Bilateral Simultaneous Anterior Ischemic Optic Neuropathy Associated with Sildenafil

We report a case of simultaneous bilateral nonarteritic anterior ischemic optic neuropathy (NAION) due to sildenafil use. A 55-year-old man with an unremarkable medical history presented simultaneous bilateral NAION 8 months after continuous use of sildenafil 4-5 times a month. At presentation, visual acuity (VA) was 0.7 in the right eye (RE) and 0.9 in the left eye (LE). The visual field showed an inferior altitudinal defect in both eyes and a fundus examination revealed prominent optic disc edema in the RE and a crowded optic disc in the LE. The patient was counseled to discontinue sildenafil, and 3 weeks later VA was 1.0 in both eyes and the optic disc edema in the RE was resolved. However, a visual field defect remained in the RE. Three months later, visual fields were unchanged. To the best of our knowledge, this is the first reported case of simultaneous bilateral NAION due to sildenafil use

Central Serous Chorioretinopathy after Rhinoplasty

We report a case of central serous chorioretinopathy after rhinoplasty for deviation of the nasal septum in a 23-year-old Caucasian man. The patient complained of deterioration of vision in the right eye 4 days after rhinoplasty. At presentation, visual acuity of the right eye was 6/9 with metamorphopsia. Fluorescein angiography revealed a focal retinal pigment epithelium leakage and optical coherence tomography an increase in macular thickness to 245 μm. The left eye was normal. One month after the operation, without any treatment, visual acuity returned to 6/6, the leakage of the retinal pigment epithelium disappeared and the macular thickness returned to 183 μm. To the best of our knowledge, central serous chorioretinopathy after rhinoplasty has not been previously reported. This case report shows a possible association between the postoperative stress and central serous chorioretinopathy. Moreover, it widens the spectrum of drugs associated with the occurrence of the disease

A clinical study of annular cyclitis

PURPOSE: To investigate six cases of annular cyclitis. METHODS: All patients with impairment of visual acuity underwent complete ophthalmologic examination, color fundus photography, laboratory tests and fluorescein angiography. Indocyanine green (ICG) angiography and B-scan ultrasonography were also performed in three cases in order to diagnose the disease. RESULTS: All patients presented a unilateral or bilateral granulomatous uveitis, associated with inflammatory annular cyclitis. They had a shallow anterior chamber, a mildly elevated intraocular pressure (under 25 mm Hg) and an annular serous retinal detachment. A resolution was observed after specific therapy associated with systemic prednisolone therapy and antiglaucomatous drops. CONCLUSION: This is the first description of an observational study of six patients with inflammatory annular cyclitis

Structural alterations of the erythrocyte membrane proteins in diabetic retinopathy

Background: Several rheological disorders of the erythrocytes, such as increased aggregation and decreased deformability, have been observed in diabetes mellitus and have been implicated in the development of diabetic microangiopathy. Structural alterations of the erythrocyte membrane proteins caused by the diabetic process may be at the origin of those observations. In the present study, we searched for erythrocyte membrane protein alterations in diabetic retinopathy. Methods: We examined peripheral blood samples from 40 type-2 diabetic patients with diabetic retinopathy of variable severity (19 males and 21 females, mean age 66.8years, Group A) and we compared them with samples from 19 type-2 diabetic patients without diabetic retinopathy (13 males and six females, mean age 66.5years, Group B) and 16 healthy volunteers (eight males and eight females, mean age 65.6years, Group C). Erythrocyte membrane ghosts from all samples were subjected to SDS-PAGE, and the electrophoretic pattern of transmembrane and cytoskeletal proteins was analysed for each sample. The protein quantification of each electrophoretic band was accomplished through scanning densitometry. Results: No significant deviations from normal electrophoresis were observed in Groups B and C, apart from an increase in band 8 in two samples from Group B (11%). In contrast, in 14 samples from Group A (35%) we detected increases in protein band 8 and/or membrane-bound haemoglobin along with a decrease in spectrin. Moreover, increased mobility of band 3, an aberrant high molecular weight (MW) (>255kDa) band and a low MW (42kDa) band were evident in ten samples from Group A (25%). Glycophorins were altered in 46% of Group-A patients versus 38% of Group-B patients. Females and patients with long duration of diabetes presented more electrophoretic abnormalities. Conclusions: Structural alterations of the erythrocyte membrane proteins are shown for the first time in association with diabetic retinopathy. Their detection may serve as a blood marker for the development of diabetic microangiopathy. Further studies are needed to assess whether pharmaceutical intervention to the rheology of erythrocytes can prevent or alleviate microvascular diabetic complication

Unique Spatial Immune Profiling in Pancreatic Ductal Adenocarcinoma with Enrichment of Exhausted and Senescent T Cells and Diffused CD47-SIRP proportional to Expression

Background: Pancreatic ductal adenocarcinoma (PDAC) is resistant to single-agent immunotherapies. To understand the mechanisms leading to the poor response to this treatment, a better understanding of the PDAC immune landscape is required. The present work aims to study the immune profile in PDAC in relationship to spatial heterogeneity of the tissue microenvironment (TME) in intact tissues. Methods: Serial section and multiplex in situ analysis were performed in 42 PDAC samples to assess gene and protein expression at single-cell resolution in the: (a) tumor center (TC), (b) invasive front (IF), (c) normal parenchyma adjacent to the tumor, and (d) tumor positive and negative draining lymph nodes (LNs). Results: We observed: (a) enrichment of T cell subpopulations with exhausted and senescent phenotype in the TC, IF and tumor positive LNs; (b) a dominant type 2 immune response in the TME, which is more pronounced in the TC; (c) an emerging role of CD47-SIRP a axis; and (d) a similar immune cell topography independently of the neoadjuvant chemotherapy. Conclusion: This study reveals the existence of dysfunctional T lymphocytes with specific spatial distribution, thus opening a new dimension both conceptually and mechanistically in tumor-stroma interaction in PDAC with potential impact on the efficacy of immune-regulatory therapeutic modalities