727 research outputs found
Emerging Insights into Pathogenesis
No full textDiabetic retinopathy (DR) is a frequent complication of diabetes mellitus (DM). Persistent hyperglycemia leads to the activation of multiple cellular pathways involved in the pathogenesis of DR, resulting in increased inflammation, oxidative stress, and vascular dysfunction. DR has been considered a "chronic, low-grade inflammatory disease of the retina". However, an increasing body of evidence suggests that inflammation and neurodegeneration both occur in human diabetes even before the development of clinical signs of DR. One of the first signs of inflammation in DM is the activation of retinal glia cells (RGC). RGC include microglia and macroglial cells (Müller cells and astrocytes). Activated RGC release cytotoxic substances responsible for the recruitment of leukocytes, blood-retinal barrier breakdown, direct glial dysfunction, and neuronal cell death. Recently, many inflammatory mediators, growth factors, and other molecules have been investigated in human vitreous and aqueous humor samples to better understand, in vivo, the multiple pathways and mechanisms leading to the pathogenesis of DR and its complications, such as diabetic macular edema, with potential for more tailored treatment. Moreover, non-invasive techniques, like optical coherence tomography, have allowed to detect new findings in the retinal layers, such as the hyperreflective intraretinal spots, which have been hypothesized to represent an in vivo marker of microglial activation, and early neural cell loss, confirming the hypothesis that neurodegeneration occurs early both in type 1 and 2 diabetes. These new emerging insights foster a better understanding of the pathogenesis of DR, which can no longer be considered as a pure retinal vascular complication of DM
Multimodal retinal imaging: An introduction
No full textMultimodal retinal imaging is a new concept in the diagnosis and follow-up of retinal disorders. It refers to the importance of combining diagnostic information related to both retinal morphology and function in a unique setting, possibly in a unique multifaceted image, to improve the final diagnostic result. When a multimodal imaging approach is used (as illustrated with a few relevant cases), the combined information are superior to the sum of any individual investigation. Moreover, this approach allows to obtain information which may be quite useful to evaluate the impact of currently used (and future) therapies on both retinal morphology and function. © Springer-Verlag Berlin Heidelberg 2014
Proptosis secondary to bilateral extraocular muscle enlargement in Noonan syndrome with hypertrophic cardiomyopathy: A case report
No full textPurpose To report and investigate proptosis in a young girl with Noonan syndrome. Methods Observational case report. Results A 16-year-old girl affected by Noonan syndrome underwent a complete ophthalmological examination showing bilateral proptosis with hypofunction of lateral rectus and superior oblique muscles. Visual acuity, color discrimination and fundus examination were unremarkable. The orbital MRI showed bilateral proptosis and symmetrical enlargement of extraocular muscles, with bellies thickening and tendon sparing. The young patient also complained restrictive hypertrophic cardiomyopathy. Conclusions Proptosis is an uncommon ocular manifestation of Noonan syndrome and its pathophysiology has never been clarified. The MRI evidence of extraocular muscles enlargement associated with hypertrophic cardiomyopathy, led us to hypothesize a common altered pathway beneath these features, more specifically the MAP kinase pathway, since extraocular and cardiac muscles share a mesenchymal embryological origin
Oct and autofluorescence: Are they useful in the diagnosis of intraocular tumors?: These newer imaging modalities may be useful for detecting predictive factors in some cases
No full textPhotodynamic therapy for iris metastasis from a mediastinal carcinoid tumor
No full textIntraocular metastasis from a carcinoid tumor is a rare event with anecdotal reports of iris involvement. We describe a case of iris metastasis from a carcinoid tumor treated with photodynamic therapy (PDT).Abstract
PURPOSE:
Intraocular metastasis from a carcinoid tumor is a rare event with anecdotal reports of iris involvement. We describe a case of iris metastasis from a carcinoid tumor treated with photodynamic therapy (PDT).
METHODS:
An isolated iris tumor was observed in a 36-year-old man. Anterior segment photography, fluorescein angiography, and fine-needle aspiration biopsy were performed. The tumor was treated with a bolus application of PDT. Regular follow-up (including clinical and angiographic evaluations) was performed over 2 years.
RESULTS:
The iris mass was cytologically consistent with metastasis from a mediastinal carcinoid tumor. The metastasis showed prominent vascularization. Bolus PDT was applied with complete and long-term regression of the iris tumor. At the 24-month follow-up, the patient was still alive, and no recurrence had been documented.
CONCLUSIONS:
PDT may be an effective therapeutic option in selected cases of iris metastasis
Diagnostic techniques: Autofluorescence
No full textAutofluorescence is a relatively new, noninvasive diagnostic tool recently introduced in the armamentarium of intraocular tumor diagnosis and characterization. This technique may reveal the effects of choroidal tumors on the overlying retinal pigment epithelium and may also provide specific information on intrinsic pigments that compose and characterize benign and malignant, congenital and acquired chorioretinal lesions. Lipofuscin, melanin, and melanolipofuscin strongly influence the different autofluorescence patterns of chorioretinal tumors, but other pigments may theoretically influence the autofluorescence pattern of these lesions. In this chapter we review the role of autofluorescence in the diagnosis of benign and malignant chorioretinal. © Springer-Verlag Berlin Heidelberg 2014
Microperimetry and fundus autofluorescence in patients with early age-related macular degeneration
No full textMicroperimetry and fundus autofluorescence in patients with early age-related macular degeneration.
Midena E, Vujosevic S, Convento E, Manfre' A, Cavarzeran F, Pilotto E.
SourceDepartment of Ophthalmology, University of Padova, Via Giustiani 2, 35128 Padova, Italy. [email protected]
Abstract
BACKGROUND: Early age-related macular degeneration (AMD) has been correlated with different functional alterations, but the exact relationship between fundus lesions and overlying sensitivity is not well known. The aim of this study was to compare fundus-related sensitivity (microperimetry) and fundus autofluorescence (FAF) of the macular area with drusen and pigment abnormalities in early AMD.
METHODS: 13 consecutive patients with early AMD and visual acuity of 20/20 were studied by means of microperimetry, which automatically analyses macular light differential threshold and fixation patterns. Fundus colour photo and FAF of the macular area were recorded on the same day. Microperimetry was exactly (topographically) superimposed over FAF images.
RESULTS: Macular sensitivity significantly decreased over large drusen (11.2 +/- 5.6 dB, p<0.0001) and over pigment abnormalities (13.1 +/- 3.6 dB, p<0.0001). When both characteristics were present the reduction was greater if compared with its absence (9.6 +/- 4.3 versus 15.0 +/- 4.5 dB, p<0.0001). Sensitivitity reduction was significant in areas with altered FAF when compared with areas with normal FAF (p<0.0001).
CONCLUSIONS: Increased FAF in early AMD has a functional correlate exactly quantified by microperimetry. In retinal areas affected by early AMD retinal sensitivity deteriorates, despite good visual acuity. Microperimetry may allow the early detection of functional impairment caused by these lesions. Both microperimetry and FAF may be useful to monitor AMD progression.
PMID: 17504849 [PubMed - indexed for MEDLINE] PMCID: PMC209542
LA FLUORANGIOGRAFIA DELLA TESTA DEL NERVO OTTICO E DELLA ZONA PERIOTTICA/ ANGIOGRAPHY OF THE OPTIC NERVE HEAD AND OF THE PERIPAPILLARY AREA
No full textCONTRIBUTO SU LIBR
Long-term choroidal vascular changes after iodine brachytherapy versus transpupillary thermotherapy for choroidal melanoma.
No full textLong-term choroidal vascular changes after iodine brachytherapy versus transpupillary thermotherapy for choroidal melanoma.
Pilotto E, Vujosevic S, De Belvis V, Parrozzani R, Boccassini B, Midena E.
SourceDepartment of Ophthalmology, University of Padova, Padova, Italy. [email protected]
Abstract
PURPOSE: To compare long-term choroidal vascular changes after iodine-125 brachytherapy (IBT) versus transpupillary thermotherapy (TTT) used as primary treatment of small choroidal melanoma.
METHODS: Ninety-five small choroidal melanomas were randomized: 49 eyes with TTT and 46 eyes with IBT alone. Fluorescein and indocyanine green angiography (ICGA) were performed at 3-month intervals during the first year, and every 6 months thereafter.
RESULTS: Mean follow-up was 56.2 months (range, 24-118 months; SD, 22.6). Tumor regressed in 45 (92%) TTT-treated vs 45 (98%) IBT-treated eyes (p=0.397). Four TTT-treated and one IBT-treated tumor recurred. Occlusion of choriocapillaris was present in all TTT and IBT cases. Closure of medium and large choroidal vessels was observed in 17 (35%) TTT-treated vs 44 (96%) IBT-treated eyes (p<0.001). Choroidal vascular remodeling was detected in 20 (41%) TTT-treated and 16 (35%) IBT-treated eyes (p=0.693). Retinochoroidal anastomosis was present in 4 of the 37 (11%) TTT-treated eyes with patency of medium and large choroidal vessels, but never observed in the IBT-treated eyes, and was associated with tumor recurrence. Among IBT-treated eyes, segments of choroidal vascular wall ICG staining and choroidal aneurysmal changes were detected in 30 (65%) and 7 (15%), respectively. These changes were never detected in TTT-treated cases (p<0.0001 and p=0.015, respectively).
CONCLUSIONS: The pattern of tumor choroidal vascular changes following IBT and TTT differs. TTT is less effective in closing all tumor vasculature. The role of long-term choroidal vascular remodeling observed after these two treatments needs longer follow-up.
PMID: 19551682 [PubMed - indexed for MEDLINE
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