Gross anterior segment ischaemia following vitreoretinal surgery for sickle-cell retinopathy.

We report the case of a 32-year-old Afrocaribbean man with known stage 3 proliferative sickle-cell retinopathy who presented with a mixed picture of tractional and rhegmatogenous macula off detachment. He underwent left primary 25 g vitrectomy with silicone oil, delamination and endolaser photocoagulation under a general anaesthetic. He, however, presented 48 hours postoperatively with gross anterior segment ischaemia. His pain and ocular signs settled over the course of a few days following administration of supplemental oxygen, oral steroids, analgesia and intravenous hydration. Examination showed resolution of his proptosis and orbital signs as well as anterior segment inflammation. He remains under follow-up.

Serum Trace Elements Profile in Graves' Disease Patients with or without Orbitopathy in Northeast China.

OBJECTIVE: The purpose of the present study was to investigate serum trace elements in Graves' disease (GD) patients with or without orbitopathy in Northeast China. METHODS: Patients with newly diagnosed Graves' disease (HyGD) (n = 66), GD patients with euthyroid status or subclinical thyroidism after treatment (EUGD) (n = 55), GO patients with euthyroid status or subclinical thyroidism after treatment (GO) (n = 57), and normal controls (NC) (n = 66) were enrolled in this study. Serum trace elements were measured with ICP-MS. RESULTS: Serum selenium (Se) levels in EUGD group (median: 7.53 µg/dL), HyGD group (median: 6.76 µg/dL), and GO group (median: 7.40 µg/dL) were significantly lower than those in NC group (median: 9.20 µg/dL, all P < 0.01). Serum copper (Cu) levels in GO group (median: 95.93 µg/dL) were significantly lower than those in the NC group (median: 113.59 µg/dL, P = 0.015). After being adjusted for multivariables, thyroid-specific antibodies grade was associated with low Se levels. Hyperthyroidism and thyroid-specific antibodies grade were associated with high Cu levels. In addition, orbitopathy was associated with low Cu levels. CONCLUSIONS: Thyroid autoimmunity was associated with low Se levels. Hyperthyroidism and thyroid autoimmunity may be associated with relatively high serum Cu levels. Alternatively, ophthalmopathy may be related to low serum Cu levels.

[Analysis of choline alfoscerate effectiveness in chronic ocular ischemic syndrome].

AIM: To investigate the effectiveness of choline alphoscerate in patients with chronic ocular ischemic syndrome (OIS) and coexisting cerebrovascular disease. MATERIAL AND METHODS: We performed a comprehensive examination of 51 patients aged 46--72 years (57.8±6.82 years on average) and diagnosed with OIS. Patients were divided into two groups. In group 1 (main group, 26 patients) the standard therapy was supplemented with choline alphoscerate. Group 2 (controls, 25 patients) received the standard therapy only. RESULTS: Clinical and functional examinations revealed a more rapid and stable improvement of visual acuity in the choline alphoscerate group. CONCLUSION: Development and application of an adequate combination therapy for patients with ocular ischemic syndrome has yielded an increase in visual acuity, visual fields, and the mean light sensitivity of the retina as well as an improvement of ocular hemodynamics.

Canine hyperlipidaemia.

Hyperlipidaemia refers to an increased concentration of lipids in the blood. Hyperlipidaemia is common in dogs and has recently emerged as an important clinical condition that requires a systematic diagnostic approach and appropriate treatment. Hyperlipidaemia can be either primary or secondary to other diseases. Secondary hyperlipidaemia is the most common form in dogs, and it can be a result of endocrine disorders, pancreatitis, cholestasis, protein-losing nephropathy, obesity, as well as other conditions and the use of certain drugs. Primary hyperlipidaemia is less common in the general canine population but it can be very common within certain breeds. Hypertriglyceridaemia of Miniature Schnauzers is the most common form of primary hyperlipidaemia in dogs but other breeds are also affected. Possible complications of hyperlipidaemia in dogs include pancreatitis, liver disease, atherosclerosis, ocular disease and seizures. Management of primary hyperlipidaemia in dogs is achieved by administration of ultra low-fat diets with or without the administration of lipid lowering drugs such as omega-3 fatty acids, fibrates, niacin and statins.

Homocysteine in ocular diseases.

Homocysteine (Hcy) is a derived sulfur-containing and non-proteinogenic amino acid. The metabolism of Hcy occurs either through the remethylation to methionine or transsulfuration to cysteine. Studies have identified hyperhomocysteinemia (HHcy) as one of the possible risk factors for a multitude of diseases including vascular, neurodegenerative and ocular diseases. Association of HHcy with eye diseases such as retinopathy, pseudoexfoliative glaucoma maculopathy, cataract, optic atrophy and retinal vessel atherosclerosis is established. The molecular mechanism underlying these ocular diseases has been reported as impaired vascular endothelial function, apoptosis of retinal ganglion cells, extracellular matrix alterations, decreased lysyl oxidase activity and oxidative stress. The formed homocysteine-thiolactone in HHcy has stronger cytotoxicity and pro-inflammatory properties which can induce lens opacification and optic nerve damage. The metabolism of Hcy requires enzymes with vitamins such as folic acid, vitamins B12 and B6. Despite the mixed conclusion of various studies regarding the level of these vitamins in elder people, studies recommended the treatment with folate and B12 to reduce Hcy levels in subjects with or without any defect in the enzymes involved in its metabolism. The levels of Hcy, folate, B6 as well as B12 should be measured early in patients with visual impairment that would aid to screen patients for life-threatening disorders related with HHcy. Elder patients may supplement with these vitamins in order to attenuate the ocular damages. This article discusses the association of Hcy in ocular diseases and the possible mechanism in the pathogenesis.

Métodos de examen en oftalmología para apoyo del diagnóstico y seguimiento en la enfermedad de Alzheimer leve o moderada / Ophthalmological examination for diagnosis and follow-up in mild and moderate Alzheimer disease

Objetivos: evaluar si existen alteraciones en la función visual y en la estructura de la retina y del nervio óptico en pacientes con demencia de tipo Alzheimer (DA). Material y métodos: se incluyeron 61 pacientes con DA leve-moderada y 36 controles sanos. En todos ellos se evaluó la agudeza visual (escala ETDRS), la sensibilidad al contraste (con los tests CSV-1000E y Pelli-Robson), la estereopsis (con el test TNO) y la visión cromática (con los tests Farnsworth 15 D y Lanthony 15 D utilizando el software Vision Color Recorder). La estructura y los espesores de la retina y del nervio óptico se evaluaron mediante tomografía de coherencia óptica (OCT). Comparamos los resultados entre pacientes y controles. Resultados: el grupo de pacientes mostró una disminución estadísticamente significativa en la agudeza visual, la sensibilidad al contraste, la visión cromática y los espesores de las nueve áreas maculares y de la capa de fibras nerviosas de la retina. Conclu siones: la DA causa alteraciones en la función visual así como una reducción de los espesores en la retina y el nervio óptico desde estadios iniciales de la enfermedad. Estos parámetros podrían ser buenos biomarcadores para el diagnóstico y seguimiento de esta enfermedad (AU)

Objective: To analyze visual function alterations and changes in the retina and the optic nerve in mild or moderate Alzheimer disease (AD) patients, compared with healthy subjects. Material and methods: Sixty one mild/moderate AD patients and 36 age-and-sex matched controls were included. All of them underwent assessment of visual acuity (ETDRS scale), contrast sensitivity (CSV-1000E and Pelli-Robson tests), stereopsis (TNO test), and color vision (Farnsworth 15 D and Lanthony 15 D tests using the Vision Color Recorder software). Optical coherence tomography (OCT) of the macula and optic disc was also acquired to evaluate macular and the retinal nerve fiber layer (RNFL) thicknesses. Comparison between patients and healthy controls were analyzed. Results: AD group showed statistical significant decrease in visual acuity, contrast sensitivity color vision, macular thicknesses in the 9 analyzed areas and RNFL thickness. Conclusions: Visual function alterations and reduction of macular and optic nerve thicknesses appear in AD patients since earlier stages. These parameters may be usefull as biomarker in diagnosis and follow-up of AD patients (AU)

Silicone intraocular lens surface calcification in a patient with asteroid hyalosis.

PURPOSE: To confirm a substance presence on the posterior intraocular lens (IOL) surface in a patient with asteroid hyalosis. METHODS: An 80-year-old man had IOLs for approximately 12 years. Opacities and neodymium-doped yttrium aluminum garnet pits were observed on the posterior surface of the right IOL. Asteroid hyalosis and an epiretinal membrane were observed OD. An IOL exchange was performed on 24 March 2008, and the explanted IOL was analyzed using a light microscope and a transmission electron microscope with a scanning electron micrograph and an energy-dispersive X-ray spectrometer for elemental analysis. To confirm asteroid hyalosis, asteroid bodies were examined with the ionic liquid (EtMeIm+ BF4-) method using a field emission scanning electron microscope (FE-SEM) with digital beam control RGB mapping. RESULTS: X-ray spectrometry of the deposits revealed high calcium and phosphorus peaks. Spectrometry revealed that the posterior IOL surface opacity was due to a calcium-phosphorus compound. Examination of the asteroid bodies using FE-SEM with digital beam control RGB mapping confirmed calcium and phosphorus as the main components. CONCLUSIONS: Calcium hydrogen phosphate dihydrate deposits were probably responsible for the posterior IOL surface opacity. Furthermore, analysis of the asteroid bodies demonstrated that calcium and phosphorus were its main components.

Specific attentional impairments and complex visual hallucinations in eye disease.

OBJECTIVE: To test the prediction by the Perception and Attention Deficit (PAD) model of complex visual hallucinations that cognitive impairment, specifically in visual attention, is a key risk factor for complex hallucinations in eye disease. METHODS: Two studies of elderly patients with acquired eye disease investigated the relationship between complex visual hallucinations (CVH) and impairments in general cognition and verbal attention (Study 1) and between CVH, selective visual attention and visual object perception (Study 2). The North East Visual Hallucinations Inventory was used to classify CVH. RESULTS: In Study 1, there was no relationship between CVH (n=10/39) and performance on cognitive screening or verbal attention tasks. In Study 2, participants with CVH (n=11/31) showed poorer performance on a modified Stroop task (p<0.05), a novel imagery-based attentional task (p<0.05) and picture (p<0.05) but not silhouette naming (p=0.13) tasks. Performance on these tasks correctly classified 83% of the participants as hallucinators or non-hallucinators. CONCLUSIONS: The results suggest that, consistent with the PAD model, complex visual hallucinations in people with acquired eye disease are associated with visual attention impairment.

Association for Research in Vision and Ophthalmology (ARVO)--2010 Annual Meeting. For Sight: The Future of Eye and Vision Research--part 1.

The 2010 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), held in Fort Lauderdale, FL, USA, included topics covering new therapeutic developments in the field of eye and vision research. This conference report highlights selected presentations on the development of FOV-2304 (Fovea Pharmaceuticals SA) for the potential treatment of diabetic macular edema; PHA-666859 (Pfizer Inc) for diabetic retinopathy; GTx-878 (GTx Inc) and FCFD-4514S (Genentech Inc) for age-related macular degeneration; SYL-040012 (Sylentis Sau) for ocular hypertension associated with open-angle glaucoma; PEG-PLA-TNP-470 (Harvard Medical School) for ocular neovascularization; recombinant galectin-3 (Senju Pharmaceutical Co Ltd) for corneal injury; and CellBead Neuro (CellMed Inc) for neurological trauma and neurodegeneration.

Association for Research in Vision and Ophthalmology (ARVO)--2010 Annual Meeting. For Sight: The Future of Eye and Vision Research--part 2.

The 2010 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), held in Fort Lauderdale, FL, USA, included topics covering new therapeutic developments in the field of eye and vision research. This conference report highlights selected presentations on the development of OT-440 (Othera Pharmaceuticals Inc) for the potential treatment of glaucoma, an extended-release implant of brimonidine (pSivida Corp) for ocular hypertension, AR-12286 (Aerie Pharmaceuticals Inc) for ocular hypertension or glaucoma, AC-8 (Calmune Corp/RiboVax Biotechnologies SA) for ocular diseases following HSV infection, and fidarestat (Sanwa Kagaku Kenkyusho Co Ltd) and the recombinant proteins NOV and NOVCter (INSERM/University Rene Descartes) for corneal neovascularization.

Manifestaciones oculares en adultos con drepanocitosis de la provincia Cienfuegos / Ocular manifestations of drepanocytemia in adult patients resident in Cienfuegos province

Se realizó estudio descriptivo de corte transversal para evaluar las manifestaciones oculares de la drepanocitosis en 64 adultos atendidos en Consulta de Hemoglobinopatías del Hospital Universitario Dr Gustavo Aldereguía Lima. Los objetivos fueron: evaluar la frecuencia de las alteraciones oftalmológicas, relacionarlas con parámetros clínico-hematológicos y estimar sus consecuencias funcionales. Se realizó examen oftalmológico completo en condiciones basales. Para el análisis de los datos se usaron estadísticos descriptivos, comparaciones de medias y la prueba chi cuadrado. El signo de la coma fue la alteración más frecuente, se asoció con el genotipo SS y con niveles más bajos de hemoglobina. La tortuosidad de los vasos fue el hallazgo más común en la retina en todos los genotipos, mientras que las opacidades del vítreo y los broches negros en figura de sol, mostraron una asociación estadísticamente significativa en algunos casos. Se diagnosticó retinopatía falciforme no proliferativa en la mayoría de los enfermos estudiados y en varios de ellos se demostraron hallazgos de ambos tipos de retinopatías. A pesar de las numerosas lesiones demostradas, la agudeza visual se clasificó como buena en el 94,6 por ciento de los ojos examinados(AU)

A cross-sectional and descriptive study was carried out to assess the ocular manifestations of drepanocytemia in 64 adult patients seen in Hemoglobinopathy of Dr Gustavo Aldereguía Lima University Hospital. The aims of present paper were: to assess the ophthalmologic alterations frequency related to clinical-hematological parameters and to estimate its functional consequences. A basal total ophthalmologic examination was performed. For data analysis descriptive statistical models, mean comparisons and the Chi² test. The decimal point sign was the more frequent alteration associated with SS genotype and with lower hemoglobin levels. Vessel tortuous was the commonest finding in retina in all genotypes, whereas the vitreous body opacities and the black cupping in sun shape showed a statistically significant association in some cases. A non-proliferative retinopathy was diagnosed in most of study patients and in some of them the findings of both types of retinopathy were showed. Despite the numerous lesions showed, visual acuity was qualified as good in the 94,6 percent of study eyes(AU)

Vitiligo and ocular findings: a study on possible associations.

OBJECTIVE: In this study, we aimed to evaluate the ocular findings in vitiligo patients and reveal any clinical feature that might suggest an association or a risk factor. BACKGROUND: Very few reports in the literature are available about the ocular findings in vitiligo and the possible associations of the ocular findings in vitiligo patients have not been studied so far. METHODS: A total of 45 patients with previously documented cutaneous vitiligo were examined for ocular findings. Demographic features including age, gender, duration of vitiligo, presence of associated autoimmune diseases, type of vitiligo and the anatomical distributions of vitiligo were recorded to evaluate a possible relationship with the ocular findings. Univariate and multivariate analyses as well as cluster analysis were performed. After description of the clusters, the Mann-Whitney U-test and Fisher's exact test were used to determine the variables. Concordance among the variables in each group was evaluated with the McNemar test. RESULTS: Ten patients had ocular findings that included anterior segment (iris) involvement, ring-like peripapillary atrophy around the optic nerve, atrophy of pigment epithelium, focal hypopigmented spots and diffuse hypopigmentation. The presence of periorbital vitiligo was significantly related to the ocular findings. Cluster analysis revealed concordances between periorbital and genitalial localizations of vitiligo and ocular findings. CONCLUSION: The number of patients and the range of ocular findings in our study are insufficient to make definite conclusions but anatomical localizations, primarily periorbital and to a lesser extent genitalial vitiligo, seem to be the most probably alerting features for ocular findings.

Application of transpupillary thermotherapy in a patient with asteroid hyalosis and premacular hemorrhage.

A 70-year-old woman with long-term poor vision was found to have unilateral massive premacular hemorrhage and asteroid hyalosis. Transpupillary thermotherapy (TTT) was applied sequentially to the vitreous in four separate spots, covering the area of the asteroid hyalosis and hemorrhage. Outcome measures included visual acuity, biomicroscopic appearance, ultrasonography, and fluorescein angiography. Significant resolution of the hemorrhage was observed 3 months after TTT, with visual acuity improvement from counting fingers at 25 cm to 20/60. There were no complications noted during the procedure or during follow-up. The long-term safety measures and visual prognosis following TTT for resolution of the vitreous impurities remain to be evaluated, but the procedure may be effective for treating premacular hemorrhage and asteroid hyalosis.

Liver-directed neonatal gene therapy prevents cardiac, bone, ear, and eye disease in mucopolysaccharidosis I mice.

Mucopolysaccharidosis I (MPS I) due to deficient alpha-L-iduronidase (IDUA) activity results in accumulation of glycosaminoglycans in many cells. Gene therapy could program liver to secrete enzyme with mannose 6-phosphate (M6P), and enzyme in blood could be taken up by other cells via the M6P receptor. Newborn MPS I mice were injected with 10(9) (high dose) or 10(8) (low dose) transducing units/kg of a retroviral vector (RV) expressing canine IDUA. Most animals achieved stable expression of IDUA in serum at 1240 +/- 147 and 110 +/- 31 units/ml, respectively. At 8 months, untreated MPS I mice had aortic insufficiency, increased bone mineral density (BMD), and reduced responses to sound and light. In contrast, MPS I mice that received high-dose RV had normal echocardiograms, BMD, auditory-evoked brain-stem responses, and electroretinograms. This is the first report of complete correction of these clinical manifestations in any model of mucopolysaccharidosis. Biochemical and pathologic evaluation confirmed that storage was reduced in these organs. Mice that received low-dose RV and achieved 30 units/ml of serum IDUA activity had no or only partial improvement. We conclude that high-dose neonatal gene therapy with an RV reduces some major clinical manifestations of MPS I in mice, but low dose is less effective.

The EORTC ophthalmic oncology quality of life questionnaire module (EORTC QLQ-OPT30). Development and pre-testing (Phase I-III).

AIMS: The research objective was to develop a questionnaire module to be used, in addition to the European Organisation into Research and Treatment of Cancer (EORTC) QLQ-C30, for measurement of quality of life (QL) among patients with uveal melanoma treated with methods such as transpupillary thermotherapy, plaque radiotherapy, proton beam radiotherapy, local resection, and enucleation. The present paper describes the development through Phases I-III. METHODS: Relevant QL issues were generated from literature search and from interviews with ophthalmologists, nurses, and patients with uveal melanoma representing three major treatment options: enucleation, plaque brachytherapy, and proton beam therapy. RESULTS: The provisional module was pretested in 61 patients from Finland, Sweden, and UK. The EORTC QLQ-OPT30 module consists of 26 items for all patients, and four additional items for patients receiving treatments other than enucleation. It measures ocular irritation, vision impairment, headache, worry about recurrent disease, problems with driving, problems with appearance functional problems due to vision impairment, and problems reading. CONCLUSIONS: Several treatment modalities are available for uveal melanoma. There is limited knowledge of the impact of these treatments on QL in the long and short term. We hope that the OPT30 module together with the EORTC QLQ-C30 core questionnaire can be a useful tool in research.

A clinical evaluation of ophthalmic assessment in children with sensori-neural deafness.

BACKGROUND: Since 1991, children with sensori-neural deafness and their families within Southern Derbyshire have been supported by a multiagency approach to their diagnosis and management. RESULTS: One hundred and twenty-two children were seen at the Child Development Centre for an holistic assessment, and 110 of these children have had an ophthalmic assessment, of whom 48 (43.6%) were found to have ophthalmic abnormalities. These included 43 children (39.1%) with refractive errors, ranging from mild to severe. Of 82 children with uncomplicated deafness, 26 (31.7%) had refractive errors. The prevalence of ophthalmic problems was higher than the prevalence in hearing school children in the literature and in local pre-school children. There were six cases of Usher syndrome. Twenty-one children had more than one eye defect. The findings indicate that deaf and hearing impaired children are two to three times more likely to develop ophthalmic abnormalities than their hearing peers, which makes early detection of paramount importance. An important local outcome has been the establishment of guidelines for ophthalmic assessment to include assessment of vision and screening for Usher syndrome by electro-physiological testing at aged 7 years and above. Screening has been completed to date in 78 children with congenital sensori-neural deafness. CONCLUSIONS: Sensitive and efficient ophthalmic assessment and management are essential for all deaf and hearing impaired children and national guidelines need to be established for both assessment of vision and screening for Usher syndrome, based on further evaluated research.

Is acupuncture an useful tool for pain-treatment in ophthalmology?

Pain that does not respond to conventional treatment procedures makes it necessary to look for alternative methods. Acupuncture is an ancient procedure with empirical effects on pain. Previous studies established the increased output of messengers at neuronal junctions in spinal cord and hypothalamic locations, especially of endorphins which inhibit the perception of pain. We treated several painful symptoms with acupuncture and evaluated the outcome of the treatment. Patients with various kinds of therapy-refractory pain and patients in whom conventional treatment methods could not be applied were included in the study. The diagnoses included glaucoma. Tolosa-Hunt-Syndrome, ophthalmic migraine, blepharospasm, and dry eyes. In one case acupuncture was used for analgesia during surgery. Acupuncture was performed with sterile disposable needles, at points known to have an empirical analgesic effect. The stimulation was adapted to the patient's individual needs. VAS assessments before and after acupuncture were compared. The t-test was used for statistical evaluation. Acupuncture had no side effects, but reduced pain to a variable extent. Especially in cases of severe pain and in surgery, very effective pain reduction was achieved. In general, pain was significantly reduced in all patients by the use of acupuncture. A statistically significant effect was noted (p < 0.05). Further studies should be conducted to demonstrate the specific effect in larger patient populations. Monitoring neurotransmitter activity will possibly help to illustrate the effect.

Drug interactions in the treatment of Parkinson's disease.

In recent years, the antiparkinsonian drug regime has become increasingly complicated. A wide range of antiparkinson agents is meanwhile available. Combination therapies may unfortunately induce interactions up to the point of life-threatening events. The potential of drug-drug interactions must be taken into account before starting a patient on combination treatment. Moreover, the frequent multimorbidity of patients with Parkinson's disease necessitates the application of additional drugs. A general overview is difficult to maintain because of the countless number of possible interactions. Cautious proceeding is certainly indicated in particular cases. The most common interactions will be discussed below. We should bear in mind that many of the interactions related to drug combinations are unknown yet.

Management of diabetes mellitus in the Lovelace Health Systems' EPISODES OF CARE program.

OBJECTIVE: To design and implement the Lovelace Diabetes EPISODES OF CARE program in a managed care setting. This program is intended to address the complex needs of patients with type 2 diabetes mellitus by using specific physician-provider and patient interventions. DESIGN: Observational study. SETTING: Lovelace Health Systems, the second-largest and most fully integrated health care delivery system in New Mexico. The main facility is located in Albuquerque. PARTICIPANTS: Lovelace Health Plan members with type 2 diabetes. INTERVENTIONS: Physician-provider interventions included practice guidelines medical profile screens, and provider support reports. Patients interventions included diabetes education; improved access to care, with focused diabetes clinic visits and "Diabetes Days"; and reminder systems. MAIN OUTCOME MEASURES: Glycohemoglobin values, dilated eye examination rates, and access to education. RESULTS: Significant lowering of glycohemoglobin values, dilated eye examination rates exceeding benchmark measures, and increases in educational access rates have occurred since the Lovelace Diabetes EPISODES OF CARE program was implemented. CONCLUSIONS: An integrated health care delivery system with a comprehensive, diabetes disease management program can substantially improve outcomes.

Axial spondylometaphyseal dysplasia.

UNLABELLED: We present a previously undescribed skeletal dysplasia characterized by mild platyspondyly, small thorax with cupping of the anterior ends of the ribs, irregular proximal femoral metaphyses, and lacy appearance of the iliac wings. Two of the three cases were siblings. Retinitis pigmentosa and optic atrophy are associated findings. CONCLUSION: We describe a new type of spondylometaphyseal dysplasia (SMD) and propose the name axial SMD.