Daniela Domanico

Efficacy of intravitreal triamcinolone acetonide in long standing diabetic macular edema: a microperimetry and optical coherence tomography study.

Purpose: To investigate the efficacy of intravitreal triamcinolone acetonide in patients suffering from diffuse long standing diabetic macular edema, by the assessment of retinal thickness and retinal function by means of optical coherence tomography (OCT) and microperimetry-1. Methods: Twenty eyes received 8 mg in 0.2 mL preservative free intravitreal triamcinolone injection delivered through the pars plana. The best corrected visual acuity (BCVA), foveal thickness, and the average retinal sensitivity of the 45 stimuli were considered in our study. Patients were instructed to attend for OCT and microperimetry-1 follow-up at baseline, 1, 3, and 6. Results: At the baseline, mean macular thickness was 692&mgr; ± 70&mgr;; mean visual acuity was 0.13 ± 0.09. Mean macular sensitivity determined with the microperimetry-1 was 6.85 dB ± 2.1 dB. At the 1 month follow-up, mean OCT macular thickness decreased to 348.28&mgr; ± 132.10&mgr; (P = 0.0001); mean BCVA improved to 0.23 ± 0.15 (P = 0.019); mean retinal sensitivity improved to 8.71 dB ± 2.79 dB (P = 0.03). At the 3 months follow-up, mean OCT macular thickness changed to 363.7&mgr; ± 123.52&mgr; (P = 0.0002); mean BCVA was 0.23 ± 0.15 (P = 0.0024); mean retinal sensitivity 8.54 dB ± 2.78 dB (P = 0.048). Six months after the injection, mean OCT macular thickness was 460.61&mgr; ± 104.9&mgr; (P > 0.05); mean BCVA was 0.15 (P > 0.05); mean retinal sensitivity 7.54 dB ± 2.58 dB (P > 0.05). Conclusion: In our study, we found intravitreal effective in improving BCVA, macular thickness, and retinal sensitivities during the first 3 months. At 6 months, follow-up of the data were not dissimilar to those obtained at baseline. Further investigation is warranted to asses the correlation among daily life visual performance, retinal sensitivities, and macular thickness.

Potential role of intravitreal human placental stem cell implants in inhibiting progression of diabetic retinopathy in type 2 diabetes: neuroprotective growth factors in the vitreous

Background: Intravitreal injection of human mesenchymal stem cells has been shown to be effective in slowing the progression of diabetic retinopathy in an animal model of chemically induced diabetes mellitus. We studied changes in growth factor levels released from human mesenchymal stem cells in the vitreous cavity as well as changes in growth factor levels in host retinal neurons following intravitreal injection. Methods: Twenty-two Lewis rats were treated with an intravitreal human mesenchymal stem cell microinjection. Determination of neurotrophic factors released by human mesenchymal stem cells in the vitreous was carried out using real-time polymerase chain reaction. Results: Detectable levels of neurotrophic factors were identified postoperatively in the vitreous of all rats. Conclusion: Increased intravitreal and retinal concentrations of neuroprotective growth factors in rats confirm the neuroprotective activity of human mesenchymal stem cells in diabetic retinopathy.

Genetic Analysis for Two Italian Siblings with Usher Syndrome and Schizophrenia

Usher syndrome is a group of autosomal recessive genetic disorders characterized by deafness, retinitis pigmentosa, and sometimes vestibular areflexia. The relationship between Usher syndrome and mental disorders, most commonly a “schizophrenia-like” psychosis, is sometimes described in the literature. The etiology of psychiatric expression of Usher syndrome is still unclear. We reported a case of two natural siblings with congenital hypoacusis, retinitis pigmentosa, and psychiatric symptoms. Clinical features and genetic analysis were also reported. We analyzed possible causes to explain the high prevalence of psychiatric manifestations in Usher syndrome: genetic factors, brain damage, and “stress-related” hypothesis.

Optical coherence tomography and electro-oculogram abnormalities in X-linked retinitis pigmentosa

PurposeTo determine the correlations between morphological optical coherence tomography (OCT) and electrophysiological electro-oculogram (EOG) alterations in families with X-linked retinitis pigmentosa (XLRP).DesignObservational case series.Participants and MethodsAbout 32 eyes of 16 members of four different families: Seven obligate carriers, four affected male homozygotes and five unaffected females underwent ophthalmologic completed exams including EOG and OCT. All the subjects were previously tested with genetic analysis. The results were statistically analysed.ResultsThe abnormalities in OCT were detected in all carriers and affected males consisting of macular edema and increased RPE reflectivity compared to no alterations in unaffected females. The EOG was flat in all affected males; distinctly abnormal in eight eyes of obligate carriers; normal in two eyes of obligate carriers and in all unaffected females. In two obligate carriers, the EOG was not performed due to a nuclear cataract. The correlations between OCT and EOG alterations were statistically significant.ConclusionsThe OCT and EOG were demonstrated to be useful methods to identify the minimal alterations in carriers of X-linked retinitis pigmentosa.

Circulating levels of reactive oxygen species in patients with nonproliferative diabetic retinopathy and the influence of antioxidant supplementation: 6-month follow-up

Aims: The aim was to evaluate circulating levels of reactive oxygen species (ROS) and changes in central macular thickness (CMT) in patients with nonproliferative diabetic retinopathy (NPDR) after antioxidant supplementation. Materials and Methods: A total of 68 patients (68 eyes) with NPDR were enrolled. Patients were randomly divided into two groups: Treated with antioxidant supplement (Group A) and untreated control group (Group B). Each tablet, for oral administration, containing pycnogenol 50 mg, Vitamin E 30 mg and coenzyme Q10 20 mg. CMT and free oxygen radical test (FORT) were analyzed at baseline (T0), 3 (T1) and 6 (T2) months in both groups. Results: In Group A, FORT levels and CMT were significantly reduced over time (P < 0.001 for both). In Group B, FORT levels were increased (P < 0.001) and CMT did not vary significantly (P = 0.81) over 3 time points. Conclusions: This is the first study showing the reduction of ROS levels in patients with NPDR thanks to antioxidant therapy. Moreover, our findings have suggested also an influence on retinal thickness.

Low vision rehabilitation: current perspectives

Quality of life in low vision patients is deeply conditioned by their visual ability, and increased rates of depression, domestic injury, and need for caregiver assistance can be expected as a result of low performance. Much effort have been made recently in order to develop new tools and aids for rehabilitation of low vision, and this research has led to better knowledge of visual function and increased the likelihood of new therapies in the future. Modern low vision rehabilitation is the result of recent advances in science and technology, and will soon have an important role in people with vision impairment, numbers of whom are likely to increase, give the increasing age of the population. This review outlines scientific developments in low vision rehabilitation based on a search of the literature, covers the role of digital technology and advances in neurofunctional rehabilitation, and the possibility of restoring vision by use of retinal prostheses and cellular therapy.

Cystoid Macular Edema Induced by Low Doses of Nicotinic Acid

Cystoid macular edema (CME) is a condition that involves the macula, causing painless vision loss. In this paper, we report a case of niacin-induced bilateral cystoid macular edema (CME) in a middle-age woman taking low dose of niacin (18 mg of nicotinic acid). Optical coherence tomography (OCT) showed retinal thickening and cystoid spaces in both eyes, whereas fluorescein angiography (FA; HRA 2, Heidelberg Engineering) revealed the absence of fluorescein leakage also in later phases. Four weeks after discontinuation of therapy there were a complete disappearance of macular edema at funduscopic examination and an improvement of visual acuity in both eyes. Furthermore OCT showed a normal retinal profile in both eyes. In our opinion considering the wide availability of niacin, medical monitoring and periodical examination should be considered during niacin administration. To our knowledge, this is the first report in the literature that described the very low-dose niacin-induced bilateral niacin maculopathy.

Visual Recovery after Primary Retinal Detachment Surgery: Biofeedback Rehabilitative Strategy

Purpose. To evaluate possible speeding up recovery time after retinal detachment (RD) surgery using biofeedback strategy. Methods. A total of 52 eyes were selected. After surgery, patients were divided into two groups: group A, including patients submitted to biofeedback with MP-1 strategy; group B, patients who received common care strategy. Biofeedback strategy was started 15 days after the suspension of cycloplegic eye drops in buckling procedure or after silicone oil removal in the vitrectomized eyes. Controls were scheduled at baseline and 6, 12, and 18 weeks. Results. At baseline, there was no significant difference in BCVA between groups (P = 0.4230). At the end of biofeedback treatment (WK 6) BCVA of group A was significantly better (P < 0.001) than group B and BCVA was still better in group A than group B at WK 12 (P = 0.028) and at WK 18 (P = 0.041). Conclusions. Visual recovery after RD surgery is still unclear, and it does not depend on entity of the RD. Our data demonstrate that in biofeedback group there was a significant recovery in visual performances that still remains evident after 3 months from the baseline.

Efficacy of Microperimetric Biofeedback after Retinal Detachment

Background: To evaluate visual recovery after rehabilitation with microperimetric biofeedback in patients submitted to surgery for retinal detachment. Methods: We have randomly divided 44 eyes of 44 patients after surgery for retinal detachment into two group: group A, 23 eyes, submitted to biofeedback training with microperimetry MP-1, 10 training sessions, once a week, ten minutes for each eye; group B (control group), 21 eyes, treated with common care strategy. We have compared best correct visual acuity (BCVA) of two groups at baseline, 6, 12 and 18 weeks with Student’s t test. Results: At baseline the mean BCVA was 0.6 ± 0.43 logMAR in group A and 0.66 ± 0.67 logMAR in group B (p=0.74). At 6 weeks after training the mean BCVA of group A was 0.27 ± 0.29 logMAR significantly better (p=0.02) than group B (0.67 ± 0.67 logMAR). At 12 weeks the mean BCVA was 0.18 ± 0.25 logMAR in group A better than the control group in which the mean BCVA was 0.60 ± 0.66 logMAR (p=0.01). At 18 weeks visual performances were still better in biofeedback group than in group B (p=0.01) in which the mean BCVA was 0.58 ± 0.68 logMAR. Conclusions: Microperimetric biofeedback allowed a better and faster visual recovery after surgery for retinal detachment than normal condition.