Subthreshold micropulse laser for long-lasting submacular fluid after rhegmatogeous retinal detachment surgery

Purpose: To assess the safety and efficacy of subthreshold micropulse laser (SML) photo-stimulation in the management of persistent subfoveal fluid (PSF) after surgery for rhegmatogenous retinal detachment (RRD). Methods: In this pilot study, 11 eyes of 11 patients (8 men, 3 women) with long-lasting (12–18 months) PSF after surgery for RRD were evaluated before and after photostimulation with subthreshold micropulse yellow laser. Ophthalmic examination included best-corrected visual acuity (BCVA), Amsler grid test, ophthalmoscopy, autofluorescence (AF), and optical coherence tomography (OCT) with measurement of central point foveal thickness (CPFT). Primary outcome was subfoveal fluid resolution and secondary outcome was BCVA improvement. Results: The mean CPFT and BCVA were, respectively, 436.8 ± 28.8 μm and 0.25 ± 0.1 µm decimal equivalent (DE) before photostimulation and 278 ± 54.4 μm and 0.57 ± 0.2 µm DE after photostimulation, a statistically significant difference (P < 0.001). Nine (81.8%) eyes showed improved BCVA, disappearance of macular detachment on ophthalmoscopy, reduced retinal pigment epithelium distress on AF, and restored macular profile with no neuroretinal alterations on OCT scans. Conclusion: Although PSF after RRD surgery is often a self-limiting disease, our results suggest that SML photostimulation may be effective and safe in patients with clinically significant long-lasting PSF. Larger case–control studies are necessary to confirm these results. © 2022 Esposti et al

Ocular Tics and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

Little is known about ocular tics in Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections (PANDAS). In this retrospective study, we examined the clinical records of children with motor tics referred to the Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, Italy, in 2010-2019. The presence of ocular tics was investigated. Data about antistreptolysin O (ASO) and anti-DNase B antibody titers, erythrocyte sedimentation rate (ESR), plasma C-reactive protein (CRP), and antibiotic use were recorded. Forty children (thirty-four boys and six girls; mean age: 7.65 +/- 2.5 years) with motor tics were identified; thirty-three (82.5%) showed ocular tics. Children with ocular tics had significantly higher titers of anti-DNase B antibodies (p = 0.04) and CRP (p = 0.016) than those with extraocular tics. A diagnosis of PANDAS was made in 24 (60%) children. PANDAS children with oculomotor tics had significantly higher titers of anti-DNase B antibodies (p = 0.05) than those with extraocular tics. Oral antibiotics were given to 25/33 (76%) children with ocular tics and 21/24 (87.5%) with PANDAS. All treated patients showed marked improvement/complete resolution of symptoms. Results suggest that higher titers of anti-DNase B antibodies may be implicated in the pathogenesis of ocular tics in PANDAS. Oral antibiotics may be beneficial in improving ocular tics. Further research is necessary to confirm our findings

MicroRNA Expression in the Aqueous Humor of Patients with Diabetic Macular Edema.

We identified and compared secreted microRNA (miRNA) expression in aqueous humor (AH) and plasma samples among patients with: type 2 diabetes mellitus (T2D) complicated by non-proliferative diabetic retinopathy (DR) associated with diabetic macular edema (DME) (DME group: 12 patients); T2D patients without DR (D group: 8 patients); and non-diabetic patients (CTR group: 10 patients). Individual patient AH samples from five subjects in each group were profiled on TaqMan Low Density MicroRNA Array Cards. Differentially expressed miRNAs identified from profiling were then validated in single assay for all subjects. The miRNAs validated in AH were then evaluated in single assay in plasma. Gene Ontology (GO) analysis was conducted. From AH profiling, 119 mature miRNAs were detected: 86 in the DME group, 113 in the D group and 107 in the CTR group. miRNA underexpression in the DME group was confirmed in single assay for let-7c-5p, miR-200b-3p, miR-199a-3p and miR-365-3p. Of these four, miR-199a-3p and miR-365-3p were downregulated also in the plasma of the DME group. GO highlighted 54 validated target genes of miR-199a-3p, miR-200b-3p and miR-365-3p potentially implied in DME pathogenesis. Although more studies are needed, miR-200b-3p, let-7c-5p, miR-365-3p and miR-199a-3p represent interesting molecules in the study of DME pathogenesis

Central Retinal Vein Occlusion and Prothrombotic Factors

Retinal vein occlusion (RVO) is an important cause of visual loss. Known risk factors are hypertension, diabetes mellitus, hyperlipidaemia, open angle glaucoma and abnormalities of haemostatic factors and blood viscosity. The aim of our study was to identify any relationships between RVO and fibrinolytic-coagulative pattern in patients affected either by metabolic disorders or not Methods: 50 patients (22 male, 28 female) affected by RVO underwent a study of metabolic, coagulative and fibrinolytic parameters. All patients were not submitted to any previous ocular theraphy before the episode of RVO. After a complete ophtalmologic evaluation, blood was collected to perform various laboratory tests: Enzymatic-colorimetric: glicaemia, total-cholesterol (TC), HDL-cholesterol (HDL-C), Tryglicerides (TG), Antitrombin III (ATIII), Protein C and S (PC, PS), Alpha-2-antiplasmin (A2P), Plasminogen (PL). ELISA: D-dimer (DD), tissue plasminogen activator and inhibitor (t-PA, PAI-1), thrombin activable fibrinolysis inhibitor (TAFI), Soluble P and E selectin (sP-sel, sE-sel), vonWillebrand factor (vWF), fragment 1+2 (F1+2), lipoprotein (a) [lp(a)]. Coagulative: Protein C resistance (APCR), Factor VII and VIII (VII, VIII). HPLC: Homocysteine. Our data show a decreased fibrinolytic power in 43/50 subjects (86%) (ELT 318±36 min, PAP 107±19 ug/l). PAI-1 was 21.4±4.2 UI/l in the general population with differences between diabetic and dyslipidaemic subjects and not-metabolic patients. 1 patients suffered from low ATIII levels (60%), none had PC, PS deficiency or APCR. 2 not-metabolic subjects had increased Lp (a) and impairment of fibrinolysis. Hyper Hc (21.6±3.1umol/l) was detected in 4 subjects TAFI and sP-sel were increased in patients (4) with type IIa hyperlipidemia. sE-sel and vWF were particularly increased in dysmetabolic subjects (diabetes and Hyper TG or low HDL-C). A prothrombotic state involving defects in coagulative and fibrinolytic factors has been previously associated with the onset of RVO. Our data show that a fibrinolytic impairment is the most common feature in such patients regardless dysmetabolic or not associated diseases. Moreover mechanisms leading to fybrinolysis alterations vary between subjects in order to associated metabolic conditions. Defects in anticoagulant natural proteins or platelet hyperactivity are very rare conditions detected in our population. Such data suggest that the fibrinolytic system may be an important target of acute treatment and profilaxys in RVO affected patients

Peptidergic innervation of mesenteric lymphatics in guinea pigs: an immunocytochemical and pharmacological study.

By immunocytochemistry, substance P immunoreactive (SP-IR) and vasoactive intestinal peptide immunoreactive (VIP-IR) nerve fibers were examined in guinea pig mesenteric lymph collectors. The immunoreactive nerve fibers, located in the adventitia of lymphatics, were few and were irregularly distributed along the vessel wall. These fibers appeared to be more numerous and more evenly distributed along the corresponding artery and vein walls within the same area. SP immunoreactivity in the vascular nerves was depleted in guinea pigs injected with capsaicin but was unaffected by the injection of 6-hydroxydopamine. By contrast, VIP-IR nerve fibers were unaffected by both treatments. It is concluded that SP-IR nerve fibers in the lymphatics are likely to be of sensory origin and that VIP containing nerves in the lymph collectors are distinct from SP-containing and noradrenergic nerves. It is also suggested that lymph collectors possess a complex although limited innervation pattern not only of autonomic nerve fibers containing classic neurotransmitters but also of peptidergic nerve fibers of a different origin with a vasomotor and/or sensory action

Role of computer-assisted analysis of the corneal endothelium in vitreoretinal surgery with intraocular silicone oil injection: a technical report.

The innermost lining of the cornea consists of a single layer of cells called the endothelium. Despite its name, the endothelium of the cornea differs considerably from the vascular endothelium, both functionally and morphologically. The corneal endothelium plays a fundamental role in maintaining the transparency of the corneal membrane, as the result of both its function as a barrier against penetration of the aqueous humor in the parenchyma and its ability to remove water from the stroma (usually referred to as the endothelial "pump" function). Any abnormality in the corneal endothelium causes, first, the impairment of its function as a barrier and pump due to the loss of stromal anti-turgor mechanisms, followed by edema and possible development into keratopathy. The specular microscope is an instrument which makes it possible to see the endothelial "mosaic" in the reflected image of the posterior corneal surface. A large variety of clinical specular microscopes is presently available, both contact and non-contact, which allow, for easy and rapid photography of the corneal endothelium "in vivo". In the present case, we used a non-contact computerized specular microscope to analyze the corneal endothelium in a group of patients affected by retinal detachment who needed to undergo vitreoretinal surgery with immission of silicone oil into the vitreal chambe

Congenital Optic Pit and Argon Laser Photocoagulation

Congenital Optic Pit of the papilla (CPP) is a monolateral little hole located in the inferior temporal portion of the optic nerve CPP is characterized by a spherical shape involving 1/3 of the optic nerve surface and has a deep face with pigmented base The most important complication is retinal detachment, in particular macular detachment. The origin of subretinal fluid is unknown. We observed 2 cases, both females, 18 and 25 years old, one complicated by macular detachment. We treated macular detachment with argon laser photocoagulation applying spots around the detached retina and achieved improvement of visual acuity. Most important diagnostic feature in CPP seems to be retinal angiography, demonstrating hyperfluorescence of CPP and macular detachment

MEDICAL TREATMENT OF CRVO

Purpose: A disorder of fibrinolytic power is a risk factor for both venous and arterial thrombosis. An hypofibrinolytic state has been described as a common feature in Central Retinal Vein Occlusion (CRVO) affected subjects. Aim of our study was to evaluate the efficacy of a thrombotic-risk assessement related therapy either in acute phase treatment or secondary prophylaxis in CRVO affected patients. Methods: Phase A: 60 subjects (28 female, 22 male) were respectively treated with ASA 325 mg/die (19), heparin 12500 to 25000 U/die (16) , and mesoglycan 100 mg/die (25) for one month. Phase B: 35 subjects were treated with ASA 325 mg/die for 6 months and 29 patients with mesoglycan 100 mg/die. The development of new thrombotic events was assessed by fundoscopy at one and six months. Results: In phase A 5/19 (26%) subjects in the ASA, 6/16 (37%) in the heparin and 2/25 (8%) (p< 0.001) in the mesoglycan group experienced a new thrombotic event. In phase B 13/35 (37%) in the ASA and 3/29 (10%) (p< 0.001) in the mesoglycan group showed new thrombotic signs. Conclusions: Our data suggest that a profibrinolytic treatment in thrombotic risk-profile selected subjects is safe and effective for the therapy and prophylaxis of CRVO when compared to other antithrombotic agents