Peripapillary RNFL Thickness Changes Evaluated with Spectral Domain Optical Coherence Tomography after Uncomplicated Macular Surgery for Epiretinal Membrane

PURPOSE

To evaluate the peripapillary RNFL (p-RNFL) thickness changes after vitrectomy for epiretinal membrane (ERM). The relationship between p-RNFL thickness change and visual function was assessed.

METHODS

Thirty-five eyes from 35 patients with ERM who underwent vitrectomy with internal limiting membrane (ILM) removal were included. Average p-RNFL and the four quadrants thickness were measured by spectral-domain optical coherence tomography (SD-OCT) before and at one, three, and six months after surgery.

RESULTS

At six months after surgery, p-RNFL thickness of the temporal and inferior quadrant was decreased in the operated eyes compared with fellow eyes (p<0.05). Pattern standard deviation (PSD) was higher than that of fellow eyes (p = 0.002). The temporal and inferior quadrant p-RNFL thickness showed a relationship with both best-corrected visual acuity (BCVA) outcome and the six-month PSD (p<0.05, respectively).

CONCLUSIONS

The selective decrease in the temporal and inferior p-RNFL thickness after vitrectomy for ERM removal could indicate inner retinal damage related to ILM peeling.

ICP and CBF regulation: a new hypothesis to explain the "windkessel" phenomenon

The brain tamponade represents the final condition of a progressive intracranial pressure (ICP) increase up to values close to arterial blood pressure (BP) producing a reverberating flow pattern in the cerebral arteries with no net flow. This finding implies intracranial volume changes, therefore a full application of the Monro-Kellie doctrine is impossible. To resolve this contradiction, in eight pigs a reversible condition of brain tamponade was produced by infusing saline into a cerebral ventricle. The following parameters were measured: BP in the common carotid artery, ICP by the same needle utilised for the infusion, arterial and venous blood flow velocity (BFV) at, respectively, internal carotid artery (ICA) and sagittal sinus (SS) site by ultrasound technique. When ICP approached carotid BP values, reverberating BFV waves both at ICA and SS site were simultaneously observed. The arterial and venous reverberating waves appeared to be almost exactly superimposable, with a delay of about 40 msec. This synchronism between the pulsatile arterial and venous BFV indicates that the residual pulsation, still occurring at the arterial proximal level, is compensated by a passive compression-distension of the SS with no blood volume (that is net flow) crossing the intracranial vasculature.

ICP and CBF regulation: effect of the decompressive craniectomy

The view of the intracranial system as a rigid and closed box has been criticised by many authors who take into account the possibility of a certain degree of elastic bulk accommodation, mainly in the spinal sac. In nine patients, who underwent decompressive craniectomy for treatment of life-threatening intracranial hypertension, when the clinical conditions improved, just before cranioplasty, the blood flow velocities at middle cerebral artery (MCA) and at superior sagittal sinus (SSS) level were simultaneously recorded. The measurements were repeated after cranioplasty. The blood flow velocity recorded from SSS in craniectomized patients appeared flat, without evident pulsation; after cranioplasty a clear-cut pulsatile wave became again evident. The disappearance of a pulsatile shape in the blood flow velocity recorded from the SSS when the intracranial system was "open" and the reappearance of a pulsatile blood flow waveform after the "closure" of the skull confirm that the venous bed acts as a bulk compensatory system in order to maintain the intracranial volume absolutely constant.

Ibopamine treatment in chronic hypotony secondary to long-lasting uveitis. A case report

PURPOSE

To assess the clinical efficacy of ibopamine eye drops in severe hypotony secondary to chronic progressive uveitis.

METHODS

Case report. A 47-year-old man with a 37-year history of diffuse uveitis and severe refractory hypotony was treated with topical 2% ibopamine (Trazyl) six times a day. Intraocular pressure, visual acuity, visual field and side effects were recorded during 15 months of follow-up.

RESULTS

IOP, visual acuity and visual field increased after four days of therapy and lasted for two months when the drug was suspended because of the onset of filamentous keratopathy. A new course of treatment with 2% ibopamine eye drops in a different solvent (BSS) resulted in a stable increase in IOP, VA and visual field, with no side effects in a follow-up of 13 months.

CONCLUSIONS

Ibopamine 2% eye drops in BSS solvent seem effective in the treatment of uveitis-related hypotony.

Long-term follow-up of anterior uveitis after cataract extraction and intraocular lens implantation

PURPOSE

To assess whether cataract surgery and intraocular lens (IOL) implantation in patients with anterior uveitis interfere with the natural course of the ocular disease.

SETTING

Tertiary care center at the University of Rome "La Sapienza", Rome, Italy.

METHODS

Cataract extraction and IOL implantation were performed in 24 patients with uveitis-related cataract: 12 with Fuchs' heterochromic iridocyclitis (Group 1) and 12 with other types of anterior uveitis (Group 2). The mean follow-up in the 2 groups was 33.6 months and 24.8 months, respectively. The number and severity (inflammatory score) of uveitis relapses in all patients over the same period were recorded.

RESULTS

After surgery, the mean number and severity of uveitis relapses decreased: Group 1, from 1.83 +/- 1.90 (SD) to 1.00 +/- 1.21 and from 1.08 +/- 0.90 to 0.92 +/- 0.67, respectively; Group 2, from 2.74 +/- 3.44 to 1.25 +/- 1.71 and from 1.83 +/- 1.10 to 1.25 +/- 0.75, respectively (P = .046). There were no statistically significant between-group differences. In Group 2, a trend toward worse visual rehabilitation was seen; this was significantly different from the result in Group 1 (P = .018) because of preoperative optic nerve damage, macula disease, or both.

CONCLUSION

Cataract surgery and IOL implantation did not negatively influence the natural course of uveitis in patients with Fuchs' heterochromic iridocyclitis. Correct surgical timing, selection of cases, and adequate anti-inflammatory therapy may promote similar results in patients with other types of anterior uveitis.

Endogenous uveitis: an analysis of 1,417 cases

A retrospective study on 1,417 uveitic patients referred to the Ocular Immunovirology Service of the University of Rome 'La Sapienza' was carried out to determine the occurrence of the various forms of uveitis. To detect also the possible changing patterns of uveitis during the last 25 years the obtained data were compared with those reported in two previous studies performed by the same author, at the same institution in 1978 and 1985. Anterior uveitis was the most frequent anatomical type of intraocular inflammation (49.12%); intermediate uveitis was diagnosed in 12.42% of all the cases and showed an increased incidence over the years (p < 0.0001). Posterior and diffuse uveitis accounted for 22.1 and 16.37% of the cases. An improvement in diagnostic definition has been confirmed by the significant decrease in the percentage of 'idiopathic uveitis' from 56.8 to 38.1% (p < 0.0001). Associated infectious conditions were detected in 17.43% of the cases. Toxoplasma gondii was the most common etiologic agent of uveitis (6.63%). An associated systemic disease was diagnosed in 15.03% of uveitic patients, and 6% of them were affected with Behçet's disease. Specific ocular diseases and clinical entities increased from 7.8 and 14.68% to 29.42% in the last 25 years (p < 0.0001), the most frequent being pars planitis (11.99%) and Fuchs' heterochromic iridocyclitis (8.32%).

Structural alterations in the carboxyl-terminal domain of the BCRABL gene product activate its fibroblastic transforming potential

Activation of the c-abl protooncogene occurs in Abelson murine leukemia virus, Hardy-Zuckerman-2 feline sarcoma virus, and during the chromosomal translocation that generates the BCRABL fusion gene. The three genes exhibit varying degrees of transforming activity; the two viral genes transform NIH-3T3 cells in vitro, whereas the BCRABL gene is incapable of transforming these cells. To determine whether genetic alterations can enhance the transforming potential of the BCRABL gene, we employed genetic selection techniques which led to the isolation of a mutant form of the BCRABL gene with high levels of fibroblastic transforming activity. Molecular analysis of this clone shows that it suffered a deletion of 3' ABL sequences and their replacement with a cellular sequence of unknown origin, termed X. This tripartite gene is capable of inducing 35 foci/10 ng of DNA. Deletion of 3' ABL sequences analogous to that seen in the activated BCRABL protein without the addition of X yields 5 foci/100 ng of DNA. These results suggest that carboxyl-terminal truncations unmask the fibroblastic transforming activity of the BCRABL gene product and the addition of X sequences dramatically enhances this transforming potential, indicating a dominant contribution by the X reading frame.

[Duodenal diverticula]

After an examination of the anatomopathological and clinical features of duodenal diverticula, the various ancillary pathologies are analysed as are the complications linked to the diverticulum itself. A meticulous review of the literature and several personal surgical cases confirms the view that only those diverticula causing evident symptoms or complications should be treated. The various surgical techniques selected as appropriate for the different cases are also described.