitant decreasing of the time between onset of the disease and decision for operation.

Incidence of cataract and risk factors in Northeastern Poland

There are at least three avenues of investigation that support the theoretical value of vitrectomy for the treatment of DME, based on (1) vitrectomy with ILM peeling for the relief of traction on the macula, (2) vitrectomy to improve oxygenation of the macula leading to decreased vascular permeability with subsequent resolution or decrease in DME, and (3) ILM peeling to remove a part of the Muller cell endfeet and the horizontal gliosis. Visual improvement could be due to the induction of a higher overexpression of GFAP at the Muller cells level. It is likely that the proliferation of GFAP-stained gliofibrils, observed in these cells, preserves the blood-retinal barrier, reinforces architectural cohesion, and opposes the installation of the edema. In addition, the search for a specific pharmacological treatment is ongoing on the basis of new findings regarding the involvement of cytokines and growth factors in the formation of macular edema. Vascular endothelial growth factor (VEGF), inhibitors are currently being investigated in clinical studies. However, endogenous VEGF is required for visual function. Growing body evidence indicates that VEGF acts also on nonvascular cells, it plays survival role on Muller cells and photoreceptors. Therefore anti-VEGF therapies should be administered with caution.

Combined surgical and pharmacological treatment of diabetic maculopathy

Recurrent anterior uveitis (AU) is an autoimmune disease that in 20% of patients leads to severe visual loss or blindness, thereby a severe disability and significant quality of life impairment. That is why, it is important to conduct a long term treatment after an acute phase of the disease, to keep the remission as long as possible. Up to 50% of patients with recurrent AU have no additional symptoms of systemic disease. This situation, classified as idiopathic AU (IAU), causes a lot of problems when a therapeutic strategy has to be chosen. Nevertheless, IAU is considered to be a first symptom of spondylarthropathy (SpA), even several dozen years prior to other typical manifestations of SpA. There have been published few papers concerning only small groups of patients with IAU, treated with disease modifying anti-rheumatic drugs. The authors present the recommendations for systemic treatment of IAU, based on their own clinical experience, and systematic review of the literature.

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Pharmacological treatment of recurrent idiopathic anterior uveitis

Multifocal intraocular lenses are the new option not only in cataract surgery, but either in refractive surgery. Use of multifocal lenses make patients less dependent on spectacle, than after implantation of monofocal intraocular lenses. In this article we present an actual review of multifocal intraocular lenses. Two main types of the implants: refractive and diffractive are described with their detailed characteristics. Special attention we paid on advantages and disadvantages as well as some limits to implantation of the multifocal implants.

Andrzej Stankiewicz

Papers

Activity of cathepsin a in subretinal fluid in primary retinal detachment

Incidence of cataract and risk factors in Northeastern Poland

Combined surgical and pharmacological treatment of diabetic maculopathy

Pharmacological treatment of recurrent idiopathic anterior uveitis

Multifocal intraocular lenses