C. Balacco Gabrieli

Optic neuropathy in systemic lupus erythematosus and antiphospholipid syndrome (APS): clinical features, pathogenesis, review of the literature and proposed ophthalmological criteria for APS diagnosis.

Abstract: Optic neuropathy is a well-known ocular manifestation occurring in patients with systemic lupus erythematosus (SLE), and it remains one of the major causes of blindness in these patients. We report data from six SLE patients with optic neuropathy, one of whom was considered to have antiphospholipid syndrome (APS). This patient had monolateral optic neuropathy, whereas the other five SLE patients had bilateral optic nerve disease. We believe that the monolateral occurrence of optic neuropathy in our patient can be considered as a ‘focal’ neurological disease due to a thrombotic event involving the ciliary vasculature. Conversely, bilateral optic nerve damage in SLE could be considered to be a ‘general’ neurological disease due to different immunological mechanisms, such as vasculitis. Additionally, the literature on SLE patients affected by optic neuropathy is reviewed to evaluate the major clinical features, particularly neurological features. In reviewing the literature, it appears that bilateral optic neuropathy in SLE occurs more frequently than monolateral optic neuropathy, and the main neurological manifestation seen in these patients is transverse myelitis, particularly in SLE patients with bilateral optic nerve disease. Finally, we propose a clinico-ophthalmological spectrum of APS and outline the ocular clinical manifestations that can be considered as diagnostic for the syndrome.

Improvement of Visual Functions and Fundus Alterations in Early Age-Related Macular Degeneration Treated with a Combination of Acetyl-L-Carnitine, n-3 Fatty Acids, and Coenzyme Q10

The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10 (Phototrop®) on the visual functions and fundus alterations in early age-related macular degeneration (AMD). One hundred and six patients with a clinical diagnosis of early AMD were randomized to the treated or control groups. The primary efficacy variable was the change in the visual field mean defect (VFMD) from baseline to 12 months of treatment, with secondary efficacy parameters: visual acuity (Snellen chart and ETDRS chart), foveal sensitivity as measured by perimetry, and fundus alterations as evaluated according to the criteria of the International Classification and Grading System for AMD. The mean change in all four parameters of visual functions showed significant improvement in the treated group by the end of the study period. In addition, in the treated group only 1 out of 48 cases (2%) while in the placebo group 9 out of 53 (17%) showed clinically significant (>2.0 dB) worsening in VFMD (p = 0.006, odds ratio: 10.93). Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes (p = 0.045) or the less affected eyes (p = 0.017) were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early AMD.

Mitotropic Compounds for the Treatment of Age-Related Macular Degeneration

Recent histopathologic studies have shown that mitochondria and peroxisomes of the retinal pigment epithelium may play a central role in the pathophysiology of age-related macular degeneration (AMD). We supposed that compounds which improve mitochondrial functions (mitotropic compounds) may show beneficial effects in preventing AMD. Fourteen patients affected by early AMD were treated with a mixture containing acetyl-L-carnitine (ALC), polyunsaturated fatty acids (PUFAs), coenzyme Q10 (CoQ10) and vitamin E, while an equal number of age- and sex-matched patients affected by early AMD were treated with vitamin E only. Recovery time after macular photostress, foveal sensitivity and mean defect in the visual field as well as blood lipid levels were recorded at the beginning and after 3, 6, 9, 12 and 24 months of follow-up. In the treated group, all the visual functions showed slight improvement which was evident after 3 months of treatment and remained nearly stationary by the end of 24 months. The same tests in the control group showed slow worsening. The divergence between treated and control groups became more marked with time, but the difference was not significant at any time of the follow-up. These findings suggest that the blend of ALC, PUFA, CoQ10 and vitamin E may improve retinal functions in early AMD.

Calcium, potassium, zinc, and copper determinations in cataractous human lenses

The determination of inorganic ions such as Ca, K, and Na in cataractous lenses has been the subject of several investigations. On the other hand, few studies have been concerned with trace element contents in lenses and with their changes under pathological conditions. Moreover, the data reported are sometimes rather contradictory. The present investigation was carried out to evaluate the presence of Ca, Cu, K, and Zn in human lenses (53 cataractous and 10 clear lenses). Determinations of the elements were performed by atomic absorption spectrometry (both flame and flameless methods) after acid digestion of samples. Compared with results obtained in samples from normal subjects (namely, Ca, 9.9 ± 2.7; Cu, 0.53 ± 0.08; K, 10,306 ± 1232; Zn, 16.5 ± 2.5 mg/kg dry wt), the mean concentration values of cataractous lenses showed significant changes on the basis of the Mann-Whitney test. In fact, sensible increases in concentrations were noted for three of the said elements (Ca, 514 ± 449; Cu, 0.74 ± 0.22; Zn, 24.3 ± 6.0 mg/kg dry wt), whereas K showed a lower concentration (6440 ± 3003 mg/kg dry wt). A positive correlation was found between Zn and Cu concentrations (Y = 0.030X + 0.007, r = 0.79) while an inverse one was valid between Ca and K (Y = −0.097X + 1141, r = 0.65).

Work-Related Accidents of Ophthalmologic Interest in Italy During 1986–1991

The authors analysed accidents of ophthalmological interest obtaining information from the database of the INAIL (National Insurance Institute for Professional Casualties) concerning the period of 1986-1991. The INAIL registers all casualties that cause work disabilities exceeding 3 days. The investigation included all job types grouped into two major categories: agriculture (16% of all insured labour) and industry/craftsmanship (84%). Over 78% of the cases examined were in the industry/craftsmanship category. Approximately 22% of the cases were in the agriculture category. Every year in Italy, about 6% of regularly employed workers suffer casualties. The incidence of casualties of ocular interest has been a stable 0.37% in the years examined; 2.88% of these casualties produce permanent consequences (1/10,000 workers per year). The risk in 3 times higher in agriculture.

Correlation Between Steroid Hormone Balance and Etiopathology of High Myopia: Clinical Trial

Summary. The purpose of this study was to determine the relationship between steroid hormone balance in fertile women and the progression of high myopia. Variations of cortisol, progesterone, and estradiol were evaluated. A case-control clinical trial was conducted on two groups of subjects. The first group included patients affected by high myopia (with insufficient optical correction). The control group was composed of emmetropic or hypermetropic women of the same age group. We observed increased serum cortisol levels in the women with high myopia, whereas progesterone and 17-~-estradiol did not differ between the two groups. The significantly higher cortisol values in the group with high myopia supported Balacco Gabrielis theory on the role of hormonal balance in the progression of high myopia.