Adénocarcinome de la glande lacrymale dans un rétinoblastome bilatéral traité avec radiothérapie externe : à propos d’un cas

This clinical case report describes the clinical findings and diagnosis of lacrimal gland adenocarcinoma that developed 20 years after external beam radiotherapy in the treatment of bilateral retinoblastoma. Visual acuity, slit lamp biomicroscopy, fundus color photography, nuclear magnetic resonance, lateral orbitotomy and histological analysis are described

OCT is not useful for detection of minimal diabetic retinopathy in type 1 diabetes.

Optical coherence tomography (OCT) has been proven useful in measuring retinal thickness (RT) in patients with diabetes, although with discordant results in different studies. We examined RT in patients with type 1 diabetes (T1D) with or without minimal diabetic retinopathy (MDR) to test whether OCT is able to identify early retinal changes and potential correlations with metabolic parameters. RT of 102 patients with T1D (53 females, 49 males, aged 27.03 +/- 7.4 years) and of 42 healthy controls was examined, with analysis of nine different sectors (fovea, four pericentral and four peripheral sectors). According to the results of basal fundus photography, patients were divided into two groups, without MDR (48 cases) and with MDR (54 cases). Patients with proliferative DR or macular edema were excluded. No difference was found between patients with or without MDR and the control group for all OCT parameters investigated. Mean HbA1c of the last 5 years (P < 0.001), microalbuminuria (P = 0.002), total (P = 0.046) and LDL cholesterol (P = 0.007) and triglyceride (P < 0.001) levels were higher in patients with MDR, along with higher prevalence of hypertension (P = 0.013), younger age at diagnosis (P = 0.018) and longer diabetes duration (P < 0.001) with regard to the patients without MDR and controls, although no significant correlation between these parameters and RT was found. Our study suggests that MDR without macular edema in patients with T1D cannot be detected with OCT. Therefore, the conventional diagnostic methods are mandatory to detect early DR

Uso della monoterapia con Bimatoprost nella clinica quotidiana

Gli Autori riportano i risultati di uno studio multicentrico,prospettico, osservazionale condotto nel 2010 sull'uso nella pratica clinica della monoterapia con l'analogo prostanidico ,Bimatoprost 0.3 mg/ml, in pazienti con glaucoma cronico ad angolo aperto mai trattati in precedenza se non con farmaci betabloccanti

In vitro generation of pancreatic endocrine cells from human adult fibroblast-like limbal stem cells

Stem cells might provide unlimited supply of transplantable cells for β-cell replacement therapy in diabetes. The human limbus is a highly specialized region hosting a well-recognized population of epithelial stem cells, which sustain the continuous renewal of the cornea, and the recently identified stromal fibroblast-like stem cells (f-LSCs), with apparent broader plasticity. However, the lack of specific molecular markers for the identification of the multipotent limbal subpopulation has so far limited the investigation of their differentiation potential. In this study we show that the human limbus contains uncommitted cells that could be potentially harnessed for the treatment of diabetes. Fourteen limbal biopsies were obtained from patients undergoing surgery for ocular diseases not involving the conjunctiva or corneal surface. We identified a subpopulation of f-LSCs characterized by robust proliferative capacity, expressing several pluripotent stem cell markers and exhibiting self-renewal ability. We then demonstrated the potential of f-LSCs to differentiate in vitro into functional insulin-secreting cells by developing a four-step differentiation protocol that efficiently directed f-LSCs towards the pancreatic endocrine cell fate. The expression of specific endodermal, pancreatic, islet, and β-cell markers, as well as functional properties of f-LSC-derived insulin-producing cells, were evaluated during differentiation. With our stage-specific approach, up to 77% of f-LSCs eventually differentiated into cells expressing insulin (also assessed as C-peptide) and exhibited phenotypic features of mature β-cells, such as expression of critical transcription factors and presence of secretory granules. Although insulin content was about 160-fold lower than what observed in adult islets, differentiated cells processed ∼98% of their proinsulin content, similar to mature β-cells. Moreover, they responded in vitro in a regulated manner to multiple secretory stimuli, including glucose. In conclusion, f-LSCs represent a possible relevant source of autologous, transplantable, insulin-producing cells that could be tested for the reversal of diabetes

Large diurnal variation of intraocular pressure in open angle glaucoma in subjects with type A behaviour pattern

Aim : To evaluate the possible causes of the greater perimetric damage found in OAG subjects with type A behaviour and the possible role of psycho-physiological stress. Materials and methods : 80 patients with OAG, 44 women and 36 men, 40 with type A behaviour and 40 with type B studied with the Type A/B Personality Questionnaire (A modified version of the Jenkins Activity Survey), underwent a complete ophthalmologic examination consisting of bio-microscopy, tonometry and daily tonometric curve, examination of the visual field by means of Octopus 1-2-3 computerised perimeter and its assessment with the Glaucoma Staging System 2 (GSS2), morphological monitoring of the Retinal Nerve Fibre Layer (RNFL) with GDxVCC and monitoring of arterial tension (times 8.30 am–10.30 am–12.30 pm–3 pm–5 pm and 7 pm) with a UA-1010 automatic Digital Blood Pressure Monitor device. Results : In subjects with type A behaviour fluctuation in IOP values is observed in the daytime hours in concomitance with similar oscillations in arterial pressure values. In the subjects with type B behaviour both IOP and the arterial pressure values remain more or less constant with oscillations that are not statistically significant. In GSS2 more significant impairment of the visual field is observed in subjects with type A behaviour. In the same subjects, GDxVCC examination shows statistically significant impairment of the values. The NFI index is positively correlated with the perimetric damage (r=0.74). Conclusions : Personality study is an extremely important part of the diagnostic work-up and treatment of OAG. The frequent oscillations in IOP observed in subjects with type A behaviour could constitute a risk factor in the evolution of perimetric damage

Valutazione tonometrica in due posizioni di sguardo nell'orbitopatia di Graves

Aim.To asses effective role of thickness of superior rectus muscle in the variation of intraocular pression (IOP) in the patients with Graves' ophthalmopathy.Methods.IOP was measured in 76 eyes of 38 patients(mean age,42.4 years;range 19 to 58 years)with Graves' ophthalmopathy in primary and in upgaze position(Elevation with divergence of 23°).Results.IOP in 52 of the 76 eyes was 17.5 +/-2.12 mm Hgin primary position and 21.2 +/-2.75 mm Hg in upgaze position.In the eyes (28)with thickness of the superior rectus muscle >4.6 mm,IOP was 22.7+/-1.48 mm Hg in primary position and 27.1 +/-1.92 mm Hg in upgaze position.The difference in the values in this group is statistically significant ( the paired t test,p=0.05).Conclusions. These findings suggest that ocular ipertension in upgaze position in patients with Graves'ophthalmopathy is caused, in part, by increased thickness of superior rectus muscle

Involvement of the visual evoked potentials in type 2 diabetes

Objective :To assess the function of the optic pathway in type 2 diabetics without retinopathy (40 subjects) or with mild Non Proliferative Diabetic Retinopathy (40 subjects). Methods: VEPs , elicited by means of pattern-reversal stimulation, were studied in a group of 80 non-insulin-dependent diabetics . Results: In subjects suffering from diabetes for less than 10 years, with mild retinopathy or without retinopathy, the amplitude N75-P100 decreased, and this is statistically significant with stimulation at 15’. As the time from disease onset increases, VEP latency (P100) shows a greater increase with the use of small checks (15’), than with large checks (30’) and this becomes statistically significant after 20 years (p =0.01) . There is a positive correlation between VEP-latency and the duration of the diabetes. No correlation was found with other parameters taken into consideration, such as patient age, plasma-glucose level at 8 a.m., mean daily plasma glucose and glycosylated-haemoglobin. Conclusion: The amplitude N75-P100 decreased in subjects suffering from diabetes type 2 for less 10 years. VEP latency increases (in type 2 diabetics) 10 years after disease onset. Functional deficiency of the central retinal layers seems to precede retinopathy. This finding might prove to be a useful index for the evaluation of visual neuropathy

Retinal nerve fibre layer thickness measurements in myopia by optical coherence tomography

Aim: Our study aimed to evaluate through OCT, in a homogeneous group of subjects with various degrees of myopia, the macular thickness and that of the RNFL with the purpose of highlighting the possible presence of a correlation between their impairment and the degree of myopia. Material and Methods : 83 students of the Faculty of Medicine were considered, distinguished into 4 groups, 3 of them according to the degree of myopia and the last group (control group) was made of emmetropic subjects. Each subject was submitted to a determination of visual acuity and refractive defect and evaluation of the thickness of the macular fibres and of the retinal nerve fibre layer (RNFL) through OCT (Stratus Oct 3000 - Carl Zeiss Meditec inc) Results: With a growth in axial length there was a reduction in the average macular thickness in all quadrants of the parafovea with the exception of the superior one. By contrast, in the foveola and fovea there was an increase in thickness with a rise in the refractive defect. The lowest thickness was found in the emmetropic subject Conclusion : Our data found therefore allow us to conclude, in agreement with others, that the progressive increase in axial length in myopic subjects involves reshaping of the arrangement of the nerve fibres which needs to be taken into account, especially in subjects with glaucoma that are also very myopi

Anatomia e fisiologia delle palpebre

E' stato eseguito un breve escursus aggiornato dell'anatomia e della fisiologia delle palpebr