86,657 research outputs found
Ultra-wide-field fluorescein angiography in diabetic retinopathy: a narrative review
No full textAlessandro Rabiolo,1 Mariacristina Parravano,2 Lea Querques,1,2 Maria Vittoria Cicinelli,1 Adriano Carnevali,1,3 Riccardo Sacconi,1,4 Teresa Centoducati,1 Stela Vujosevic,5 Francesco Bandello,1 Giuseppe Querques1 1Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, 2G. B. Bietti Foundation – IRCCS, Rome, 3Department of Ophthalmology, University of “Magna Graecia,” Catanzaro, 4Department of Neurological and Movement Sciences, University of Verona, Verona, 5Department of Neuroscience, Ophthalmology Clinic, University of Padova, Padova, Italy Abstract: Fluorescein angiography (FA) is a useful examination in patients suffering from diabetic retinopathy (DR). Traditional angiograms explore 30°–50° of the retina at once; however, visualization of peripheral retina is fundamental in order to assess nonperfused areas, vascular leakage, microvascular abnormalities, and neovascularizations. In order to expand the field of view, wide-field and ultra-wide-field imaging has been developed allowing to image up to 200° of retinal surface in one single shot. The aim of this narrative review was to provide an overview of the role of the most recent technique of ultra-wide-field fluorescein angiography in DR. Keywords: ischemic index, targeted retinal photocoagulation, diabetic macular edema, diabetic macular ischemia, peripheral vessel leakage, capillary nonperfusio
Management of diabetic macular edema with intravitreal dexamethasone implants: Expert recommendations using a Delphi-based approach
No full textObjectives: Despite being approved and effective, steroids, and especially dexamethasone intravitreal implants, still have a poorly-defined role in management of diabetic macular edema. In order to overcome some of the limitations in current recommendations, a group of experts met to define consensus on some of the most controversial issues on the use of dexamethasone intravitreal implants in daily management of diabetic macular edema. Methods: A Delphi-based approach was utilized to develop clinically relevant statements applicable to routine treatment settings. A Steering Committee composed of four experts formulated 30 relevant statements, which were voted upon by a panel of 40 ophthalmologists/retinal specialists from across Italy. Results: Dexamethasone intravitreal implants were considered to be a valid first-line alternative to treatment with an anti-vascular endothelial growth factor agent and should be the first choice in pseudophakic and vitrectomized patients. A Pro Re Nata regimen was felt to be appropriate for retreatment with dexamethasone intravitreal implants while a 6-month waiting period was not considered suitable. Among steroid treatments, dexamethasone intravitreal implants were considered to have the best ocular tolerability. In patients with persistent macular edema after the loading-phase treatment with an anti-vascular endothelial growth factor, consensus was reached that clinicians should consider switching therapy to dexamethasone intravitreal implants. Moreover, dexamethasone intravitreal implants can reduce the treatment burden for individuals who are not able to cope with the more intensive treatment regimen required by anti-vascular endothelial growth factor therapy. Conclusions: While further studies are needed, this survey provides some key recommendations for clinicians treating diabetic macular edema that may be useful when choosing dexamethasone intravitreal implants in daily practice
Interleukin-1beta tear concentration in glaucomatous and ocular hypertensive patients treated with preservative-free nonselective beta-blockers
No full textPURPOSE: To evaluate the ocular surface inflammatory response to the presence of preservatives in nonselective
beta-blocker eyedrops.
DESIGN: Prospective, crossover, single-masked, randomized
clinical study. METHODS: STUDY POPULATION: Twenty primary open angle glaucoma or ocular hypertensive patients were divided in two groups, one treated with preservative-free timolol 0.5% (group 1) and the other with preserved timolol 0.5% (group 2) eyedrops. After 60 days of therapy and 3 more weeks of washout, the two groups switched to the other therapy. PROCEDURE: At each visit,basal tear samples were collected from the inferior conjunctival fornix for the determination of interleukin (IL)-1 tear concentrations by an enzyme-linked immunosorbent assay. Intraocular pressure measurement, conjunctival
hyperemia, superficial punctate keratitis, and tear film breakup time were evaluated. MAIN OUTCOME MEASURE: IL-1 concentration in tears following the use of preserved eyedrops.
RESULTS: IL-1 tear concentrations increased significantly in both groups, compared with baseline values,during preserved timolol therapy. There were no statistically significant changes in hyperemia and superficial punctate keratitis throughout the study in either group.A statistically significant breakup time reduction was observed in both groups after 30 days and after 60 days of preserved therapy.
CONCLUSION: The use of preservatives in timolol 0.5% eyedrops leads to tear film instability and ocular surface inflammatory changes documented by a reduction of breakup time and an increase of IL-1 tear concentrations.Preservative-free beta-blockers are preferable for long-term hypotensive therapy to prevent ocular surface inflammation
Vision-related quality of life in patients treated for myopic choroidal neovascularization : A post hoc analysis of the OLIMPIC study
No full textPurpose: To investigate vision-related quality of life in patients referred to the Italian Retina Services for intravitreal ranibizumab treatment for choroidal neovascularization due to pathologic myopia. Design: Post hoc analysis of a multicenter, interventional phase IIIb study (OLIMPIC). Methods: Patients with either previously untreated (naïve) or treated choroidal neovascularization due to pathologic myopia were enrolled. Vision-related quality of life was measured using the Italian version of the Impact of Vision Impairment Questionnaire with scores from 0 (no impact) to 5 (severe impact). Burden of illness data were collected regarding income, and personal and public resource use. Results: In the 200 included subjects, mean best-corrected visual acuity in the better eye was 68.3 Early Treatment Diabetic Retinopathy Study letters (standard deviation: 15.2) compared with 42.5 Early Treatment Diabetic Retinopathy Study letters (standard deviation: 23.3) in the worse eye. The proportion of better eyes affected by choroidal neovascularization was 147/200 (73.5%). In multivariable analyses, lower better eye, but not worse eye, best-corrected visual acuity was associated with lower vision-related quality of life (per 10 fewer letters, beta: + 0.17, p < 0.001). An annual income below 20,000 euros was also associated with lower vision-related quality of life (beta: + 0.38; standard error: 0.13, p = 0.004). Moreover, in univariate analyses, increasing income level was linearly associated with better presenting best-corrected visual acuity in the better eye (p < 0.003), with a difference of 15 Early Treatment Diabetic Retinopathy Study letters for patient income <20,000 euros compared with >70,000 euros. Conclusion: Italian patients with myopic choroidal neovascularization and a low income presented with lower better-eye best-corrected visual acuity and lower vision-related quality of life compared with those with a higher income. Future research should investigate disease awareness and candidacy issues that may influence the quality of life of patients
Influence of macular choroidal thickness on visual function in highly myopic eyes
No full textPurpose: To explore the retinal and choroidal thicknesses (RT, CT), as measured using enhanced depth imaging (EDI) optical coherence tomography (OCT, Spectralis) in highly myopic eyes and its relationship with visual function. Materials and Methods: Prospective, case-control, noninterventional clinical study. CT was measured by EDI-OCT in highly myopic eyes (>= 6 dpt) without any macular diseases and age-matched control eyes. A complete ophthalmological examination, visual acuity assessment and MP1 microperimetry were obtained. Results: 38 myopic (15 M/23 F, mean age 51 +/- 8.9 years) and 21 control eyes (5 M/16 F, mean age 50 +/- 5.4 years) were included. The myopic mean refractive error was -13.3 +/- 4.9 dpt and axial length 29.2 +/- 2.2 mm. The mean best-corrected visual acuity (BCVA) was lower in highly myopic than in control eyes (77.3 +/- 9.25 vs. 84.8 +/- 0.6 letters, p = 0.0001, respectively) as was the mean retinal sensitivity (MRS; 16.32 +/- 2.6 vs. 19.9 +/- 0.2 dB, p < 0.0001). While RT was similar between groups (291.5 +/- 24.2 vs. 283.6 +/- 13.9 mu m, p = 0.06, respectively), subfoveal CT was thinner in highly myopic compared to control eyes (114.3 +/- 78.5 vs. 272.6 +/- 110.2 mu m, p < 0.0001). A significant relationship was found between subfoveal CT and MRS (R-2 = 0.22; p = 0.003) and BCVA (R-2 = 0.13; p = 0.027). Conclusions: Macular function is reduced in highly myopic eyes without any visible macular diseases compared to controls, and a significant proportion of the macular function variability seems to be related to a reduced CT
Activation of retinal Müller cells in response to glucose variability
No full textPurpose In the earliest stages of diabetic retinopathy (DR), a dysfunction of Muller cells, characterized by high levels of glial fibrillary acidic protein (GFAP), and aquaporins (AQP), has been observed. Although chronic hyperglycemia causes the activation of Muller cells, the effect of glycemic fluctuations is yet unknown. The aim of the study was to analyze the impact of glucose variability on rat retinal Muller cells (rMC-1) adapted to either normal (5 mM) or high (25 mM) glucose levels. Methods rMC-1 were cultured in a medium containing either 5 mM (N cells) or 25 mM of glucose (H cells) and then incubated for 96 h in a medium containing (a) low glucose (either 1-3 or 5 mM), (b) basal glucose (either 5 or 25 mM), (c) high glucose (either 25 or 45 mM), (d) basal and high glucose alternated every 24 h; (e) low- and high glucose alternated every 24 h; (f) basal glucose with episodes of low glucose for 30 min twice a day. Muller cells activation was evaluated by measuring the levels of GFAP, AQP4, and phospho-active extracellular signal-regulated kinase (pERK). Results Under both basal and high glucose concentrations rMC-1 were viable, but their response to glucose excursions was different. In N cells kept under normal (5 mM) glucose, a significant glial activation was measured not only in response to constant high glucose but also to alternating low/high glucose. In H cells, adapted to 25 mM glucose, a significant response was observed only after exposition to a lower (5 mM) glucose concentration. Conclusion Our results highlight Muller cells activation in response to glucose variability and a different susceptibility depending on the basal glucose conditions
Long-term functional and morphologic retinal changes after ranibizumab and photodynamic therapy in myopic choroidal neovascularization
No full textPurpose: To assess and compare the long-term functional and anatomical outcomes in
eyes with myopic choroidal neovascularization (CNV) treated with intravitreal injections of
ranibizumab or with photodynamic therapy (PDT).
Methods: Eighty-five eyes of 85 consecutive patients with myopic CNV and treated with
either PDT (43/85) or ranibizumab 0.5 mg (42/85) and at least 24 months of follow-up were
collected. Data from the best-corrected visual acuity, optical coherence tomography, and
fluorescein angiography were compared between the groups. Differences in the regression
pattern of myopic CNV and the rate of chorioretinal atrophy development were also
compared between the groups.
Results: The effect of treatment over time on best-corrected visual acuity and the central
retinal thickness was significantly greater in the ranibizumab group (P = 0.0012 and P ,
0.0002, respectively), with eyes treated with ranibizumab showing a significant central
retinal thickness decrease since the first visit and maintained until 24 months. The proportion
of patients showing a complete closure of CNV was similar between the groups
(93% [39 of 42 eyes in the ranibizumab group] vs. 88% [38 of 43 eyes in the PDT group], P =
0.48). Both treatments were associated with an increase of chorioretinal atrophy size, which
was greater in the PDT-treated eyes (P = 0.016).
Conclusion: Ranibizumab therapy showed a greater long-term efficacy compared with
PDT in myopic CNV eyes, with a fewer proportion of eyes developing an increase of lesion
and chorioretinal atrophy size
Quality of Vision Index: a new method to appraise visual function changes in age-related macular degeneration.
No full textAbstract
PURPOSE: To explore the correlation between psychophysical measures of visual function and vision-related quality of life (QOL) in exudative age-related macular degeneration (AMD) and to obtain a new quality of vision index expressed as corrected visual acuity (cVA) that is scaled like visual acuity (VA), but that incorporates the weighted contribution of VA, contrast sensitivity (CS), and reading ability.
METHODS: Visual acuity, CS, and reading ability were measured in 293 patients with AMD in this multicenter prospective study. Vision-related QOL was quantified by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The validity of the questionnaire was assessed using Rasch analysis. The relationship between psychophysical tests and NEI-VFQ-25 scores was investigated. A cVA index was developed integrating Rasch-scaled NEI-VFQ-25 score with VA, CS, and reading ability as a tool to be used for evaluating vision-related QOL on the same scale as VA.
RESULTS: A total of 27.5% of the variability of VFQ score was found to be explained by VA alone in patients with AMD. The proportion of Rasch-scaled QOL estimate variance explained by cVA was 33.2% as compared to 27.5% explained by VA and 24.5% by CS, which was a statistically significant improvement in both cases (p=0.015 and p<0.001, respectively). The correlation of reading ability with vision-related QOL was largely mediated by VA and CS and therefore it was not retained in the vision index.
CONCLUSIONS: Visual acuity is poorly correlated with vision-related QOL in patients with AMD. Even though the new cVA index is a new method which better correlates with vision-related QOL, the major components of the individual perception of vision remain unexplained by common psychometric test
Effects of circadian rhythm disruption on retinal physiopathology: Considerations from a consensus of experts
No full textThe circadian rhythms originate within the organism and synchronize with cyclic fluctuations in the external environment. It has been demonstrated that part of the human genome is under control of the circadian clock and that a synchronizer that helps to maintain daily rhythms is Melatonin, a neuro-hormone primarily synthesized by the pineal gland during the night. The chronic disruption of circadian rhythm has been linked to many conditions such as obesity, metabolic syndrome, type 2 diabetes, cancer, and neurodegenerative diseases. Studies in the mice showed that the disruption of the retinal circadian rhythm increases the decline during the aging of photoreceptors, accelerating age-related disruption of cone cell structure, function, and viability and that the melatonin receptor deletion seems to influence the health of retinal cells, speeding up their aging. In conclusion, preserving the circadian rhythms could be to add to the prevention and treatment of age-related degenerative retinal diseases, and although additional studies are needed, melatonin could be a valid support to favor this “chronoprotection action”
Diurnal trajectories of salivary cortisol and α-amylase and psychological profiles in patients with central serous chorioretinopathy
No full textIt has been hypothesized that the occurrence of central serous chorioretinopathy (CSC) might be associated with stress. Therefore, our purpose was to investigate the diurnal trajectories of salivary cortisol and α-amylase (α-Amy)–markers of hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) system activity, respectively–and psychological profiles in idiopathic acute CSC. This cross-sectional observational case-control study, which included self-reported psychometric questionnaires, was formally approved by the Ethics Committee. Written informed consent was obtained from all participants. Home diurnal saliva collection was scheduled at several timepoints: at awakening, 30 and 60 min later, and at approximately 13:00 h and 20:00 h. Twenty consecutive male subjects with first-episode CSC attending the outpatient clinic of the Retina Medical Service at the Bietti Foundation were enrolled in the study. Twenty age-matched subjects were recruited as controls. After their initial enrollment, 3 subjects per group were excluded. The production of cortisol and α-Amy and the scores on the negative subscale of the Positive/Negative Affect Schedule, the Daily Hassles and Stress Scale and the Beck Depression Inventory were higher in the CSC group than in the control group. To estimate the diurnal trends in the production of salivary cortisol and α-Amy, an equation was derived for each group of the study population. The equations describing the interpolated regression lines gave salivary cortisol and salivary α-Amy slopes that were determined to be significantly different by Student’s t-test (cortisol: t = 3.533, p < .001; α-Amy: t = 2.382, p = .018). Furthermore, the area under the curve with respect to the ground (AUCG) was calculated to summarize repeated salivary biomarker measurements from 07:00 h to 08:00 h for assessment of the cortisol awakening response (CAR) and the α-Amy awakening response (AR). The diurnal cortisol AUCG and diurnal α-Amy AUCG were calculated from 07:00 h to 20:00 h. The CAR AUCG values of the CSC patients were significantly higher than those of the controls. No differences between the two groups were detected for the α-Amy AR AUCG. The present study adds novel information to the growing body of data suggesting that abnormal diurnal activity of the HPA axis and the SAM system is associated with CSC in susceptible individuals, providing ophthalmologists with a new chronobiological approach for these patients
- …
