Selective Serotonin Reuptake Inhibitors: A Review of its Effects on Intraocular Pressure

The increase in serotonin (5-HT) neurotransmission is considered to be one of the most efficacious medical approach to depression and its related disorders. The selective serotonin reuptake inhibitors (SSRIs) represent the most widely antidepressive drugs utilized in the medical treatment of depressed patients. Currently available SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram and escitalopram. The primary SSRIs pharmacological action’s mechanism consists in the presynaptic inhibition on the serotonin reuptake, with an increased availability of this amine into the synaptic cleft. Serotonin produces its effects as a consequence of interactions with appropriate receptors. Seven distinct families of 5-HT receptors have been identified (5-HT1 to 5-HT7), and subpopulations have been described for several of these. The interaction between serotonin and post-synaptic receptors mediates a wide range of functions. The SSRIs have a very favorable safety profile, although clinical signs of several unexpected pathologic events are often misdiagnosed, in particular, those regarding the eye. In all cases reported in the literature the angle-closure glaucoma represents the most important SSRIs-related ocular adverse event. Thus, it is not quite hazardous to hypothesize that also the other reported and unspecified visual disturbances could be attributed - at least in some cases - to IOP modifications. The knowledge of SSRIs individual tolerability, angle-closure predisposition and critical IOP could be important goals able to avoid further and more dangerous ocular side effects

Analisi della dinamica interna di nubi molecolari translucent ad alta latitudine Galattica

Il mezzo interstellare (ISM) nella nostra Galassia non è distribuito uniformemente, ma presenta delle fluttuazioni di densità, sotto forma di grandi nubi e filamenti che risaltano rispetto al mezzo diffuso circostante. Questi complessi si formano sotto l'azione di vari processi, come ad esempio collasso gravitazionale e instabilità termiche, ed è al loro interno che avviene la formazione di nuove stelle. Lo studio delle proprietà delle nubi interstellari è quindi di fondamentale importanza per comprendere le condizioni in cui avviene la formazione stellare. In particolare, la distribuzione di velocità interna alle nubi è determinante per l'instaurarsi di processi di frammentazione gravitazionale, presupposto necessario per la formazione di nuove strutture. La dinamica del gas interstellare può essere indagata tramite osservazioni spettroscopiche dell'emissione di specie molecolari come 12CO e CS, che sono forti emettitori radio. La velocità lungo una linea di vista viene ricavata tramite lo spostamento doppler della riga di emissione. Obiettivi ideali per questo tipo di analisi sono le High Latitude Molecular Clouds, nubi molecolari poste ad alte latitudini galattiche. Le HLMC presentano due caratteristiche fondamentali che le distinguono dalle nubi molecolari presenti sul piano galattico. Innanzitutto non hanno al loro interno formazione di stelle, che perturba il campo di velocità con venti e shocks e rende molto difficile l'interpretazione dei dati raccolti. Inoltre, essendo lontane dal piano galattico, possiamo ragionevolmente supporre che lungo una linea di vista e in un dato intervallo di velocità non si affollino troppe strutture diverse. Questo è essenziale per interpretare correttamente il profilo di emissione osservato. A partire dai primi anni ottanta, si sono susseguite molte osservazioni di HLMC, che hanno rivelato interessanti proprietà del campo di velocità interno alle nubi. La caratteristica principale di queste osservazioni è che tutte mostrano profili di riga sovratermici, cioè la dispersione di velocità lungo la linea di vista è maggiore di quella che ci aspetteremmo se questa fosse dovuta solamente all'agitazione termica del gas. Questa dispersione non termica fornisce alle strutture un supporto contro il collasso gravitazionale. Gran parte delle HLMC non è infatti gravitazionalmente legata. Nonostante le nubi molecolari perdano costantemente energia sotto forma di radiazione infrarossa e millimetrica, queste sembrano strutture abbastanza stabili, con tempi di vita caratteristici di almeno 10^7 anni. Deve quindi esistere un meccanismo che reintegri l'energia radiata. Una possibile spiegazione sia dei moti supersonici osservati, sia dell'energetica delle nubi molecolari, potrebbe essere la presenza di un campo di velocità turbolento. In questo scenario l'energia verrebbe immessa a grande scala dai gradienti di velocità dovuti alla rotazione differenziale della galassia e si propagherebbe poi a scale più piccole tramite una cascata turbolenta, per essere infine dissipata sotto forma di calore o tramite processi radiativi. A sostegno dell'ipotesi turbolenta si sono accumulate negli ultimi 10 anni molte osservazioni che rivelano come le nubi molecolari abbiano caratteristiche simili ai fluidi turbolenti osservati in laboratorio, come la formazione di strutture coerenti (vortici, filamenti) e la presenza di distribuzioni di velocità non Gaussiane. In un certo numero di complessi molecolari sono state riscontrate inoltre relazioni tipo legge di potenza tra larghezza di riga e dimensioni della regione osservata, che mimerebbero le leggi di scala tipiche delle teorie classiche della turbolenza. ll mio lavoro si inserisce in questo contesto e consiste nell'analisi di nuove osservazioni di emissione molecolare, ad alta risoluzione spaziale e spettrale, in nubi ad alta latitudine galattica. Le osservazioni, effettuate nell'inverno 2006 con il telescopio di 20m di diametro dell'Onsala Space Observatory in Svezia, consistono sia di spettri singoli che di mappe delle prime transizioni rotazionali di CS,12CO e HCO+, all'interno delle sorgenti ad alta latitudine MBM40, L1512 e Polaris Flare

Combined photodynamic therapy and intravitreal bevacizumab for idiopathic polypoidal choroidal vasculopathy: one-year follow-up

Abstract OBJECTIVE: To report the efficacy and safety of combined photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection in the treatment of idiopathic polypoidal choroidal vasculopathy (IPCV). MATERIAL AND METHODS: A prospective case series of 10 eyes of 10 consecutive patients affected by IPCV with subfoveal involvement. PDT plus IVB (1.25 mg/0.05 mL) injection two weeks later was performed in all patients. Two adjunctive injections of bevacizumab were scheduled at four and eight weeks after the initial treatment. Best-corrected visual acuity (BCVA), fluorescein and indocyanine green angiographies, and optical coherence tomography were obtained at baseline, and at one, three, six, nine, and 12 months. RESULTS: The combined treatment led to an improvement of both neurosensory detachment and pigmented epithelial detachment in all eyes, with a decrease of exudation and regression of macular thickness, which remained stable to the end of follow-up. However, BCVA remained stable over the 12 months of follow-up. CONCLUSION: These findings demonstrate that PDT/IVB combined therapy is able to achieve morphologic stabilization of the IPCV lesion, through a rapid decrease of macular thickness and regression of the size of polypoidal vascular lesion

Good Epidemiologic Practice in Retinitis Pigmentosa: From Phenotyping to Biobanking

Inherited retinal dystrophies, such as retinitis pigmentosa (RP), include a group of relatively rare hereditary diseases caused by mutations in genes that code for proteins involved in the maintenance and function of the photoreceptor cells (cones and rods). The different forms of RP consist of progressive neurodegenerative disorders which are generally related to various and severe limitations of visual performances. In the course of typical RP (rod-cone dystrophy), the affected individuals first experience night-blindness and/or visual field constriction (secondary to rod dysfunctions), followed by variable alterations of the central vision (due to cone damages). On the other hand, during the atypical form of RP (cone-rod dystrophy), the cone’s functionalities are prevalently disrupted in comparison with the rod’s ones. The basic diagnosis of RP relies upon the documentation of unremitting loss in photoreceptor activity by electroretinogram and/or visual field testing. The prevalence of all RP typologies is variably reported in about one case for each 3000-5000 individuals, with a total of about two millions of affected persons worldwide. The inherited retinal dystrophies are sometimes the epiphenomenon of a complex framework (syndromic RP), but more often they represent an isolated disorder (about 85-90 % of cases). Although 200 causative RP mutations have been hitherto detected in more than 100 different genes, the molecular defect is identifiable in just about the 50% of the analyzed patients with RP. Not only the RP genotypes are very heterogeneous, but also the patients with the same mutation can be affected by different phenotypic manifestations. RP can be inherited as autosomal dominant, autosomal recessive or X-linked trait, and many sporadic forms are diagnosed in patients with no affected relatives. Dissecting the clinico-genetic complexity of RP has become an attainable objective by means of large-scale research projects, in which the collaboration between ophthalmologists, geneticists, and epidemiologists becomes a crucial aspect. In the present review, the main issues regarding clinical phenotyping and epidemiologic criticisms of RP are focused, especially highlighting the importance of both standardization of the diagnostic protocols and appropriateness of the disease’s registration systems

Inflammatory Mediators and Angiogenic Factors in Choroidal Neovascularization: Pathogenetic Interactions and Therapeutic Implications

Choroidal neovascularization (CNV) is a common and severe complication in heterogeneous diseases affecting the posterior segment of the eye, the most frequent being represented by age-related macular degeneration. Although the term may suggest just a vascular pathological condition, CNV is more properly definable as an aberrant tissue invasion of endothelial and inflammatory cells, in which both angiogenesis and inflammation are involved. Experimental and clinical evidences show that vascular endothelial growth factor is a key signal in promoting angiogenesis. However, many other molecules, distinctive of the inflammatory response, act as neovascular activators in CNV. These include fibroblast growth factor, transforming growth factor, tumor necrosis factor, interleukins, and complement. This paper reviews the role of inflammatory mediators and angiogenic factors in the development of CNV, proposing pathogenetic assumptions of mutual interaction. As an extension of this concept, new therapeutic approaches geared to have an effect on both the vascular and the extravascular components of CNV are discussed

Clinical and Rehabilitative Management of Retinitis Pigmentosa: Up-to-Date

The term retinitis pigmentosa (RP) indicates a heterogeneous group of genetic rare ocular diseases in which either rods or cones are prevalently damaged. RP represents the most common hereditary cause of blindness in people from 20 to 60 years old. In general, the different RP forms consist of progressive photo-receptorial neuro-degenerations, which are characterized by variable visual disabilities and considerable socio-sanitary burden. Sometimes, RP patients do not become visually impaired or legally blind until their 40-50 years of age and/or maintain a quite acceptable sight for all their life. Other individuals with RP become completely blind very early or in middle childhood. Although there is no treatment that can effectively cure RP, in some case-series the disease’s progression seems to be reducible by specific preventive approaches. In the most part of RP patients, the quality of vision can be considerably increased by means of nanometer-controlled filters. In the present review, the main aspects of the routine clinical and rehabilitative managements for RP patients are described, particularly focusing on the importance of specific referral Centers to practice a real multidisciplinary governance of these dramatic diseases

Clinical and Rehabilitative Management of Retinitis Pigmentosa: Up-to-Date

The term retinitis pigmentosa (RP) indicates a heterogeneous group of genetic rare ocular diseases in which either rods or cones are prevalently damaged. RP represents the most common hereditary cause of blindness in people from 20 to 60 years old. In general, the different RP forms consist of progressive photo-receptorial neuro-degenerations, which are characterized by variable visual disabilities and considerable socio-sanitary burden. Sometimes, RP patients do not become visually impaired or legally blind until their 40-50 years of age and/or maintain a quite acceptable sight for all their life. Other individuals with RP become completely blind very early or in middle childhood. Although there is no treatment that can effectively cure RP, in some case-series the disease’s progression seems to be reducible by specific preventive approaches. In the most part of RP patients, the quality of vision can be considerably increased by means of nanometer-controlled filters. In the present review, the main aspects of the routine clinical and rehabilitative managements for RP patients are described, particularly focusing on the importance of specific referral Centers to practice a real multidisciplinary governance of these dramatic diseases

Tamponade or filling effect: changes of forces in myopic eyes

Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye

Intraocular pressure changes following the use of silicone oil or Densiron® 68 as endotamponade in pars plana vitrectomy

OBJECTIVE: To compare the effects of standard silicone oil 5700 (SSO) and heavy silicone oil (HSO) such as Densiron(®) 68 on intraocular pressure (IOP). MATERIALS AND METHODS: Retrospective case series including 180 eyes (105 treated with SSO and 75 with HSO). IOP was measured before surgery, 1 day after, and then at 1-, 3-, 6-, and 12-month follow-ups. RESULTS: In the SSO group, a significant increase in IOP occurred in 14% of the eyes (15/105) at 1 day postoperatively, and persisted in 11.4% (12/105) at 1-month follow-up. In the HSO group, a persistent elevated IOP was recorded in 20% of the eyes (15/75) at 1 day postoperatively, and in 16% (12/75) at 1-month follow-up. At 12-month follow-up, mean IOP was 16.7 ± 8.7 mmHg and 19.7 ± 3.8 mmHg, respectively, in the SSO and HSO groups. The difference between the 2 groups was always not significant. CONCLUSION: Overall, the use of Densiron 68 was not associated with higher IOP values as compared with SSO

Current Trends about Inner Limiting Membrane Peeling in Surgery for Epiretinal Membranes

The inner limiting membrane (ILM) is the basement membrane of the Müller cells and can act as a scaffold for cellular proliferation in the pathophysiology of disorders affecting the vitreomacular interface. The atraumatic removal of the macular ILM has been proposed for treating various forms of tractional maculopathy in particular for macular pucker. In the last decade, the removal of ILM has become a routine practice in the surgery of the epiretinal membranes (ERMs), with good anatomical results. However many recent studies showed that ILM peeling is a procedure that can cause immediate traumatic effects and progressive modification on the underlying inner retinal layers. Moreover, it is unclear whether ILM peeling is helpful to improve vision after surgery for ERM. In this review, we describe the current understanding about ILM peeling and highlight the beneficial and adverse effects associated with this surgical procedure