The association between duration of remission, fatigue, depression and health-related quality of life in Italian patients with systemic lupus erythematosus.

OBJECTIVE: To evaluate the impact of duration of remission on the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE). METHODS: We conducted a 5-year retrospective study on two Italian cohorts. Remission was defined as a continuative period of no clinical disease activity, according to the Systemic Lupus Erythematosus Disease Activity Index 2 K, and a permitted maximum prednisone dose of 5 mg/day. HRQoL was measured using the 36-Item Short-Form Health Survey (SF36) during the last visit. RESULTS: We enrolled 136 female SLE patients. During observation, 15 (11%) patients had been in remission for ≥1 and <2 years, 15 (11%) for ≥2 and <3 years, 19 (14%) for ≥3 and <4 years, 9 (7%) for ≥4 and <5 years, and 53 (39%) had been in prolonged remission for ≥5 years. In the multivariate model, considering depression and fatigue as covariates, patients in prolonged remission showed significantly better scores in the physical functioning (p = 0.039), role physical (p = 0.029), bodily pain (p = 0.0057), general health (p = 0.0033) and social functioning (p = 0.0085) components of the SF36, compared with those in remission <5 years or unremitted. Subsequent mediation analyses found that these effects were partly influenced by depression. CONCLUSION: Lupus remission could improve the HRQoL of SLE patients, particularly when associated with appropriate management of depression and fatigue.

Health status and concomitant prescription of immunosuppressants are risk factors for hydroxychloroquine non-adherence in systemic lupus patients with prolonged inactive disease.

Background/objective The objectives of this paper are to assess the extent of and the factors associated with hydroxychloroquine (HCQ) non-adherence in systemic lupus erythematosus (SLE) patients with prolonged inactive disease and to investigate relationships between blood HCQ concentration and quality of life (QoL). Methods Consecutive SLE patients, in remission for at least one year and taking a stable dose of HCQ were investigated. At study entry (T0) and six months later (T6) a blood venous sample was taken to measure whole blood concentration of [HCQ] and desethylchloroquine ([DCQ]). Moreover, at T0 each patient completed validated questionnaires assessing QoL, disability, anxiety, depression and visual analogue scales for fatigue, pain, general health (GH), and self-assessment of disease activity. Results Eighty-three patients with a median [HCQ] of 327 ng/ml were enrolled. At T0, 24 (29%) were defined as non-adherent ([HCQ] < 100 ng/ml). At multiple logistic regression analysis the physical summary of SF-36 ( p = 0.038), and the concomitant use of immunosuppressants ( p = 0.010) were independently associated with non-adherence. A significant increase of HCQ adherence was observed at T6 ( p < 0.05). Conclusions A better health status and the concomitant prescription of immunosuppressants represent risk factors for HCQ non-adherence in SLE patients in remission. Monitoring HCQ levels might represent an important opportunity to improve adherence.

Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review.

Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000-2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

Successful culture of rat embryos on human serum: use in the detection of teratogens.

Growth of head-fold-stage rat embryos cultured with human serum for 48 hours was enhanced by supplementation with glucose. Embryo growth (protein and DNA contents) varied with the source of the serum. Serum from 16 of 19 untreated subjects produced normal embryos. Serum from five subjects undergoing cancer chemotherapy and six subjects receiving anticonvulsants was either lethal or teratogenic.

Psychological, emotional and social impairments are associated with adherence and healthcare spending in type 2 diabetic patients: an observational study.

OBJECTIVE: The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients. PATIENTS AND METHODS: Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending. RESULTS: Mathematical linear regressions models were performed showing the predictive effects of: anxiety and social support scores (RSAS) on adherence levels (respectively p =. 019; p =. 016); adherence levels on anxiolytic use (p =.04); aggressiveness scores (RSAS) on the number of general check-ups (p =.031); TAS-20 and physician-patient communication (IPC) on the number of hospitalization days (respectively p=.001; p=.008); physician patient decision making (IPC) scores on physical activity (IPAQ) levels (p=.025); physical activity (IPAQ) on the number of medical examinations (p=.039). CONCLUSIONS: An association among psychosocial impairment, adherence and healthcare spending was found. Future studies should investigate the effect of a brief psychological intervention in increasing adherence levels and reducing the healthcare spending in this clinical population.

OCT-guided photodynamic therapy for angiographic occult CNV in pathologic myopia.

PURPOSE: Pathologic myopia (PM) is frequently complicated by choroidal neovascularization (CNV). Diagnosis is mainly clinical and angiographic but in recent years optical coherence tomography (OCT) has been noted to add important information. The authors report on the successfully OCT-guided photodynamic therapy (PDT) of an angiographic occult CNV complicating PM. METHODS: Observational case report. Fluorescein angiography with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT Stratus (Carl Zeiss Meditec, Inc.) imaging were used for diagnosis and monitoring of the CNV. Standard PDT was performed. RESULTS: A highly myopic 17-year-old girl complained of a drop in visual acuity (VA) in left eye (LE), dating back a few weeks. Her best-corrected (BC) VA was 20/40 in the LE, with some metamorphopsia. No hemorrhage or evident signs of CNV were visible either at fundus or at dynamic fluorescein angiography. OCT scans indicated a slight elevation of the RPE-choriocapillary complex with rarefaction of neuroretinal tissue that has been interpreted as CNV. PDT was then performed. LE BCVA had improved to 20/25, metamorphopsias disappeared, and at OCT examination no retinal morphologic modification was evident. Nine months later, BCVA and ophthalmoscopy are still stable. CONCLUSIONS: In this case, OCT was the fundamental tool for the correct diagnosis and posttherapymonitoring of CNV-complicated PM. The CNV, not clearly detectable using angiographic imaging, was treated with PDT, and results in terms of VA and anatomic resolution were good.

Observation or surgical excision of bilateral subfoveal choroidal neovascularization in Best disease.

The purpose of this article is to describe a case of bilateral neovascularization complicating Best Disease. A 12-year-old patient with bilateral neovascularization was managed with observation in the right eye and surgical removal in the other eye. Visual acuity, biomicroscopy and fluorangiography were carried out from 1997 to 2005. The right eye did not experience any change in visual acuity from baseline (20/50) while left eye varied from 20/200 to 20/32. Macular exudative-hemorrhagic manifestations resolved bilaterally. Eight years later, VA and retinal findings were unchanged. In this case, although VA was reasonably good in both eyes, it is difficult to assess the prognosis of surgically excised neovascularization vs natural history, also considering that nowadays photodynamic therapy and antiangiogenetic drugs are considered the therapy of choice in subfoveal neovascularization.

Choroidal excavation in choroidal osteoma complicated by choroidal neovascularization.

PurposeTo describe multimodal imaging features of choroidal osteoma (CO) complicated by choroidal neovascularization (CNV) and focal choroidal excavation (FCE).MethodsPatients presenting with CO and CNV between January and October 2016 were considered for this study. Diagnosis of CO was confirmed by ultrasound examination. All patients underwent multimodal imaging including optical coherence tomography (OCT), swept-source OCT angiography (DRI OCT Triton, Topcon, Inc., Tokyo, Japan) and fluorescein angiography (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany).ResultsTwo patients (one with bilateral CO) were included in the study. OCT showed a FCE in two eyes of two patients (one in correspondence of the CNV and the other adjacent to the CNV). OCT-A demonstrated presence of microvascular flow within neovascular network of the CNVs. Decalcification of the tumor was noted in correspondence of one eye with FCE.ConclusionsFCE may be found in eyes with choroidal osteoma and CNV. OCT-A was a valuable tool for detection of CNV complicating choroidal osteoma. Decalcification of choroidal osteoma may represent a common pathogenic pathway for development of FCE and CNV in choroidal osteoma.

Optical Coherence Tomography Angiography of Diabetic Retinopathy.

PURPOSE: To describe the optical coherence tomography angiography (OCTA) features of diabetic retinopathy. METHODS: Literature review and case series. RESULTS: Four cases are presented. CONCLUSION: OCTA is an effective method for evaluating retinal changes in diabetic retinopathy and represents a novel complement or alternative to fluorescein angiography. Although OCTA should currently be considered an investigational technique, in the near future, it may play key roles in the diagnosis and management of diabetic retinopathy.

Choroidal calcifications in patients with Gitelman's syndrome.

Gitelman's syndrome is a renal tubular disorder characterized by a sodium and chloride reabsorption defect in distal tubular cells that determines hypokalemia, metabolic alkalosis, hypomagnesemia, and low calcium excretion. The presence of choroidal calcifications was sought in five patients with Gitelman's syndrome by ophthalmic examination, fluorescein angiography, indocyanine green angiography, and ocular ultrasonography. Calcifications observed in the choroid of two patients were shown by ultrasonography in both patients. Ophthalmic and fluorangiographic examinations detected this alteration in one of the two subjects. Chondrocalcinosis was found in one patient with choroidal calcifications. These findings suggest that precipitation of calcium salts can occur in the choroidal tissue of patients with Gitelman's syndrome. Deposits appeared to be well seen by ultrasonography because of their depth in ocular tissues. Sclerochoroidal calcifications may be favored by the low calcium excretion, which is associated with normal intestinal calcium absorption in patients with Gitelman's syndrome.

Preoperative astigmatic influence on the predictability of intraocular lens power calculation.

The preoperative and postoperative influence of different parameters on the predictability of formulas used for intraocular lens (IOL) power calculation (axial length, corneal dioptric power, IOL malposition, postoperative astigmatism) has been shown by various authors. In this study, we evaluated the preoperative astigmatic influence on the prediction of postoperative refraction in eyes operated on for cataract with IOL implantation. Three hundred and fifty-nine eyes were evaluated after cataract surgery and IOL implantation. We calculated predictive errors of both the Binkhorst and SRK formulas for each eye. Based on the outcome of the predictive errors we divided the eyes into six groups: three of high and three of low predictability. Preoperative astigmatism in these groups was statistically compared (using the Student's t-test). The preoperative astigmatism was always higher in the group with low predictability than in the group with high predictability (P less than .05).

Clinical variability in keratometry, ultrasound biometry measurements, and emmetropic intraocular lens power calculation.

We calculated inter-examiner and intra-examiner variability in keratometry and ultrasound biometry when performed by two different examiners. The potential effect on intraocular lens power calculation was also considered. Intra-examiner variability was statistically and clinically significant for axial measurements, particularly in eyes with axial length greater than 24 mm. Thus, variability in biometric examination affected the emmetropic intraocular lens power, especially in myopic eyes.

Reliability of preoperative ultrasonography evaluation for vitreoretinal surgery.

To evaluate the present level of reliability of common ultrasonography prior to vitreoretinal surgery, we carried out a prospective study to compare preoperative ultrasonography data with direct intraoperative findings. A total of 228 eyes with different vitreoretinal disorders and opaque or clear media were studied. In the group of 187 eyes with tractional retinal detachment (group I), the percentage of agreement between the ultrasonography data and the surgical findings ranged from 77.1% to 92.2%, depending on the pathology. In the group of 41 eyes without retinal detachment (group II), agreement ranged from 90.4% to 100%. The most frequent causes of failure of preoperative ultrasonography were incorrect prediction of macular detachment, partial posterior vitreous detachment, posterior vitreoschisis and vitreoretinal adhesions. The main cause of failure was the presence of multiple complicated echoes in group I, particularly in tractional diabetic retinal detachment. To achieve maximum benefits from ordinary preoperative ultrasonography, the vitreoretinal surgeon must be fully aware of its present level of reliability and general limitations.

OCT images and surgery of juvenile Macular retinoschisis.

We describe three cases of X-linked juvenile retinoschisis confined to the posterior pole of the eye, one of which surgically treated. In the first two cases, in vivo optical coherence tomography (OCT) had revealed a cleavage plane in both nerve fiber and outer retinal layers. In the two similar operated eyes of the third case, postoperative OCT had revealed the disappearance of macular schisis in the eye with good recovery of visual function after surgery. On the contrary, it had revealed a persistent splitting of the retina in the other eye, not clinically visible, which explained the poor recovery of visual function after surgery. In cases with progressive worsening of macular involvement in X-linked juvenile retinoschisis, highly accurate surgery may be considered, and the pre- and postsurgical OCT monitor of these patients is indicated.

Optical coherence tomography in idiopathic epiretinal macular membrane surgery.

PURPOSE: To evaluate the usefulness of Optical Coherence Tomography (OCT) images for surgical indication, intraoperative management and postoperative outcome of patients with idiopathic epiretinal macular membrane (IEMM). METHODS: 28 selected eyes underwent surgery for removal of IEMM. The patients' mean age was 57.3 years. The macular region and the IEMMs were studied before and after surgery using OCT, slit-lamp biomicroscopy and fundus photography. The mean postoperative follow-up was 6.2 months (range 1.3-14). RESULTS: Preoperatively, in 12 of the 28 eyes (42.9%) only the OCT images revealed IEMM partially separated from the macula, with tractional focal point(s) of attachment to the macular region. In the other 16 eyes (57.1%) in which IEMMs were totally adherent to the macular region, the membranes were barely visible by OCT in 13 eyes and not visible in three. Intraoperatively, the surgeon was guided in the peeling procedures. A significant correlation (p < 0.001) was found between visual acuity and macular thickness before surgery and at the end of the postoperative follow-up. CONCLUSIONS: OCT images provide very useful information for the surgical indication, intraoperative management and postoperative outcome of patients with IEMM.

Macular thickness measured by optical coherence tomography (OCT) in diabetic patients.

PURPOSE: 1) To compare macular thickness (MT) by optical coherence tomography (OCT) in diabetics and controls; 2) to assess the relationship between MT and stage of diabetic retinopathy (DR) and macular edema (ME); 3) to quantify MT changes after laser treatment for ME. METHODS: One-hundred and thirty-seven patients with diabetes mellitus (216 eyes) were admitted to the study and examined by stereo-color fundus photos, retinal fluorangiography and OCT. DR was classified as: 1) no DR (46 eyes: 21.3%); 2) background DR (66 eyes: 30.6%); 3) pre-proliferative DR (50 eyes: 23.1%); 4) proliferative DR (54 eyes: 25%). The study group was then divided into three ME groups: 1) no edema (65 eyes: 30.1%); 2) not clinically significant ME (no CSME) (45 eyes: 20.8%); 3) clinically significant macular edema (CSME) (106 eyes: 49.1%). Three-month follow-up tomograms were taken to evaluate eyes laser-treated only for ME. The control group consisted of 50 eyes of 50 non-diabetic, age- and sex-matched subjects. RESULTS: MT was 369.3 +/- 163.2 microm in diabetics and 161.9 +/- 12.9 microm in controls (p < 0.001). In the four DR groups it was: 1) 211.0 +/- 37.6 microm; 2) 370.8 +/- 159.6 microm; 3) 419.1 +/- 138.2 microm; 4) 456.1 +/- 162.0 microm (p<0.001). In the three ME groups, MT was: 1)227.8 +/- 53.4 microm; 2) 321.8 +/- 124.2 microm; 3) 476.2 +/-146.6 microm (p < 0.001). In the 52 eyes treated with laser photocoagulation of the posterior pole only and with a follow-up > 3 months, MT before and after treatment was 468.2 +/- 83. 17 microm and 372.1 +/- 120.63 microm. CONCLUSIONS: MT was greater in diabetics than controls and tended to increase with DR and ME severity. OCT is a sensitive technique for detecting early diabetic macular abnormalities and quantifying their reduction after laser treatment.

Optical coherence tomography (OCT) angiomatous prolifieration (RAP) in retinal.

PURPOSE: To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD). METHODS: Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA). RESULTS: RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70. 7%]). All eyes had either no or only a low-reflecting OCTsignal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization. CONCLUSIONS: OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.

Diclofenac increases beta-endorphin plasma concentrations.

Plasma and ventricular cerebro-spinal fluid (CSF) Beta-endorphin concentrations were evaluated after chromatographic separation in patients carrying a ventricular shunt before and after the administration of diclofenac or placebo. In the same subjects the ventricular CSF concentrations of the serotonin and the catecholamine metabolites 5-hydroxyindole-acetic acid (5-HIAA), homovanillic acid (HVA) and MOPEG were also evaluated. Plasma, but not ventricular, Beta-endorphin concentrations increased significantly after diclofenac, while placebo was ineffective. No significant changes in ventricular 5-HIAA, HVA or MOPEG levels were observed. These data suggest a role for Beta-endorphin in the analgesic effect of diclofenac.

Unilateral macular retinoschisis with stellate foveal appearance in two females with myopia.

Stellate foveal retinoschisis is considered the hallmark of X-linked retinoschisis. We describe the finding of unilateral retinoschisis with stellate foveal appearance in 2 females with myopia who had no evidence of familial disease. Optical coherence tomography (OCT) and fluorescein angiography were obtained in both cases. Neither patient had a family history of low vision, night blindness, or retinal detachment. Visual acuity in the affected eyes was 20/50 and 20/25, respectively. Both fellow eyes had normal fundi, except for mild myopic changes. With OCT, widespread retinal splitting was detected at the posterior pole in the affected eyes, whereas the fellow eyes were normal. In one case, OCT showed that foveal retinoschisis represented the macular involvement of a flat inferior retinoschisis, although this was not clinically apparent. Macular retinoschisis with stellate foveal appearance may rarely be associated with pathologic myopia. OCT was useful to establish the true extension of these macular changes.

[Bilateral choroidal osteoma in an aged patient]. / Ostéome de la choroïde bilatéral chez un sujet âgé.

The authors report a case of choroidal osteoma in an elderly patient. The affection was bilateral and multifocal. This rare benign tumor mostly affects young females. We report the outcome of the clinical and instrumental examinations leading to the diagnosis of choroidal osteoma. The patient underwent retinal fluoroangiography, A and B-scan ocular ultrasonography, Computerized Axial Tomography (CAT) with and without dye, orbit RNM, and electroretinography. The same investigations were performed 6-7 months after the first control. No changes in the findings were found except for retinal fluoroangiograms that revealed an increased area of the most central lesion in the right eye. Particularly relevant among these diagnostic techniques were ocular ultrasonography and CAT, which revealed the osseous nature of the tumor. Contact B-scan ultrasound examination showed a small number of dense opacities in both eyes. In the retrobulbar area the tumor caused diminution in echo amplitude. A-scan examination showed high reflectivity peaks (100%) corresponding to the lesion that were detectable even with reduced sensitivity of the system and, in the orbit, low reflectivity that confirmed the tumor's enhanced ultrasound absorption. CAT detected small calcified areas corresponding to the location of the lesions. Haematochemical examinations performed at each control to measure blood calcium, phosphate and alcaline phosphatase were in the normal range. Urinalysis also excluded possible systemic affections underlying the chorioretinal pathology. We discuss possible pathogenetical hypothesis focusing on the age and sex of the patient. These factors in fact, rule out both the hypothesis of a osteogenesis inhibiting factor present in the last 20-30 years of age and the hypothesis of endocrine stimulation in female patients.(ABSTRACT TRUNCATED AT 250 WORDS)