A randomised controlled trial investigating the effect of nutritional supplementation on visual function in normal, and age-related macular disease affected eyes: design and methodology [ISRCTN78467674]

BACKGROUND: Age-related macular disease is the leading cause of blind registration in the developed world. One aetiological hypothesis involves oxidation, and the intrinsic vulnerability of the retina to damage via this process. This has prompted interest in the role of antioxidants, particularly the carotenoids lutein and zeaxanthin, in the prevention and treatment of this eye disease. METHODS: The aim of this randomised controlled trial is to determine the effect of a nutritional supplement containing lutein, vitamins A, C and E, zinc, and copper on measures of visual function in people with and without age-related macular disease. Outcome measures are distance and near visual acuity, contrast sensitivity, colour vision, macular visual field, glare recovery, and fundus photography. Randomisation is achieved via a random number generator, and masking achieved by third party coding of the active and placebo containers. Data collection will take place at nine and 18 months, and statistical analysis will employ Student's t test. DISCUSSION: A paucity of treatment modalities for age-related macular disease has prompted research into the development of prevention strategies. A positive effect on normals may be indicative of a role of nutritional supplementation in preventing or delaying onset of the condition. An observed benefit in the age-related macular disease group may indicate a potential role of supplementation in prevention of progression, or even a degree reversal of the visual effects caused by this condition

Apoptotic photoreceptor cell death after traumatic retinal detachment in humans

Objective: To determine the mechanism of photoreceptor cell death after traumatic retinal detachment in humans. Design: Clinical records from 1975 to 1993 of 75 patients, whose eyes were enucleated after traumatic retinal detachment, were reviewed for age, sex, previous ocular or systemic medical history, interval from initial trauma to enucleation, visual acuity, and types of trauma. The patients were divided into five groups of 15 cases each, based on the interval from initial trauma to enucleation. The retinal tissue was examined for two markers of apoptosis: (1) nicked nuclear DNA in situ by the terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end labeling (TUNEL) technique and (2) apoptotic bodies by light and electron microscopy. Result: Of the 75 cases of ruptured globe and traumatic retinal detachment that were evaluated, 19 eyes (25.3%) showed TUNEL-positive labeling of photoreceptor cells. Nicked nuclear DNA was detected in photoreceptor cells of detached retinas as early as 8 hours after trauma. The detached retinas in seven of 15 eyes enucleated within 2 days after ocular trauma showed TUNEL-positive photoreceptor nuclei. The number of cases showing TUNEL-positive photoreceptor nuclei decreased as the interval between initial trauma and enucleation increased. The TUNEL-positive photoreceptor cells could still be seen in the detached retinas of two eyes enucleated 22 days after trauma. Light microscopy disclosed condensation and fragmentation of photoreceptor nuclei in the detached retinas. Electron microscopy showed structures resembling apoptotic bodies phagocytosed by neighboring cells in the TUNEL-positive retinas. Conclusions: Apoptosis is an important mechanism of photoreceptor cell degeneration in the early stage after traumatic retinal detachment in humans.link_to_subscribed_fulltex

Magnetic resonance imaging findings in a case of advanced Coats' disease

Coats' disease is an idiopathic, primary vascular anomaly of the retina often presenting with retinal detachment. In this report, the unusual radiologic findings of a 17-month-old patient with advanced Coats' disease are discussed. Computed tomography (CT) showed diffuse increased density of the right eye. Magnetic resonance imaging (MRI) demonstrated moderately hyperintense signal intensity on T1-weighted images, mildly hypointense signal intensity on T2-weighted images, and linear enhancement of the leaves of the detached retina with intense enhancement in the retinal periphery following gadolinium-diethylenetriamine penta-acetic acid (DTPA) contrast administration. The hypointense T2-weighted images and the linear enhancement of the detached retina have not been reported previously in cases of Coats' disease. These observations correlated with the histopathologic features, which showed a totally detached retina containing large telangiectatic vessels and a subretinal space occupied by eosinophilic proteinaceous exudates containing abundant cholesterol crystals. It appears that the MRI characteristics observed in Coats' disease may vary depending on the nature of the subretinal exudate and the severity of the disease.link_to_subscribed_fulltex

Hypertensive retinopathy

10.1056/NEJMra032865New England Journal of Medicine351222310-2317NEJM