Potential retinal phototoxicity

Nitric oxide leads to cytoskeletal reorganization in the retinal pigment epithelium under oxidative stress

Light is a risk factor for various eye diseases, including age-related macular degeneration (AMD) and retinitis pigmentosa (RP). We aim to understand how cytoskeletal proteins in the retinal pigment epithetlium (RPE) respond to oxidative stress, including light and how these responses affect apoptotic signaling. Previously, proteomic analysis revealed that the expression levels of vimentin and serine/threonine protein phosphatase 2A (PP2A) are significantly increased when mice are exposed under continuous light for 7 days compared to a condition of 12 hrs light/dark cycling exposure using retina degeneration 1 (rd1) model. When melatonin is administered to animals while they are exposed to continuous light, the levels of vimentin and PP2A return to a normal level. Vimentin is a substrate of PP2A that directly binds to vimentin and dephosphorylates it. The current study shows that upregulation of PP2Ac (catalytic subunit) phosphorylation negatively correlates with vimentin phosphorylation under stress condition. Stabilization of vimentin appears to be achieved by decreased PP2Ac phosphorylation by nitric oxide induction. We tested our hypothesis that site-specific modifications of PP2Ac may drive cytoskeletal reorganization by vimentin dephosphorylation through nitric oxide signaling. We speculate that nitric oxide determines protein nitration under stress conditions. Our results demonstrate that PP2A and vimentin are modulated by nitric oxide as a key element involved in cytoskeletal signaling. The current study suggests that external stress enhances nitric oxide to regulate PP2Ac and vimentin phosphorylation, thereby stabilizing or destabilizing vimentin. Phosphorylation may result in depolymerization of vimentin, leading to nonfilamentous particle formation. We propose that a stabilized vimentin might act as an anti-apoptotic molecule when cells are under oxidative stress.

Iatrogenic retinal traumas in ophthalmic surgery

BACKGROUND

To describe the main retinal iatrogenic traumas possibly related to ophthalmic surgery and the precautions to be adopted to avoid them.

METHODS

The article reviews the main peer-reviewed literature concerning retinal injuries caused by surgically related maneuvers. Safety measures alleged to inhibit any possible iatrogenic damage are also evaluated.

RESULTS

Photochemical damage of the retina, retinal complications after strabismus surgery, retinal complications related to local anesthesia for ophthalmic surgery, retinal damage during cataract surgery and retinal damage during vitreoretinal surgery are the most common iatrogenic retinal injuries. Their incidence is related to risk factors peculiar to each condition.

CONCLUSIONS

Ophthalmic surgeons are aware that there are a number of circumstances in which several undesirable retinal iatrogenic injuries might occur, sometimes with serious consequences. This is why surgeons should take every precaution at each surgical step to avoid any possible retinal iatrogenic damage.

Photochemical damage of the retina

Visual perception occurs when radiation with a wavelength between 400 and 760 nm reaches the retina. The retina has evolved to capture photons efficiently and initiate visual transduction. The retina, however, is vulnerable to damage by light, a vulnerability that has long been recognized. Photochemical damage has been widely studied, because it can cause retinal damage within the intensity range of natural light. Photochemical lesions are primarily located in the outer layers at the central region of the retina. Two classes of photochemical damage have been recognized: Class I damage, which is characterized by the rhodopsin action spectrum, is believed to be mediated by visual pigments, with the primary lesions located in the photoreceptors; whereas Class II damage is generally confined to the retinal pigment epithelium. The action spectrum peaks in the short wavelength region, providing the basis for the concept of blue light hazard. Several factors can modify the susceptibility of the retina to photochemical damage. Photochemical mechanisms, in particular mechanisms that arise from illumination with blue light, are responsible for solar retinitis and for iatrogenic retinal insult from ophthalmological instruments. Further, blue light may play a role in the pathogenesis of age-related macular degeneration. Laboratory studies have suggested that photochemical damage includes oxidative events. Retinal cells die by apoptosis in response to photic injury, and the process of cell death is operated by diverse damaging mechanisms. Modern molecular biology techniques help to study in-depth the basic mechanism of photochemical damage of the retina and to develop strategies of neuroprotection.

Discrimination between normal and glaucomatous eyes with visual field and scanning laser polarimetry measurements

AIM

To evaluate the ability of structural parameters (as determined by retinal nerve fibre layer (RNFL) measurements obtained with the scanning laser polarimeter (SLP-NFA/GDx)) and functional parameters (as determined by automated perimetry) to discriminate between normal and glaucomatous eyes.

METHODS

In a case-control study, a total of 91 normal subjects and 94 patients with glaucoma underwent automated perimetry and RNFL measurements obtained with the SLP. Three independent scans of each eye were obtained and a mean image was created and used for further analysis. Only one eye per individual was randomly included in the study. The sensitivity (Se) and specificity (Sp) of 12 RNFL parameters were calculated according to the SLP internal normative database. The Se and Sp of the visual field (VF) global indices and the glaucoma hemifield test (GHT) were also calculated according to the instrument's normative database. Receiver operator characteristic (ROC) curves were built for each SLP parameter and VF index. Fisher's linear discriminant formulas (LDFs) were developed for VF indices (VF LDF), SLP measurements (SLP LDF), and both examinations (combined LDF).

RESULTS

According to the SLP internal database, the parameters with better Se and Sp were: superior/nasal ratio (Se = 58.5%; Sp = 86.8%), and GDx the number (Se = 43.3%; Sp = 96.7%). The construction of an ROC curve for the number resulted in Se = 84% and Sp = 79%. The creation of LDFs improved both the sensitivities and specificities when compared with isolated parameters SLP LDF (Se = 90.4%; Sp = 82.4%), VF LDF (Se = 89.4%; Sp = 89.0%), and combined LDF (Se = 93.0%; Sp = 90.1%). The sensitivity to diagnose early and moderate glaucomatous damage observed with the GHT was lower than that obtained with the number (p < 0.01).

CONCLUSIONS

Creation of LDFs enhanced the Se and Sp for both VF and SLP. Integration of SLP and VF in a combined LDF reached the highest Se/Sp relation, suggesting that these examinations may be additive concerning the diagnosis of glaucoma. The SLP parameter the number may be more sensitive than the GHT in diagnosing early and moderate glaucomatous damage.

Nitric oxide in the eye: multifaceted roles and diverse outcomes

Recent works have highlighted the role of nitric oxide in a wide array of disease entities, including septic shock, hypertension, cerebral ischemia, and chronic degenerative diseases of the nervous system. The functions of nitric oxide appear very diverse, having actions on vascular tone, neurotransmission, immune cytotoxicity, and many others. Nitric oxide is an important mediator of homeostatic processes in the eye, such as regulation of aqueous humor dynamics, retinal neurotransmission and phototransduction. Changes in its generation or actions could contribute to pathological states such as inflammatory diseases (uveitis, retinitis) or degenerative diseases (glaucoma, retinal degeneration). Localization in the eye and biochemical characteristics of nitric oxide will be reviewed. A better understanding of the nitric oxide pathway will be the key to the development of new approaches to the management and treatment of various ocular diseases.

Updating on intraoperative light-induced retinal injury

We are presenting the state of knowledge concerning intraoperative light-induced retinal injury, considered to be a combination of photic retinopathy and retinal photocoagulation. It may arise from retinal light exposure to the operating microscope or to the fiberoptic endoilluminator. Ultraviolet and short-wavelength visible light are more dangerous than longer wavelength light. Many risk factors may facilitate the onset of this iatrogenic disease following surgery. Many aspects of the retinal damage are still poorly understood. Many mid light-induced retinal injuries probably remain undiagnosed in routine postoperative examination. Current appropriate light filters are not the definitive solution. Appropriate precautions should be taken during both anterior segment and vitreoretinal surgery.