Stefano Dore

Levels of Human Tissue Kallikrein in the Vitreous Fluid of Patients with Severe Proliferative Diabetic Retinopathy

The aim of this study was to determine the levels of human tissue kallikrein in the vitreous fluid of patients with severe proliferative diabetic retinopathy (PDR). Tissue kallikrein levels were measured using a specific ELISA (range: 0.4–25 ng/ml) in 7 vitreous fluids from eyes with severe PDR. Seven vitreous samples from eyes which underwent vitrectomy because of rhegmatogenous retinal detachment served as non-PDR controls. Enzymatic activity was also tested by an amidolytic assay using a chromogenic substrate. In the PDR patients, vitreous tissue kallikrein was <0.4 ng/ml (5 eyes) or very low (0.52 and 0.58 ng/ml). Vitreous tissue kallikrein was <0.4 ng/ml in all non-PDR controls. These results were confirmed by the amidolytic test. Results suggest that vitreous tissue kallikrein probably plays either a secondary or no role in the pathogenesis of PDR.

Corneal graft rejection after penetrating keratoplasty for keratoconus in Turner's syndrome

Purpose To report a patient with Turners syndrome who developed graft rejection after penetrating keratoplasty (PK) for keratoconus and to review the ophthalmic literature on the association between keratoconus and Turners syndrome. Methods A woman with bilateral keratoconus and Turners syndrome (45,XO) was referred for progressive visual loss in the right eye. Best-corrected visual acuity was 20/400 in the right eye. Slit-lamp examination revealed corneal thinning with ectatic protrusion of the central cornea and Vogts striae in the right eye. The patient underwent PK in the right eye in January 2001. She developed graft rejection in April 2003 and visual acuity dropped to hand motion. After treatment with topical and systemic steroids and systemic cyclosporine A, visual acuity recovered to 20/80 in July 2003. Results The authors know of only three other reported patients (six eyes) with keratoconus in Turners syndrome. Five eyes underwent PK with good visual rehabilitation, but one developed immunologic graft rejection 7 years after surgery. On the whole, considering the current report and the other cases described in the literature, graft rejection occurred in 2 out of 6 eyes (33.3%). The graft survival rate was 80% after 2 years and 40% after 7 years. Conclusions The results suggest that grafts for keratoconus in patients with Turners syndrome might have an increased risk of immunologic rejection. Corneal grafts in Turners syndrome need to be monitored closely. Early detection of graft rejection and aggressive treatment with topical and systemic steroids and systemic cyclosporine A can save the graft and restore useful vision.

Complete Blood Cell Count–Derived Inflammation Biomarkers in Men with Age-Related Macular Degeneration

ABSTRACT Purpose: To investigate the role of some blood count–derived inflammation biomarkers in age-related macular degeneration (AMD). Methods: Seventy-nine men with late-stage AMD and 79 male age-matched cataract controls without AMD were recruited in March–December, 2016. A blood sample was taken. The following blood cell count–derived indexes were evaluated: neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR = neutrophils/(white blood cells ‒ neutrophils)], platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), (neutrophils × monocytes)/lymphocyte ratio (SIRI), and (neutrophils × monocytes × platelets)/lymphocyte ratio (AISI). Results: AMD patients had significantly lower median values of white blood cells, monocytes, neutrophils, platelets, and mean platelet volume (MPV). Regarding the combined indexes, only AISI was significantly lower in AMD patients than in controls. Receiver operating characteristics curve analysis revealed that the ability of AISI and MPV to predict AMD is poor. Conclusion: Results suggests that NLR, dNLR, PLR, MLR, SIRI, and AISI are unreliable disease biomarkers in men with AMD. Larger scale studies are necessary to confirm these findings.

Isolated complex limbal choristoma in a newborn baby

Choristomas are congenital lesions caused by the overgrowth of normal tissues in an abnormal location. Complex choristomas are characterized by the presence of two or more ectopic tissues of meso-ectodermal origin. We report herein a rare case of isolated complex limbal choristoma, successfully treated by simple excision. A boy was born after an uneventful full-term pregnancy by vaginal delivery. At birth, he presented with a fleshy mass involving the right temporal hemicornea and adjacent bulbar conjunctiva (Fig. 1a). The rest of the eye was normal. Skin examination, abdomen ultrasound, and MR imaging of the brain and orbit failed to find any associated abnormalities. The baby underwent general anaesthesia at the age of 3 weeks. Evaluation under operating microscope disclosed a vascularized lesion measuring *10 9 10 mm, adherent to the underlying episcleral tissue and the cornea. The mass was then fully excised and sent to the pathologist. Histopathologically, the excised material showed both stratified squamous and columnar epithelium, adipose tissue lobules, cartilage, and lachrymal gland elements (Fig. 1c–e). Postoperatively, antibiotic eye-drops were administered for 10 days, followed by a tapering course of topical steroids for 5 months. On last followup examination, 9 months after surgery, the eye was quiet and there was a mild scar on the temporal cornea (Fig. 1b). The baby was then referred to the paediatric ophthalmology clinic for amblyopia treatment.

Neuro-ophthalmological findings in neurofibromatosis type 1

Objectives: To describe the neuro-ophthalmological findings in five patients with neurofibromatosis type 1 (NF-1). Methods: Retrospective case series. Results: Five patients (3 males, 2 females) with NF-1 who showed neuro-ophthalmogical findings were included in this study. Their ages ranged from one to 28 years (mean: 8 years).Two patients had glioma of the optic chiasm, one glioma of the optic nerve, one orbitotemporal plexiform neurofibroma and glioma of the optic chiasm, and one absence of the greater sphenoid wing. Conclusions: Patients with NF-1 may show different neuro-ophthalmological findings. Lesions tend to develop early in life and might have a favorable long-term natural history. Given the potential for serious visual loss, close follow-up until adolescence is recommended.