Ksenija Karaman

IL-12 concentrations in the aqueous humor and serum of diabetic retinopathy patients

BackgroundPrevious studies suggest that inflammation plays an important part in the pathogenesis of diabetes. Cytokines may have a role in both positive and negative control of immunological reactions. Among many cytokines, interleukin 12 (IL-12) is known to be a strong pro-inflammatory cytokine.MethodsA total of 76 participants were enrolled in this study and classified into four groups: 23 diabetic patients with non-treated retinopathy, 17 diabetic patients with treated retinopathy, 12 diabetic patients without retinopathy, and 24 healthy control patients. Serum and aqueous humor samples were taken for the analysis of IL-12 concentration.ResultsThe aqueous humor IL-12 concentration was significantly elevated in the patients with non-treated diabetic retinopathy (χ2(3, n = 76) = 27.137; p < 0.001).No significant differences in IL-12 serum concentrations between the groups were found (F = 0.405, p = 0.750). Correlation analysis of IL-12 concentrations in the serum and aqueous humor showed a linear association between the two variables only in non-diabetic patients (p = 0.003).ConclusionsThis is the first study to show a significantly higher concentration of pro-inflammatory cytokine IL-12 in the aqueous humor of non-treated diabetic retinopathy patients in comparison with diabetic patients treated for retinopathy, without retinopathy, or with healthy individuals. Because the serum levels of IL-12 did not differ considerably between the studied groups, it is plausible that this is due to its local production and secretion.

Serpiginous-like choroiditis as sign of intraocular tuberculosis

BACKGROUND Tuberculosis is a world-wide public health problem which may clinically present in many different ways. Here we report on a patient with presumed serpiginous choroiditis (PSC) found to have latent ocular tuberculosis. CASE REPORT The clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, chest radiograph, fundus fluorescein angiography, tuberculin skin test, serological tests, and systemic evaluation carried out by consultant internist of a 42-year-old man with PSC were evaluated. The patient presented with gradual painless loss of central vision in his left eye and dark rings in the central visual field of the right eye. Upon examination, he was found to have 1 round choroidal lesion centered in the left macula and multiple serpiginous-like choroidal lesions in the right eye. Based on positive tuberculin skin test result, the patient was initially treated with anti-tubercular therapy combined with systemic corticosteroids. An immunosuppressive agent (Azathioprine) was consequently administered due to unsatisfactory response to initial therapy and the vicinity of the pathological process to the right fovea. CONCLUSIONS It is important to remember that tubercular choroiditis may present with clinical features of serpiginous choroiditis, requiring timely and appropriate therapy and close observation in order to prevent the progression of visual loss and recurrences.

Epidemiology of pediatric eye injury in Split-Dalmatia County.

Aims: The aim of this study was to assess the etiological factors and circumstances associated with the occurrence of eye injuries in children in Split-Dalmatia County, and to assess the visual outcomes of such injuries. Methods: All 106 cases of pediatric eye trauma presenting to the Clinical Hospital Split, during a 4-year period, were identified by a medical record search. Results: The annual calculated incidence of serious eye injuries in pediatric patients of Split-Dalmatia County that required hospitalization was 22.5 per 100,000 in the underage population. The most common causes of ocular injury were blunt objects and missiles, which mostly caused contusions and lamellar lacerations, and sharp objects, which mostly caused penetrating eye injury. In 99 (90.83%) eyes, the injuries were mechanical. Open globe injuries were significantly severer than closed globe injuries. Final visual acuity was better than upon admission in 78.10% of cases. The annual incidence of pediatric monocular blindness in Split-Dalmatia County was 0.63 per 100,000 in the underage population. Conclusions: Eye trauma in children occurs most frequently outdoors and generally results from the use of blunt objects. Prevention of ocular injury requires greater education of both children and their parents and adult supervision of children, especially while at play.

Purtscher's retinopathy associated with acute pancreatitis.

A 27–year-old woman with a six-day history of fever, diffuse abdominal pain, nausea and vomiting was hospitalised because of loss of acuity in both eyes which developed three days previously. Clinical, laboratory and ultrasound findings confirmed acute pancreatitis. Colour fundus photography bilaterally revealed normal optic discs, cotton-wool exudates, flame and dot shaped retinal haemorrhages at both posterior poles. Intravenous fluorescein angiography showed multiple bilateral ischemic areas in the choroidal and retinal microcirculations with capillary dropout, and a clear diffusion of fluorescein from the perimacular vasculature in the posterior pole. Purtscher’s retinopathy was diagnosed. The patient was treated with analgesics, intravenous fluids, antibiotics and proton pump inhibitors. Three weeks later her vision had completely recovered. Ophthalmoscopy showed complete resolution of the retinal changes. Purtscher’s retinopathy is a rare condition, initially associated with severe head injury and blunt thoracic trauma, but subsequently seen also in patients with acute pancreatitis, fat embolism syndrome, renal failure, preeclampsia, and connective tissue disorders with vasculitis. It is attributed to the occlusion of retinal arterioles by aggregated granulocytes and/or platelets, following complement activation, or to fat microemboli or fibrin clots. This rare complication develops 24-48 hours after the inciting disease and in most cases resolves spontaneously 1-3 months after disease resolution. Visual prognosis is variable and is poor if central macular infarction has occurred. Treatment is usually expectant ; however, in some cases treatment with systemic steroids may be considered.

Contents Vol. 42, 2009

Anatomy, Pathology and Cell Biology A. Prescott, Dundee Biochemistry, Molecular Biology and Molecular Genetics J. Graw, Neuherberg Clinical and Epidemiological Research M. Kojima, Kahoku Clinical Retina P. Wiedemann, Leipzig Cornea and Ocular Surface C. Marfurt, Gary, Ind. Glaucoma M. Coroneo, Sydney Immunology and Microbiology U. Pleyer, Berlin Lens and Cataract S. Varma, Baltimore, Md. Miscellaneous U. Pleyer, Berlin Neuro-Ophthalmology and Vision Sciences P. Aydin, Ankara Ocular Oncology M. Jager, Leiden Physiology, Pharmacology and Toxicology A. Wegener, Bonn Retina and Retinal Cell Biology M. Boulton, Gainesville, Fla. P. Wiedemann, Leipzig Editorial Board