Structural imaging of the retina in psychosis spectrum disorders: current status and perspectives.

PURPOSE OF REVIEW: Structural changes of the retina in schizophrenia and other psychotic disorders seem plausible as these conditions are accompanied by widespread morphological abnormalities of the brain. Advances in structural retinal imaging have led to the possibility of precise quantification of individual retinal layers, using optical coherence tomography (OCT) scanners. RECENT FINDINGS: The aggregation of information related to OCT findings in schizophrenia has resulted in three metaanalyses, which are currently described. Areas where retinal changes were reported include retinal nerve fiber layer (RNFL), ganglion cell layer complex (GCC), macular volume, and macular thickness, but findings on affected retinal segments vary to some extent across studies. Discrepancies in individual studies could be because of small samples, heterogeneity within schizophrenia (phase of the illness, illness duration, predominant symptomatology), inconsistent reporting of antipsychotic therapy, insufficient control of confounding variables (somatic comorbidities, smoking, and so on), and use of the different types of OCT scanners. SUMMARY: Exploration of potential disturbances in retinal architecture could provide new insights into neuronal changes associated with psychosis spectrum disorders, with potential to elucidate the nature and timing of developmental, progressive, inflammatory, and degenerative aspects of neuropathology and pathophysiology, and to assist with characterizing heterogeneity and facilitating personalized treatment approaches.

Retinal structural abnormalities in young adults with psychosis spectrum disorders.

BACKGROUND: Structural retinal architecture in living organisms became measurable with the development of optical coherence tomography (OCT) scanners. Single-layer analysis with spectral-domain OCT, among other techniques, may provide further insight into pathological changes in complex brain disorders such as psychosis spectrum disorders (PSD). METHODS: This study investigated potential thinning of retinal layers (retinal nerve fiber layer - RNFL, macular volume, macular thickness, ganglion cell-inner plexiform layer- GC-IPL, optic cup volume and cup-to-disk ratio) using a spectral-domain OCT device in 33 non-acute PSD patients (illness duration 5.9 ± 3.9 years) and 35 healthy controls. RESULTS: In comparison to age and gender matched controls, patients had bilateral reductions in GC-IPL layer thickness and macular volume. Macular central subfield thinning was found in the right eye, while average macular thickness was lower in the left eye only. RNFL thinning was not observed in patients in comparison to controls, but we noticed that status of this layer could be affected by daily dose of antipsychotics and by illness duration. CONCLUSION: Taken together, our results reveal that retinal thinning is present in young adults with PSDs, but in comparison to the literature we found more prominent changes in both GC-IPL and macular volume/thickness, than in RNFL. Our findings may reflect synaptic loss and neuronal atrophy in non-acute young patients with psychosis.

Juvenile diabetes eye complications and treatment.

BACKGROUND/AIM: Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia. The aim of this study was to explore the prognosis of patients with juvenile DM regarding diabetic eye complications, as well as the course of the diabetic eye disease related to the treatment undertaken. METHODS: The study series involved 33 patients with juvenile DM during the period 1992-2007. The influence of the following factors on the course of the disease was estimated: age, the age of the disease onset, time when eye complications appeared, treatment modalities. RESULTS: Of the total of 33 diabetics 15 patients were followed for 10 or more years and 18 from 5 to 9 years. At the time of their first visit the mean age was 23.12 +/- 6.39 and the mean duration of DM was 17.42 +/- 7.42 years. On their first visit, 7 eyes were without any complication. Most of the patients already developed clinical signs of proliferative diabetic retinopathy (41.39%), the signs of nonproliferative diabetic retinopathy (13.13%) and macula involvement (10.10%). Diabetic cataract was found in 8.8% as well as tractional retinal detachment. Eleven out of 66 eyes were with vitreous hemorrhage. Two patients (5.5%) suffered neovascular glaucoma. There was 1 (2.2%) patient with developed rubeosis iridis and simplex glaucoma. Panretinal photocoagulation was performed in 65% of patients, focal photocoagulation in 15%, 12% patients underwent pars plana vitrectomy and 4% had cataract surgery with intraocular lens implantation and peripheral retinal kryopexy. CONCLUSION: Total vision loss due to eye complications of juvenile DM may be prevented if timely diagnosed with regular check ups and early treatment.

Ultra B2 - Promoção de ligações covalentes do colágeno corneal (Corneal cross-linking) no tratamento de ceratocone: resultados preliminares / Corneal Cross-linking for the treatment of keratoconus: preliminary results

OBJETIVO: Apresentar os resultados visuais e ceratométricos, seis meses após tratamento foto-terapêutico com luz ultravioleta (UV) e vitamina B2 (Ultra B2), em pacientes com ceratocone progressivo. MÉTODOS: Vinte e cinco olhos de 20 pacientes (15 homens e 5 mulheres) com ceratocone progressivo, determinado pelo aumento de curvatura em exames seriados de topografia corneal, nos últimos seis meses foram avaliados. Acuidade visual não corrigida (UVA), acuidade visual melhor corrigida com óculos (BSCVA), equivalente esférico (SEQ), cilindro refrativo manifesto e a curvatura máxima (max K) pré e pós-operatórios (1, 3 e 6 meses) foram determinadas. Todos os pacientes foram submetidos ao tratamento Ultra B2 usando riboflavina (vitamina B2) e a luz ultravioleta (UV, 370 nm). O epitélio corneal foi removido após assepsia, colocação de blefarostato e anestesia tópica com proparacaína, por meio de solução de álcool hidratado (20 por cento) utilizada por 30 segundos. A córnea foi saturada com vitamina B2 por 15 minutos; em seguida, foi irradiada por luz UV por 30 minutos. Ao final do procedimento, foi colocada lente de contato terapêutica (LCT), mantida até a epitelização total. RESULTADOS: Houve melhora na UVA após o primeiro mês (de 0,15 ± 0,15 para 0,23 ± 0,20), com contínua mudança no terceiro e sexto mês pós-operatório, atingindo a diferença estatisticamente significante nesse período (p=0,025 e p=0,037 respectivamente). BSCVA melhorou de 0,41 ± 0,27 para 0,49 ± 0,29 no sexto mês, sem atingir a diferença estatisticamente significante. A progressão do ceratocone após o procedimento não foi notada em nenhum paciente, em comparação com o avanço topográfico nos 6 meses precedentes. Após 6 meses do procedimento, max K diminuiu em mais que 2,00 D (de 53,02 ± 8,42 para 50,88 ± 6,05 D), SEQ em menos que 1 D (de -3,27 ± 4,08 para -2,68 ± 3,02 D) e o cilindro refrativo em menos que 0,5 D (de -2,29 ± 1,77 para -1,86 ± 0,92), sem atingir diferença estatisticamente...

PURPOSE: To present early visual and keratometric results for corneal cross-linking with riboflavin and UV irradiation in patients with progressive keratoconus. METHODS: Twenty-five eyes of twenty patients (15 males and 5 females) with a progressive keratoconus in the previous 6 months were followed. Unaided visual acuity (UVA), best spectacle corrected visual acuity (BSCVA), spherical equivalent (SEQ), manifest cylinder, and maximal corneal curvature (max K) values were followed at 1, 3 and 6 months. All patients were submitted to corneal cross-linking using riboflavin (vitamin B2) as the photosensitizer and ultraviolet light (UV, wavelength 370 nm). Epithelium was removed with 20 percent alcohol, cornea was soaked with vitamin B2 for 15 min, and then irradiated with UV light for 30 min, after which a bandage contact lens (BCL) was placed. RESULTS: UVA increased after one month (from 0.15 ± 0.15 to 0.23 ± 0.20), and went on increasing at 3 and 6 months, reaching statistical significance (p=0.025 e p=0.037, respectively). BSCVA increased from 0.41 ± 0.27 to 0.49 ± 0.29 at month six, without reaching statistical significance at any time point. Progression of keratoconus stopped in all patients, in contrast with progression in all of them in the six-month period prior to the surgery. Max K decreased by more than 2 D (from 53.02 ± 8.42 to 50.88 ± 6.05 D), SEQ less that 1 D (from -3.27 ± 4.08 to -2.68 ± 3.02 D), while refractive cylinder decreased less than 0.5 D (from -2.29 ± 1.77 to -1.86 ± 0.92 D), without reaching a statistically significant difference. None of the eyes lost any line of BSCVA, 12 maintained the preoperative BSCVA, 7 gained one line, 5 gained two lines, and 1 patient gained three lines of BSCVA. CONCLUSIONS: Corneal cross-linking with riboflavin and UV light seems to be a safe (no loss of BSCVA) and effective (anatomical and optical properties maintained) procedure, which has shown to stop the progression of the keratoconus...

[Corneal Cross-linking for the treatment of keratoconus: preliminary results]. / Ultra B2 - Promoção de ligações covalentes do colágeno corneal (Corneal cross-linking) no tratamento de ceratocone: resultados preliminares.

PURPOSE: To present early visual and keratometric results for corneal cross-linking with riboflavin and UV irradiation in patients with progressive keratoconus. METHODS: Twenty-five eyes of twenty patients (15 males and 5 females) with a progressive keratoconus in the previous 6 months were followed. Unaided visual acuity (UVA), best spectacle corrected visual acuity (BSCVA), spherical equivalent (SEQ), manifest cylinder, and maximal corneal curvature (max K) values were followed at 1, 3 and 6 months. All patients were submitted to corneal cross-linking using riboflavin (vitamin B2) as the photosensitizer and ultraviolet light (UV, wavelength 370 nm). Epithelium was removed with 20% alcohol, cornea was soaked with vitamin B2 for 15 min, and then irradiated with UV light for 30 min, after which a bandage contact lens (BCL) was placed. RESULTS: UVA increased after one month (from 0.15 +/- 0.15 to 0.23 +/- 0.20), and went on increasing at 3 and 6 months, reaching statistical significance (p=0.025 e p=0.037, respectively). BSCVA increased from 0.41 +/- 0.27 to 0.49 +/- 0.29 at month six, without reaching statistical significance at any time point. Progression of keratoconus stopped in all patients, in contrast with progression in all of them in the six-month period prior to the surgery. Max K decreased by more than 2 D (from 53.02 +/- 8.42 to 50.88 +/- 6.05 D), SEQ less that 1 D (from -3.27 +/- 4.08 to -2.68 +/- 3.02 D), while refractive cylinder decreased less than 0.5 D (from -2.29 +/- 1.77 to -1.86 +/- 0.92 D), without reaching a statistically significant difference. None of the eyes lost any line of BSCVA, 12 maintained the preoperative BSCVA, 7 gained one line, 5 gained two lines, and 1 patient gained three lines of BSCVA. CONCLUSIONS: Corneal cross-linking with riboflavin and UV light seems to be a safe (no loss of BSCVA) and effective (anatomical and optical properties maintained) procedure, which has shown to stop the progression of the keratoconus: a reduction, although not statistically significant, of the corneal curvature, spherical equivalent and refractive cylinder took place in patients where previous progression of keratoconus had been described.