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Article: Spontaneous Bilateral Hyphema in a Patient With Idiopathic Thrombocytopenic Purpura.

Atzamoglou, Spyros / Markopoulos, Ioannis / Spanos, Evangelos / Batsos, George / Peponis, Vasileios

2023 Volume 15, Issue 8, Page(s) e43505

Abstract: The aim of this case report is to present an unusual case of idiopathic thrombocytopenic purpura (ITP) with bilateral spontaneous hyphema. It refers to an 82-year-old Caucasian woman who presented with acute unilateral vision loss. The patient's medical ... ...

Abstract	The aim of this case report is to present an unusual case of idiopathic thrombocytopenic purpura (ITP) with bilateral spontaneous hyphema. It refers to an 82-year-old Caucasian woman who presented with acute unilateral vision loss. The patient's medical history includes arterial hypertension, hypothyroidism, and uneventful bilateral cataract surgery. Bilateral anterior chamber hyphema was noted on gonioscopy, along with unilateral corneal edema. Hematology workup set the diagnosis of ITP. The cause of spontaneous bleeding in ITP patients is explained by the "second hit" hypothesis, suggesting that a secondary factor such as high blood pressure or minor trauma is necessary to cause rupture to a vessel's wall, which is already affected by the low platelet counts. The authors propose that, in this patient, the "second hit" was likely due to basement membrane alterations caused by arterial hypertension. The rarity of bilateral spontaneous hyphema cases and possible etiologies are emphasized.
Language	English
Publishing date	2023-08-15
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.43505
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Article ; Online: An Update on Drug-Nutrient Interactions and Dental Decay in Older Adults.

Bell, Victoria / Rodrigues, Ana Rita / Antoniadou, Maria / Peponis, Marios / Varzakas, Theodoros / Fernandes, Tito

Nutrients

2023 Volume 15, Issue 23

Abstract: In recent decades, the global demographic landscape has undergone a discernible shift that has been characterised by a progressive increase in the proportion of elderly individuals, indicative of an enduring global inclination toward extended lifespans. ... ...

Abstract	In recent decades, the global demographic landscape has undergone a discernible shift that has been characterised by a progressive increase in the proportion of elderly individuals, indicative of an enduring global inclination toward extended lifespans. The aging process, accompanied by physiological changes and dietary patterns, contributes to detrimental deviations in micronutrient consumption. This vulnerable aging population faces heightened risks, including dental caries, due to structural and functional modifications resulting from insufficient nutritional sustenance. Factors such as physiological changes, inadequate nutrition, and the prevalence of multiple chronic pathologies leading to polypharmacy contribute to the challenge of maintaining an optimal nutritional status. This scenario increases the likelihood of drug interactions, both between medications and with nutrients and the microbiome, triggering complications such as dental decay and other pathologies. Since the drug industry is evolving and new types of food, supplements, and nutrients are being designed, there is a need for further research on the mechanisms by which drugs interfere with certain nutrients that affect homeostasis, exemplified by the prevalence of caries in the mouths of older adults. Infectious diseases, among them dental caries, exert serious impacts on the health and overall quality of life of the elderly demographic. This comprehensive review endeavours to elucidate the intricate interplay among drugs, nutrients, the microbiome, and the oral cavity environment, with the overarching objective of mitigating the potential hazards posed to both the general health and dental well-being of older adults. By scrutinising and optimising these multifaceted interactions, this examination aims to proactively minimise the susceptibility of the elderly population to a spectrum of health-related issues and the consequences associated with dental decay.
MeSH term(s)	Humans ; Aged ; Quality of Life ; Dental Caries/epidemiology ; Dietary Supplements ; Food-Drug Interactions ; Nutrients
Language	English
Publishing date	2023-11-23
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu15234900
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Article: A Novel Modified Surgical Approach for FIL SSF Lens.

Batsos, Georgios / Bouratzis, Nikolaos / Kontomichos, Loukas / Casas, Diego Ruiz / Atzamoglou, Spyros / Peponis, Vasileios / Karagiannis, Dimitris / Paroikakis, Efstratios

Cureus

2023 Volume 15, Issue 12, Page(s) e49857

Abstract: This study aimed to describe a novel modified surgical technique for FIL SSF lens (Rome, Italy: Soleko) implantation. A retrospective study of FIL SSF lens implantation on six eyes of six patients with subluxated or dislocated intraocular lens (IOL). ... ...

Abstract	This study aimed to describe a novel modified surgical technique for FIL SSF lens (Rome, Italy: Soleko) implantation. A retrospective study of FIL SSF lens implantation on six eyes of six patients with subluxated or dislocated intraocular lens (IOL). Standard pars plana vitrectomy (PPV) was performed in all patients. The subluxated or dislocated IOL was removed from a 2.4 corneal incision. From the same incision, the folded FIL SSF lens was inserted. Then lens plugs were extremized through a 23G scleral incision inside two 4 mm pockets that were created at the beginning of the operation. In two cases one pocket had to be converted into a triagonal-shaped scleral flap. All scleral pockets were sutured with 7.0 Vicryl suture and the conjunctiva with 7.0 Vicryl. In the follow-up period of six months, the lens is centered and not tilted. The refractive outcome is within the expectations. Visual acuity is improved in all patients. No haptic exposure and no other complications were noted in all cases. FIL SSF lens is a good option for treating aphakia. This modified implantation technique is safe, fast, and easy. It is also versatile, combining the advantages of both previously described techniques, as it gives the option of flap conversion if needed. Larger studies and prospective comparative studies can highlight the best and more appropriate technique.
Language	English
Publishing date	2023-12-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.49857
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Article ; Online: Late onset corneal haze after corneal cross-linking for progressive keratoconus.

Peponis, Vasilios / Kontomichos, Loukas / Chatziralli, Irini / Kontadakis, George / Parikakis, Efstratios

American journal of ophthalmology case reports

2019 Volume 14, Page(s) 64–66

Abstract: Purpose: To present the case of a patient that underwent corneal crosslinking for progressive keratoconus and 18 months later revealed clinically significant corneal stromal haze.: Observations: A 20-year-old male presented with progressive visual ... ...

Abstract	Purpose: To present the case of a patient that underwent corneal crosslinking for progressive keratoconus and 18 months later revealed clinically significant corneal stromal haze. Observations: A 20-year-old male presented with progressive visual loss OU for the past few years. His corrected distance visual acuity (CDVA) OD was 20/30 (-2.75 -1.75 @55) and OS 20/30 (-0.50 -1.75@110). Corneal topography revealed keratoconus OU and the patient underwent corneal crosslinking according to the Dresden Protocol. The postoperative regimen included combined tobramycin and dexamethasone qid along with lubrication until epithelium healed and then fluorometholone qid with weekly tapering. At 3 months postoperatively, his topography was stable and his corrected distance visual acuity (CDVA) was 20/25 OU. On slit lamp examination, only clinically insignificant stromal haze was observed. At 18 months postoperatively, the patient reported vision deterioration. On examination his CDVA was 20/25 in right eye, and 20/40 in his left eye. Deep stromal haze was revealed in his central cornea, more dense in his left eye. Corneal topography was stable and the CDVA loss was attributed to the notable deep stromal haze. The patient was treated with dexamethasone qid with biweekly tapering. 18 months after corneal crosslinking, the patient demonstrated clinically significant stromal haze, most prominent OS. He was treated with dexamethasone qid. One month later his CDVA OS gradually improved to 20/25, and stromal haze was still noted but less dense. Conclusions and importance: Late-onset deep corneal haze is a possible complication of corneal crosslinking in keratoconic patients.
Language	English
Publishing date	2019-02-26
Publishing country	United States
Document type	Case Reports
ISSN	2451-9936
ISSN (online)	2451-9936
DOI	10.1016/j.ajoc.2019.02.008
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Article ; Online: Traumatic Aniridia and Aphakia Management with Iris Reconstruction Lens Using Gore-Tex Sutures, an Ab-Externo Approach.

Parikakis, Efstratios / Batsos, Georgios / Kontomichos, Loukas / Peponis, Vasileios / Christodoulou, Eleni / Karagiannis, Dimitrios

The American journal of case reports

2020 Volume 21, Page(s) e924706

Abstract: BACKGROUND A safer and more delicate approach is required for the management of a post-traumatic aphakia and subtotal aniridia. CASE REPORT A 55-year-old man was referred to our clinic with symptoms of decreased vision (hand motion) and photophobia in ... ...

Abstract	BACKGROUND A safer and more delicate approach is required for the management of a post-traumatic aphakia and subtotal aniridia. CASE REPORT A 55-year-old man was referred to our clinic with symptoms of decreased vision (hand motion) and photophobia in his right eye. This patient had previously undergone pars plana vitrectomy (PPV) for the management of blunt ocular trauma in the same eye. He was being treated with topical antihypertensives, due to silicone oil-induced glaucoma. On presentation, the best corrected visual acuity (BCVA) in his right eye was 20/40 and the intraocular pressure (IOP) in the same eye was 20 mmHg. Slit lamp examination of his right eye showed aphakia, aniridia, and some silicone oil droplets (fish eggs) following silicone oil extraction. His corneal endothelium and thickness were within normal limits. Dilated fundoscopic examination of the right eye revealed that the retina was attached with no signs of proliferative vitreoretinopathy (PVR). An artificial iris intraocular lens (IOL) was implanted, along with 4-point scleral fixation in conjunction with Gore-Tex sutures. After 6 months, the BCVA in his right eye was 20/40 and he had no symptoms of photophobia. The IOP in that eye was 15 mmHg while on treatment with dorzolamide-timolol eye drops. No suture-related or other serious complications were observed. The patient expressed satisfaction with the functional and cosmetic results. CONCLUSIONS Modern vitrectomy combined with an artificial iris IOL and scleral fixation with Gore-Tex sutures in eyes lacking an iris and lens can provide long-term anatomic and functional restoration. Intraoperative IOP fluctuations and extra corneal damage can be avoided by lens preparation with the sutures using a small incision ab-externo approach.
MeSH term(s)	Aphakia/surgery ; Humans ; Iris/surgery ; Lens Implantation, Intraocular ; Male ; Middle Aged ; Polytetrafluoroethylene ; Sutures ; Visual Acuity ; Vitrectomy
Chemical Substances	Polytetrafluoroethylene (9002-84-0)
Language	English
Publishing date	2020-09-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.924706
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Article: Glioma-associated radiation retinopathy treated successfully with aflibercept.

Karagiannis, D / Kontomichos, L / Georgalas, I / Peponis, V / Antoniou, E / Parikakis, E

Therapeutics and clinical risk management

2019 Volume 15, Page(s) 937–941

Abstract: Radiation retinopathy is a chronic, progressive retinal microangiopathy which can occur with variable latency after retina exposure to ionizing radiation used for cancer treatment. It can occur secondary to treatment of nasopharyngeal tumors, as well as ... ...

Abstract	Radiation retinopathy is a chronic, progressive retinal microangiopathy which can occur with variable latency after retina exposure to ionizing radiation used for cancer treatment. It can occur secondary to treatment of nasopharyngeal tumors, as well as intraocular tumors, such as uveal melanoma and retinoblastoma. Several treatment modalities have been reported including intravitreal corticosteroids, intravitreal anti-VEGFs and argon laser photocoagulation. Our purpose is to present a case report of bilateral radiation retinopathy with macular edema in one eye that was revealed 6 years after glioma therapy and treated successfully by using monotherapy of aflibercept. A 59-year-old male patient presented with gradually deteriorating visual acuity in his left eye for the past 12 months. Best corrected visual acuity in his right eye was 20/25 and in his left eye 20/100. Fundoscopy and fluorescein angiography revealed severe non-proliferative retinopathy in his right eye and proliferative retinopathy in his left eye with macular edema. Following complete work-up and due to his past medical history, he was diagnosed with radiation retinopathy. The patient received 6 intravitreal injections of aflibercept in a period of 9 months in order to treat macular edema and radiation retinopathy. According to the literature, there is minimal experience using aflibercept monotherapy to successfully treat macular edema due to radiation retinopathy. In addition, radiotherapy for glioma is a rather rare cause of radiation retinopathy compared to other more common causes, such as nasopharyngeal tumors, meningiomas, and uveal melanomas.
Language	English
Publishing date	2019-07-26
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2186560-7
ISSN	1178-203X ; 1176-6336
ISSN (online)	1178-203X
ISSN	1176-6336
DOI	10.2147/TCRM.S204841
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Article: A Corneal Perforation Related to Beauveria Bassiana and Post-Penetrating Keratoplasty Management Discussion.

Atzamoglou, Spyros / Siopi, Maria / Meletiadis, Joseph / Markopoulos, Ioannis / Kontomichos, Loukas / Batsos, George / Paroikakis, Efstratios / Peponis, Vasileios

Cureus

2021 Volume 13, Issue 6, Page(s) e15724

Abstract: Fungal keratitis is an infection that is insidious and frequently misdiagnosed. Those with chronic eye surface conditions, contact lenses, systemic immunosuppression, and diabetes have been the most frequently affected with fungal keratitis. An 84-year- ... ...

Abstract	Fungal keratitis is an infection that is insidious and frequently misdiagnosed. Those with chronic eye surface conditions, contact lenses, systemic immunosuppression, and diabetes have been the most frequently affected with fungal keratitis. An 84-year-old male patient with a history of bilateral penetrating keratoplasty (PK) for keratoconus presented with pain and decreased visual acuity on his left eye. A corneal perforation was found, which was treated immediately with a full-thickness corneal transplant. The specimen was sent for bacterial and fungal cultures. Topical corticosteroids were prescribed postoperatively.
Language	English
Publishing date	2021-06-17
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.15724
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Article ; Online: Denver and Marshall scores successfully predict susceptibility to multiple independent infections in trauma patients.

Almpani, Marianna / Tsurumi, Amy / Peponis, Thomas / Dhole, Yashoda V / Goodfield, Laura F / Tompkins, Ronald G / Rahme, Laurence G

PloS one

2020 Volume 15, Issue 4, Page(s) e0232175

Abstract: Trauma patients are at risk of repeated hospital-acquired infections, however predictive scores aiming to identify susceptibility to such infections are lacking. The objective of this study was to investigate whether commonly employed disease-severity ... ...

Abstract	Trauma patients are at risk of repeated hospital-acquired infections, however predictive scores aiming to identify susceptibility to such infections are lacking. The objective of this study was to investigate whether commonly employed disease-severity scores can successfully predict susceptibility to multiple independent infectious episodes (MIIEs) among trauma patients. A secondary analysis of data derived from the prospective, longitudinal study "Inflammation and the Host Response to Injury" ("Glue Grant") was performed. 1,665 trauma patients, older than 16, were included. Patients who died within seven days from the time of injury were excluded. Five commonly used disease-severity scores [Denver, Marshall, Acute Physiology and Chronic Health Evaluation II (APACHE II), Injury Severity Score (ISS), and New Injury Severity Score (NISS)] were examined as independent predictors of susceptibility to MIIEs. The latter was defined as two or more independent infectious episodes during the index hospital stay. Multivariable logistic regression was used for the statistical analysis. 22.58% of the population was found to be susceptible to MIIEs. Denver and Marshall scores were highly predictive of the MIIE status. For every 1-unit increase in the Denver or the Marshall score, there was a respective 15% (Odds Ratio:1.15; 95% CI: 1.07-1.24; p < 0.001) or 16% (Odds Ratio:1.16; 95% CI: 1.09-1.24; p < 0.001) increase in the odds of MIIE occurrence. APACHE II, ISS, and NISS were not independent predictors of susceptibility to MIIEs. In conclusion, the Denver and Marshall scores can reliably predict which trauma patients are prone to MIIEs, prior to any clinical sign of infection. Early identification of these individuals would potentially allow the implementation of rapid, personalized, preventative measures, thus improving patient outcomes and reducing healthcare costs.
MeSH term(s)	APACHE ; Adult ; Cross Infection/epidemiology ; Cross Infection/etiology ; Disease Susceptibility ; Female ; Humans ; Injury Severity Score ; Longitudinal Studies ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Trauma Severity Indices ; United States/epidemiology ; Wounds and Injuries/complications
Language	English
Publishing date	2020-04-29
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0232175
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Article ; Online: Glioma-associated radiation retinopathy treated successfully with aflibercept

Karagiannis D / Kontomichos L / Georgalas I / Peponis V / Antoniou E / Parikakis E

Therapeutics and Clinical Risk Management, Vol Volume 15, Pp 937-

2019 Volume 941

Abstract: D Karagiannis,1 L Kontomichos,1 I Georgalas,2 V Peponis,1 E Antoniou,3 E Parikakis11Second ...

Abstract	D Karagiannis,1 L Kontomichos,1 I Georgalas,2 V Peponis,1 E Antoniou,3 E Parikakis11Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece; 2First Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece; 3Moorfields Eye Hospital, London, UKAbstract: Radiation retinopathy is a chronic, progressive retinal microangiopathy which can occur with variable latency after retina exposure to ionizing radiation used for cancer treatment. It can occur secondary to treatment of nasopharyngeal tumors, as well as intraocular tumors, such as uveal melanoma and retinoblastoma. Several treatment modalities have been reported including intravitreal corticosteroids, intravitreal anti-VEGFs and argon laser photocoagulation. Our purpose is to present a case report of bilateral radiation retinopathy with macular edema in one eye that was revealed 6years after glioma therapy and treated successfully by using monotherapy of aflibercept. A 59-year-old male patient presented with gradually deteriorating visual acuity in his left eye for the past 12months. Best corrected visual acuity in his right eye was 20/25 and in his left eye 20/100. Fundoscopy and fluorescein angiography revealed severe non-proliferative retinopathy in his right eye and proliferative retinopathy in his left eye with macular edema. Following complete work-up and due to his past medical history, he was diagnosed with radiation retinopathy. The patient received 6 intravitreal injections of aflibercept in a period of 9months in order to treat macular edema and radiation retinopathy. According to the literature, there is minimal experience using aflibercept monotherapy to successfully treatmacular edema due to radiation retinopathy. In addition, radiotherapy for glioma is a rather rare cause of radiation retinopathy compared to other more common causes, such as nasopharyngeal tumors, meningiomas, and uveal melanomas.Keywords: aflibercept, macular edema, glioma, radiation retinopathy
Keywords	aflibercept ; macular edema ; glioma ; radiation retinopathy ; Medicine (General) ; R5-920
Subject code	535
Language	English
Publishing date	2019-07-01T00:00:00Z
Publisher	Dove Medical Press
Document type	Article ; Online
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Article ; Online: Risk factors for intraoperative floppy iris syndrome: a prospective study.

Chatziralli, I P / Peponis, V / Parikakis, E / Maniatea, A / Patsea, E / Mitropoulos, P

Eye (London, England)

2016 Volume 30, Issue 8, Page(s) 1039–1044

Abstract: PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The ... ...

Abstract	PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The following data were recorded and evaluated as possible risk factors: ophthalmological conditions, axial length of the eye, sociodemographic features, clinical data (hypertension and diabetes mellitus), medications being taken at the time of surgery, and duration of their intake. Cases were characterized intraoperatively as IFIS and non-IFIS. Univariate and multivariate logistic regression analysis were performed.ResultsIFIS was observed in 63/1274 eyes (4.9%, 95% CI: 3.9-6.7%). Current use of tamsulosin, alfuzosin, terazosin, benzodiazepines, quetiapine, and finasteride, as well as hypertension, were all independently associated with IFIS. Significant associations were noted for male sex, rivastigmine, and short axial length, which did not reach significance at the multivariate analysis. Duration of α-blockers intake was not found to be associated with IFIS.ConclusionApart from the well-established associations with α-blockers, this prospective study points to benzodiazepines, quetiapine, finasteride, and hypertension as potential risk factors for IFIS. Short axial length and rivastigmine were significantly associated with IFIS only at the univariate analysis.
MeSH term(s)	Adrenergic alpha-1 Receptor Antagonists/adverse effects ; Aged ; Aged, 80 and over ; Axial Length, Eye ; Benzodiazepines/adverse effects ; Female ; Finasteride/adverse effects ; Humans ; Hypertension/epidemiology ; Intraoperative Complications ; Iris Diseases/chemically induced ; Iris Diseases/epidemiology ; Lens Implantation, Intraocular ; Male ; Phacoemulsification ; Prospective Studies ; Quetiapine Fumarate/adverse effects ; Risk Factors ; Sex Factors
Chemical Substances	Adrenergic alpha-1 Receptor Antagonists ; Benzodiazepines (12794-10-4) ; Quetiapine Fumarate (2S3PL1B6UJ) ; Finasteride (57GNO57U7G)
Language	English
Publishing date	2016-08
Publishing country	England
Document type	Journal Article
ZDB-ID	91001-6
ISSN	1476-5454 ; 0950-222X
ISSN (online)	1476-5454
ISSN	0950-222X
DOI	10.1038/eye.2016.122
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