Autofluorescence imaging of pingueculae.

AIMS: To analyse the autofluoresence (AF) properties of pingueculae and compare the size of AF with the extent of the visible lesion. METHODS: Forty eyes of 23 patients with pingueculae were included in the study. AF images were obtained using an HRA2 confocal scanning laser ophthalmoscope; anterior segment photographies were obtained using TRC-50IX, IMAGEnet 2000 Digital Imaging System. The AF characteristics of pingueculae were analysed. The extent of visible lesion in anterior segment photography and AF image was compared. RESULTS: AF images revealed well-defined hyper-autofluorescence in the area of pinguecula, which was greater than the extent of visible pinguecula in the slit-lamp examination, in 40 of 56 lesions (71.4%). In none of the eyes was the hyperautofluorescent area smaller than the extent of visible lesion. CONCLUSION: Pingueculae display hyperautofluorescence in AF imaging. The real size of pingueculae may be estimated by its AF characteristics, which is mostly larger than the visible lesion.

Near-infrared and short-wavelength autofluorescence imaging in central serous chorioretinopathy.

AIMS: The aim of the study was to compare the results of short-wavelength (SW) and near-infrared (NIR) autofluorescence (AF) in acute central serous chorioretinopathy (CSC). METHODS: Twenty-six eyes of the 26 patients diagnosed with CSC (mean age 37.4 years) were included in this retrospective study. AF images were evaluated and compared with angiographic and ophthalmoscopic findings. Fluorescein angiography and AF imaging were performed using a confocal scanning laser ophthalmoscope. RESULTS: Focally decreased AF at the leakage site was seen in most of the cases with acute CSC (20 of 26 eyes in SW-AF; 20 of 20 eyes in NIR-AF). Twenty-four of the 26 cases had decreased SW-AF corresponding to the area of the serous retinal detachment, while 19 of the available 20 cases had decreased NIR-AF corresponding to the area of the serous retinal detachment. Increased granular AF corresponding to the extent of the former retinal detachment was seen earlier with SW-AF imaging, but disappeared later in the course of disease with NIR-AF imaging. CONCLUSIONS: AF imaging in CSC demonstrates different patterns according to the course of the disease, reflecting RPE and outer retinal changes. Combining two different methods of AF imaging could predict recent or former CSC episodes and may be a non-invasive technique for monitoring CSC and performing differential diagnosis.

Excitation-time-dependent increment in the luminescence of fundus autofluorescence.

AIM: To investigate the excitation-time-dependent increment in luminescence of fundus autofluorescence. METHODS: Fundus autofluorescence (FAF) images were obtained with a confocal scanning laser ophthalmoscope. Consecutive 60 images of each eye were taken at 1 s time intervals immediately after the beginning of argon laser excitation. Twenty-one eyes of 21 normal subjects were enrolled in the study. To analyse the luminescence of fundus autofluorescence, an 80 x 80 pixel square selection was placed in a relatively avascular fundus area of each consecutive image. Individual grey-scale values of the selected areas were recorded, and the time slope was plotted. RESULTS: The time-dependent increment of the autofluorescence was observed in all subjects. The average luminosity value of subjects at the beginning was calculated as 32.5 mean grey value (MGV), and luminosity reached its maximum (45.4 MGV) between 25 and 30 s. CONCLUSION: The excitation-time-dependent increment in FAF luminosity should be taken into account while acquiring FAF images for quantitative, comparative and longitudinal studies.

Topical ciclosporin in the treatment of ocular surface disorders.

Mounting evidence suggests that inflammation is the key factor in the pathogenesis of various ocular surface diseases, with a complex interplay of genetic, environmental, and psychosocial factors. Management of these conditions is often challenging. Topical corticosteroids, with their associated side effects, are the mainstay of current treatments for patients with vision threatening disease. Ciclosporin A is an immunomodulator that specifically inhibits T lymphocyte proliferation. Recently, a topical ciclosporin preparation was approved by the US Food and Drug Administration and became available for use in ophthalmology. Given the increasing use of ciclosporin eye drops, the goal of this article is to provide the reader with an overview of the well established uses of ciclosporin and to help refine the questions that should be addressed by future investigations.

Protective effects of antithrombin III on retinal ischemia/reperfusion injury in rats: a histopathologic study.

PURPOSE: To investigate the effect of antithrombin III (AT III) on retinal ischemia/reperfusion (I/R) injury in rats. METHODS: The study was carried out on 10 Wistar albino rats (20 eyes) and four-vessel occlusion method was employed to induce retinal ischemia in this study. Rats were divided into two groups: Group I (control group, 10 eyes) and Group II (AT III, 10 eyes). In both groups, vertebral arteries were occluded bilaterally an electric needle coagulator under an operating microscope. A total of 48 hours after the initial procedure, the rats were re-anesthetized and both common carotid arteries were clamped to interrupt blood flow. In Group II, rats were injected intravenously with 250 U/kg of AT III 5 minutes before the induction of ischemia. Duration of ischemia was 30 minutes. At the end of this period, clamp was removed for the reperfusion of the eye for 4 hours. Following the reperfusion period, the animals were killed by decapitation. Retinal sections were evaluated under light and electron microscope. The signs of I/R injury at the microscopic level, i.e., cellular degeneration, vacuolization between retinal layers, increase in the retinal thickness due to edema, mononuclear cell infiltration, and apoptotic cells, were recorded for each group. RESULTS: Retinal sections obtained from the rats in the AT III group revealed a well preserved retinal structure. When average thickness values of the two groups were compared to each other, the difference was significant with respect to inner nuclear and inner plexiform layers indicating increased retinal thickness values in Group I due to tissue edema resulting from I/R injury. Similarly, mononuclear cell infiltration and apoptotic cell counts were found to be significantly higher in control group compared to AT III group showing the inhibitory effect of AT III on leukocyte infiltration and apoptotic cell death in rat retina. CONCLUSIONS: Antithrombin III attenuated I/R injury in rat retina.

Protective effects of antithrombin III on retinal ischemia/reperfusion injury in rats: A histopathologic study.

PURPOSE: To investigate the effect of antithrombin III (AT III) on retinal ischemia/reperfusion (I/R) injury in rats. METHODS: The study was carried out on 10 Wistar albino rats (20 eyes) and four-vessel occlusion method was employed to induce retinal ischemia in this study. Rats were divided into two groups: Group I (control group, 10 eyes) and Group II (AT III, 10 eyes). In both groups, vertebral arteries were occluded bilaterally an electric needle coagulator under an operating microscope. A total of 48 hours after the initial procedure, the rats were re-anesthetized and both common carotid arteries were clamped to interrupt blood flow. In Group II, rats were injected intravenously with 250 U/kg of AT III 5 minutes before the induction of ichemia. Duration of ischemia was 30 minutes. At the end of this period, clamp was removed for the reperfusion of the eye for 4 hours. Following the reperfusion period, the animals were killed by decapitation. Retinal sections were evaluated under light and electron microscope. The signs of I/R injury at the microscopic level, i.e., cellular degeneration, vacuolization between retinal layers, increase in the retinal thickness due to edema, mononuclear cell infiltration, and apoptotic cells, were recorded for each group. RESULTS: Retinal sections obtained from the rats in the AT III group revealed a well preserved retinal structure. When average thickness values of the two groups were compared to each other, the difference was significant with respect to inner nuclear and inner plexiform layers indicating increased retinal thickness values in Group I due to tissue edema resulting from I/R injury. Similarly, mononuclear cell infiltration and apoptotic cell counts were found to be significantly higher in control group compared to AT III group showing the inhibitory effect of AT III on leukocyte infiltration and apoptotic cell death in rat retina. CONCLUSIONS: Antithrombin III attenuated I/R injury in rat retina.

Ophthalmic manifestations of Gilles de la Tourette syndrome.

PURPOSE: To present the ophthalmic manifestations of patients with Gilles de la Tourette syndrome (GTS). METHODS: Sixteen children (average age 11.5 years), with multiple motor and vocal tics, with a diagnosis of GTS, were included in this study. All underwent a full ophthalmological examination. RESULTS: All patients except one amblyopic case had best corrected visual acuity of 20/20 in both eyes. Eleven patients (68%) had eye tics; nine had clonic blepharospasm and two had involuntary gaze deviations. Four cooperative children underwent visual field examination with Goldmann perimeter, no visual field defect was detected. Three patients had strabismus (one alternating exotropia and two partially accommodative esotropia). Anterior and posterior segment examinations were within normal limits. The symptoms improved considerably in 82% of the patients with eye tics on treatment with a neuroleptic (pimozide). CONCLUSIONS: Blepharospasm was the most common ophthalmic manifestation of GTS. Ophthalmologists should consider a diagnosis of GTS in the absence of any organic eye pathology that may cause blepharospasm and refer these cases to a child psychiatrist. These children benefit from a treatment with neuroleptics under the supervision of a psychiatrist.

CNGA3 mutations in hereditary cone photoreceptor disorders.

We recently showed that mutations in the CNGA3 gene encoding the alpha-subunit of the cone photoreceptor cGMP-gated channel cause autosomal recessive complete achromatopsia linked to chromosome 2q11. We now report the results of a first comprehensive screening for CNGA3 mutations in a cohort of 258 additional independent families with hereditary cone photoreceptor disorders. CNGA3 mutations were detected not only in patients with the complete form of achromatopsia but also in incomplete achromats with residual cone photoreceptor function and (rarely) in patients with evidence for severe progressive cone dystrophy. In total, mutations were identified in 53 independent families comprising 38 new CNGA3 mutations, in addition to the 8 mutations reported elsewhere. Apparently, both mutant alleles were identified in 47 families, including 16 families with presumed homozygous mutations and 31 families with two heterozygous mutations. Single heterozygous mutations were identified in six additional families. The majority of all known CNGA3 mutations (39/46) are amino acid substitutions compared with only four stop-codon mutations, two 1-bp insertions and one 3-bp in-frame deletion. The missense mutations mostly affect amino acids conserved among the members of the cyclic nucleotide gated (CNG) channel family and cluster at the cytoplasmic face of transmembrane domains (TM) S1 and S2, in TM S4, and in the cGMP-binding domain. Several mutations were identified recurrently (e.g., R277C, R283W, R436W, and F547L). These four mutations account for 41.8% of all detected mutant CNGA3 alleles. Haplotype analysis suggests that the R436W and F547L mutant alleles have multiple origins, whereas we found evidence that the R283W alleles, which are particularly frequent among patients from Scandinavia and northern Italy, have a common origin.

Polarimetric nerve fiber analysis in patients with peripapillary myelinated retinal nerve fibers.

PURPOSE: The aim of this study was to compare the RNFL thickness in eyes with myelinated retinal nerve fibers (MRNF) and age, sex-matched controls using scanning laser polarimetry. METHODS: Seventeen patients with MRNF underwent a comprehensive ophthalmological examination including automated visual field testing, and scanning laser polarimetry with Nerve Fiber Analyser (NFA II). Twenty eyes with MRNF from 17 patients were available for the study. Sixteen healthy, age and sex-matched subjects were taken as controls. Retinal nerve fiber thickness measurements of the four sectors (superior, inferior, nasal, temporal) and along the whole circumference of the optic disc were obtained for affected and control eyes, and compared. RESULTS: Inferior average and inferior integral parameters of the NFA revealed significantly thinner RNFL thickness measurements in eyes with inferiorly located MRNF compared to controls. CONCLUSION: Retinal myelination alters the birefringent property of the RNFL, and results in diminished thickness measurements. Hence, NFA measurements in patients with MRNF may not be reliable.

Ocular ferning during the menstrual cycle in healthy women.

PURPOSE: The aim of the study is to investigate whether tear ferning patterns change during different phases of the menstrual cycle. METHODS: The tear ferning test was performed on twelve normal women of childbearing age at three day intervals throughout one complete menstrual cycle. Serum hormone levels (progesterone, estrogen, testosterone) were measured. RESULTS: Eight women showed type I ferning, and the other four had type II ferning initially. These patterns did not change during the menstrual cycle. Serum hormone levels were all in the normal range. Since no change in ferning pattern was detected during the menstrual cycle, the ferning test can be done at any time in women. CONCLUSIONS: This study showed no effect of different menstrual cycle phases on tear ferning patterns.

Polarimetric nerve fiber analysis in patients with visible optic nerve head drusen.

OBJECTIVE: To evaluate the effect of visible optic nerve head drusen (ONHD) on retinal nerve fiber layer (RNFL) thickness retardation by using scanning laser polarimetry. METHODS: Twenty-three eyes of 13 patients with visible ONHD and 26 eyes of 13 age- and sex-matched control subjects were involved in the study. Ophthalmologic examination, scanning laser polarimetry with nerve fiber analyser (NFA) type II GDX, automated Humphrey visual field testing, and red-free fundus photography were performed. Eyes with ONHD were classified from grade 0 to III according to the amount of visible drusen. Thus, grade 0 discs had no clinically visible ONHD and grade III discs represented the presence of dense drusen. RESULTS: Measurements with NFA of RNFL thickness retardation showed significant decrease in eyes with visible ONHD compared with control eyes (P < 0.05). Although no significant difference was found between grade I and grade II discs regarding NFA measurements, grade III discs had significantly lower values, indicating the greater amount of RNFL loss with higher grade ONHD. Documentation of increased percentage of visual field defects with higher grade drusen was also in accordance with this finding. CONCLUSIONS: NFA can quantitatively detect the decrease in retardation of RNFL thickness in eyes with visible ONHD and can be used as an indicator of nerve fiber layer loss in these cases.

Retinal nerve fiber layer analysis and interpretation of GDx parameters in patients with tilted disc syndrome.

This study was conducted to determine abnormalities of the GDx Glaucoma Scanning System parameters in patients with tilted discs, in order to set guidelines for the evaluation of glaucomatous damage in this situation. The objective was to determine which GDx parameters displayed the highest level of variation, and which remained unchanged in tilted disc syndrome. RNFA was polarimetrically conducted on 45 eyes from 26 subjects with tilted discs, and 43 normal eyes with Nerve Fiber Analyzer II (Laser Diagnostic Technologies). All parameters except inferior maximum, average thickness, ellipse average, and inferior average displayed a significant difference between the two groups (p < 0.05). Although NFA is useful in glaucoma diagnosis, the majority of the GDx parameters, as shown in our study, are unreliable in tilted disc syndrome in this respect.

Agenesis of the corpus callosum in a child with Leber's congenital amaurosis.

A 2.5-year-old male infant with agenesis of the corpus callosum and Leber's congenital amaurosis is described. The infant had nystagmus as the presenting sign. The fundi showed circumscribed macular atrophy with encircling retinal pigment epithelial hyperplasia (macular coloboma-like lesions), attenuation of the retinal arterioles, and very fine pigment dusting in the peripheral retina. Photopic and scotopic ERG were extinguished. Even though this is an exceedingly rare association, these findings along with neurological symptoms should alert the physician to conduct prompt cranial imaging.