Paolo Turchetti

Preliminary results of an intravitreal dexamethasone implant (Ozurdex ® ) in patients with persistent diabetic macular edema

Background To evaluate the efficacy and safety of an intravitreal dexamethasone implant (Ozurdex®; Allergan Inc, Irvine, CA, USA) in patients with persistent diabetic macular edema (DME) over a 6-month follow-up period. Methods Seventeen patients (20 eyes) affected by DME were selected. The mean age was 67 + 8 years, and the mean duration of DME was 46.3 + 18.6 months. The eligibility criteria were: age ≥ 18, a best-corrected visual acuity between 5 and 40 letters, and macular edema with a thickness of ≥275 μm. Thirteen patients had also previously been treated with anti-vascular endothelial growth factor medication. Results The mean ETDRS (Early Treatment Diabetic Retinopathy Study) value went from 18.80 + 11.06 (T0) to 26.15 + 11.03 (P = 0.04), 28.15 + 10.29 (P = 0.0087), 25.95 + 10.74 (P = 0.045), 21.25 + 11.46 (P = 0.5) in month 1, 3, 4, and 6, respectively. The mean logMAR (logarithm of the minimum angle of resolution) value went from 0.67 + 0.23 (at T0) to 0.525 + 0.190 (P = 0.03), 0.53 + 0.20 (P = 0.034), and 0.56 + 0.22 (P = 0.12) in month 1, 3, and 4, respectively, to finally reach 0.67 + 0.23 in month 6. The mean central macular thickness value improved from 518.80 + 224.75 μm (at T0) to 412.75 + 176.23 μm, 292.0 + 140.8 μm (P < 0.0001), and 346.95 + 135.70 (P = 0.0018) on day 3 and in month 1 and 3, respectively, to then increase to 476.55 + 163.14 μm (P = 0.45) and 494.25 + 182.70 μm (P = 0.67) in month 4 and 6. Conclusion The slow-release intravitreal dexamethasone implant, Ozurdex, produced significant improvements in best-corrected visual acuity and central macular thickness from the third day of implant in DME sufferers, and this improvement was sustained until the third month.

Rare kaon decays on the lattice

Abstract We show that long-distance contributions to the rare decays K → π ν ν ¯ and K → π l + l − can be computed using lattice QCD. The proposed approach requires well established methods, successfully applied in the calculations of electromagnetic and semileptonic form factors. The extra power divergences, related to the use of weak four-fermion operators, can be eliminated using only the symmetries of the lattice action without ambiguities or complicated non-perturbative subtractions. We demonstrate that this is true even when a lattice action with explicit chiral symmetry breaking is employed. Our study opens the possibility of reducing the present uncertainty in the theoretical predictions for these decays.

The synergistic effect of exposure to alcohol, tobacco smoke and other risk factors for age-related macular degeneration.

Age-related macular degeneration (AMD) is the leadingcause of severe visual loss among people aged 50 yearsand older in the developed world [1]. Cigarette smoking,hypertension, inflammation and alcohol consumption, havebeen shown to be associated with AMD in some, but not allstudies [2–4]. In our study we have evaluated the syner-gistic effect of alcohol and tobacco smoking with other riskfactors in the risk of developing AMD.The investigation adhered to the Declaration of Helsinkiand was approved by the Ethics Committee. We recruitedpatients, providing written informed consent, with AMD(the phenotype was early AMD, both the drusen and thepigmentary changes) during the period between August andNovember 2011 from the Center Maculopathy of theDepartment Sense Organs Sapienza University of Rome,Teaching Hospital Umberto I.The controls, matched to cases by age and sex, consist oftwo distinct groups:a) patients with eye diseases (unrelated with AMD);b) individuals belonging to the Clinic Orthopedic of theTeaching Hospital Umberto I, Rome.A questionnaire was administered to cases and controlsfor collecting data including thirty-five questions dividedinto five sections. The first section asked for demographicdata regarding age, gender, occupation, education level,weight, height, eyes colour. The second section asked forAMD family history (any relative), cardiovascular disease,hypertension, hypercholesterolemia, diabetes, cataractsurgery. The third section ascertained whether the patientsare ever smokers. The fourth section asked if the patientsdrink wine, beer or hard liquor. The last section tested howmany times a week, patients eat the following foods: bread,pasta, legumes, fruit, vegetables, red meat, white meat,cheese, fish, sweets.The possible interaction between sociodemographicvariables was tested using the synergism index, calculatedas follows: S = [OR11 - 1]/([OR01 ? OR10] -2), whereOR11 is equal to OR of the joint effect of two risk factorsand OR10 and OR01 are equal to OR of each risk factor inthe absence of the other. A value of S equal to unity wasinterpreted as indicative of additivity, whereas a valuegreater than unity was indicative of superadditivity andsynergism [5].A total of 122 cases and 124 controls were enrolled.The median age in the case group was 75, whilst in thecontrol group was 74. Alcohol intake is the same in bothgroups (2.4 grams per day); as regards smoking condi-tion, we found that 61.5 % (75 persons) in the case groupare ever smokers, in the control group they are 41.9 %(52 persons).Table 1 shows OR for each variables AMD-related.There was an indication for the additivity and synergismbetween many risk factors (Table 2): family history AMDand ever smokers (S = 1.51; 95 %CI 0.11–20.69), hyper-cholesterolemia and ever smokers (S = 1.77; 95 %CI0.44–7.10), finally from hypercholesterolemia and alcoholintake (S = 1.64; 95 %CI 0 -[999). Moreover, we foundout a synergistic interaction for Obesity with Ever smokers(1.54; 95 %CI 0.24–9.63) and Alcohol intake (4.2; 95 %CI0 -[999).Our findings suggest that many risk factors are associ-ated to the development of AMD, some of them have a

Glycosaminoglycans in the Human Cornea: Age-Related Changes

Aim To investigate possible age-related changes in glycosaminoglycans (GAGs) in the human cornea. The substances today called GAGs were previously referred to as mucopolysaccharides. Methods Samples of human cornea were taken from 12 younger (age 21 ± 1.2) and 12 older (age 72 ± 1.6) male subjects. Samples were weighed, homogenized, and used for biochemical and molecular analyses. All the quantitative results were statistically analyzed. Results The human cornea appears to undergo age-related changes, as evidenced by our biochemical and molecular results. The total GAG and hyaluronic acid counts were significantly higher in the younger subjects than in the older subjects. The sulfated heavy GAGs, such as chondroitin, dermatan, keratan, and heparan sulfate, were lower in the younger subjects than in the older subjects. Discussion GAGs of the human cornea undergo numerous age-related changes. Their quantity is significantly altered in the elderly in comparison with younger subjects. GAGs play an important role in age-related diseases of the human cornea.

Dorzolamide Chlorhydrate Versus Acetazolamide in the Management of Chronic Macular Edema in Patients with Retinitis Pigmentosa: Description of Three Case Reports

Aims To assess the efficacy of topical dorzolamide for treating cystoid macular edema in patients with retinitis pigmentosa and minimize the secondary effects of maintenance therapy in patients with retinitis pigmentosa (RP) who present with chronic microcystic macular edema. Methods To replace acetazolamide systemic treatment, with a topical treatment using 2% dorzolamide in three patients. The methods performed were OCT scan with a Spectralis HRA-OCT, for the measurement of macular thickness and morphology; best corrected visual acuity was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS), was assessed slit-lamp biomicroscopy, ocular tonometry, fundus biomiocrosopy, and color fundus photography. This therapeutic protocol has been applied and described in three patients. Results In all three tested patients, following the administration of dorzolamide in eye drop, we observed a remarkable decrease in macular edema, almost comparable to that obtained with acetazolamide per os. Conclusion The study confirms the anti-edematogenic effect of topical dorzolamide in RP with recurring macular cysts, as this can have a favorable response with topical dorzolamide. In all the three examined patients, the instillation of topical dorzolamide caused a remarkable reduction in their macular edema, as highlighted on OCT.

Suspensory Materials for Surgery of Blepharoptosis: A Systematic Review of Observational Studies.

Background Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. Objectives The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. Data Source and Methods Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. Results The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. Conclusions Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results.

Differential activity and clinical utility of latanoprost in glaucoma and ocular hypertension.

Background The purpose of this study was to demonstrate the hypotensive efficacy and tolerability of latanoprost when used as monotherapy and as polytherapy associated with antiglaucomatous medication proven to be ineffective in keeping intraocular pressure under control. Methods Three hundred and thirty-seven patients (672 eyes) affected by primary open-angle glaucoma and intraocular hypertension were recruited over a period of 10 years from the Glaucoma Centre, Department of Ophthalmological Sciences, University of Rome “Sapienza”, and treated, subject to informed consent, with latanoprost 0.005% alone or in combination with other ocular hypotensive drugs. The patients were followed during this period at regular intervals, with determination of visual field, fundus oculi, visual acuity, and eventual onset of local and systemic side effects. Results Latanoprost used as monotherapy and as polytherapy renders possible optimal and durable control of intraocular pressure in the form of one antiglaucomatous drug because it can substitute for one or more drugs and obtain the same hypotensive effect. Conclusion Latanoprost can be described as the ideal hypotensive drug, not only because of its ideal compliance profile (only one daily dose in the evening), excellent hypotensive effect, and, above all, few systemic side effects.