Pilot study to evaluate the efficacy and safety of pneumatic trabeculoplasty in glaucoma and ocular hypertension

PURPOSE

Following laser-assisted in situ keratomileusis (LASIK), intraocular pressure (IOP) is measurably lower in a significant number of cases. It has been proposed that the decrease in IOP may be a real event. Prior trials have evaluated pneumatic trabeculoplasty (PNT) in combination with concomitant glaucoma medications. The aim of this study was to determine the efficacy and the safety of PNT alone to lower IOP in patients with primary open angle glaucoma (POAG) or ocular hypertension (OH).

METHODS AND RESULTS

A total of 37 subjects with POAG or OH were enrolled in a prospective, open-label, fellow-eye, multicenter trial to determine the IOP lowering effects of PNT. All subjects underwent ophthalmologic examinations and IOP measurements and were washed out from all glaucoma medications prior to the start of the study. The trial was intrapatient controlled for the first 30 days, with one eye receiving PNT at days 0 and 7 and the fellow eye serving as the control. The second eye was treated with PNT at day 30. The patients were followed for 120 days, with the first eye receiving an additional PNT treatment at days 90 and 97. Two analyses-an intent to treat analysis in which the last IOP measurement for patients dropped from the study was carried forward and an analysis including only those patients who completed the trial-were performed. Of the 37 patients enrolled, 27 (73%) completed the study. For the intent to treat analysis the baseline mean IOP was 24.7+/-1.9 mmHg for eye 1 and 23.6+/-2.3 mmHg for eye 2 and the difference was statistically significant (p<0.05). Using this analysis the differences between eye 1 mean IOP at days 1, 7, 14, and 60 and the baseline mean IOP were statistically significant (p<0.05). The differences between eye 2 mean IOP and the baseline mean IOP were statistically significant (p<0.05) at all time points except day 14 and day 30. The greater mean IOP reductions from the baseline mean IOP for eye 1 were at study day 1 (-16,1%), day 14 (-9%), and day 60 (-8.9%). For eye 2 they were at day 60 (-8.7%) and at day 120 (-9.1%). For the analysis that included only those subjects who completed the trial the decrease in eye 1 mean IOP from baseline was statistically significant (p<0.05) at all time points. The decrease in eye 2 mean IOP from baseline was statistically significant at all time points except day 30. Using this analysis the greater mean IOP reductions from the baseline mean IOP for eye 1 were at study day 1 (-19%), day 14 (-15.7%), day 37 (-16.3%), day 60 (-20.0%), day 90 (-18.1%), day 97 (-16.8%), and day 120 (-15.8%). For eye 2 greater mean IOP reductions from baseline mean IOP were seen on day 37 (-13.0%), day 60 (-16.7%), day 90 (-15.5%), day 97 (-14.5%), and day 120 (-7.2%). No statistically significant differences were found in mean IOP reduction between the two eyes treated. A total of 34 patients (92%) showed adverse effects: conjunctival hyperemia in 26 (70.3%) and conjunctival hemorrhage in 14 (37.8%).

CONCLUSIONS

This pilot study of PNT showed a potentially good IOP lowering effect on glaucoma and hypertensive patients. Additional studies would help to better define the types of patients who respond to PNT and to identify risk factors that may lead to treatment failure.

Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10

The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10 (Phototrop) on the visual functions and fundus alterations in early age-related macular degeneration (AMD). One hundred and six patients with a clinical diagnosis of early AMD were randomized to the treated or control groups. The primary efficacy variable was the change in the visual field mean defect (VFMD) from baseline to 12 months of treatment, with secondary efficacy parameters: visual acuity (Snellen chart and ETDRS chart), foveal sensitivity as measured by perimetry, and fundus alterations as evaluated according to the criteria of the International Classification and Grading System for AMD. The mean change in all four parameters of visual functions showed significant improvement in the treated group by the end of the study period. In addition, in the treated group only 1 out of 48 cases (2%) while in the placebo group 9 out of 53 (17%) showed clinically significant (>2.0 dB) worsening in VFMD (p = 0.006, odds ratio: 10.93). Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes (p = 0.045) or the less affected eyes (p = 0.017) were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early AMD.

MTHFR C677T mutation, factor II G20210A mutation and factor V Leiden as risks factor for youth retinal vein occlusion

OBJECTIVE

To determine whether methylene tetrahydrofolate reductase (MTHFR) C677T mutation, factor II G20210A mutation and factor V Leiden are risk factors for retinal vein occlusion (RVO) in patients under fifty years of age.

METHODS

Comparison of 29 patients, under 50 years old of age, as affected RVO and 62 age matched normal controls. Plasma MTHFR C677T genotype, Factor II G20210A genotype, Factor V Leiden genotype, S protein level, C protein level, APCR presence (Actived Protein C Resistance), homocysteine level and Beta-thromboglobulin level were determined.

RESULTS

Seventeen RVO patients and twenty-one controls were heterozygous for the MTHFR C677T mutation. Three RVO patients and twenty-three controls were homozygous for the MTHFR C677T mutation. Three RVO patients and two controls were heterozygous for the factor II G20210A mutation. One control was heterozygous for the factor V Leiden.

CONCLUSIONS

This study fails to demonstrate that these mutations are risk factors for RVO in patients under fifty years of age.

Mitotropic compounds for the treatment of age-related macular degeneration. The metabolic approach and a pilot study

Recent histopathologic studies have shown that mitochondria and peroxisomes of the retinal pigment epithelium may play a central role in the pathophysiology of age-related macular degeneration (AMD). We supposed that compounds which improve mitochondrial functions (mitotropic compounds) may show beneficial effects in preventing AMD. Fourteen patients affected by early AMD were treated with a mixture containing acetyl-L-carnitine (ALC), polyunsaturated fatty acids (PUFAs), coenzyme Q10 (CoQ10) and vitamin E, while an equal number of age- and sex-matched patients affected by early AMD were treated with vitamin E only. Recovery time after macular photostress, foveal sensitivity and mean defect in the visual field as well as blood lipid levels were recorded at the beginning and after 3, 6, 9, 12 and 24 months of follow-up. In the treated group, all the visual functions showed slight improvement which was evident after 3 months of treatment and remained nearly stationary by the end of 24 months. The same tests in the control group showed slow worsening. The divergence between treated and control groups became more marked with time, but the difference was not significant at any time of the follow-up. These findings suggest that the blend of ALC, PUFA, CoQ10 and vitamin E may improve retinal functions in early AMD.

A new method of biofeedback in the management of low vision

Twenty-eight patients with low vision were enrolled into the study. A preliminary study was carried out on 18 eyes of 13 patients with low vision who underwent visual rehabilitation with a new instrument for biofeedback (BF) applied to vision; improved biofeedback integrated system (Ibis). Successively, eight patients (16 eyes) with bilateral low vision were subjected to biofeedback in one eye. The experimental and control eye were evaluated separately. Then a placebo training was developed on seven patients (12 eyes). Visual acuity, colour vision, automated perimetry, contrast sensitivity and flash VEP were evaluated. A brief review of the literature and the possible mechanisms behind the results are discussed.

Subjective visual halos after sildenafil (Viagra) administration: Electroretinographic evaluation

PURPOSE

The ophthalmologic and electroretinographic (ERG) findings in one subject with subjective visual disturbances after sildenafil administration are described.

DESIGN

Interventional case report.

METHODS

A complete ophthalmologic examination was performed, including best-corrected visual acuity and ERG, repeated 1 and 2 hours after administration of 100 mg of sildenafil.

MAIN OUTCOME MEASURES

Rod responses were obtained over a range of retinal illuminances from those producing a minimum detectable response to those producing rod saturation. Intensity amplitude function was determined.

RESULTS

At 2 hours after 100 mg of oral sildenafil, we observed significant variations from baseline in parameters of best-fit Naka-Rushton function; V(max) was notably higher, and K was 0.14 log units lower than baseline.

CONCLUSIONS

Sildenafil administration resulted in a higher rod response to light stimuli and in a higher rod sensitivity. These findings are consistent with the weak PDE-6 inhibition induced by sildenafil.

Use of Erbium:YAG laser in the treatment of palpebral xanthelasmas

OBJECTIVE

In light of the research and the use of lasers in the therapy of xanthelasmas, the authors report their experience in the treatment of this pathology with Erbium:YAG laser.

MATERIALS AND METHODS

In 30 patients, all female, 70 xanthelasmas were treated with Erbium:YAG laser, 65 (93%) of which were on the upper eyelid and 5 (7%) on the lower eyelid, varying from 1 x 1.5 mm to 11 X 20 mm in size. Spots with a diameter of 1.6 mm, energy of 300 mJ, frequency of 1-5 Hz and in a number varying were used in relation to the extent of the pathology.

RESULTS

In all cases, the appearance and functional results were good, without leaving scars and/or dyschromia.

CONCLUSIONS

Erbium:YAG laser, in the treatment of xanthelasmas, is a parasurgical method that is simple to perform and because of the successful aesthetic and functional results, is a valid alternative to the more traditional treatment methods.

Transient visual symptoms in systemic lupus erythematosus and antiphospholipid syndrome

PURPOSE

To review the potential pathogenic mechanisms of transient visual symptoms (TVS) in the course of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), to discuss the most common clinical features associated with the occurrence of TVS, and to explore possible treatment options for these patients.

METHODS

The literature regarding the clinical and laboratory characteristics of SLE and APS patients experiencing TVS is reviewed from 1979 onward. A brief review of the wide spectrum of ophthalmologic features occurring in SLE and APS is also provided.

RESULTS

Data emerging from the review process point to thromboembolism as the most probable cause of TVS in SLE and APS. Thromboembolisms are likely induced by cardiac valve abnormalities and should be treated with anticoagulant drugs.

CONCLUSION

While progress has been made in understanding the association of TVS with SLE and APS, further investigation is needed to clarify this interesting relationship.

Excimer laser photorefractive keratectomy for hyperopia

BACKGROUND AND OBJECTIVE

Photorefractive keratectomy (PRK) has been extensively evaluated for the correction of myopia. This study was undertaken to assess the safety, efficacy, and reliability of PRK in the correction of hyperopia.

PATIENTS AND METHODS

There were 28 eyes with refractions of +1 to +7.75 D treated for hyperopia with the Chiron Technolas 217-C excimer laser. Thorough visual assessments were made before treatment and at regular follow-up to 18 months. Complications and patient satisfaction were noted.

RESULTS

At 18 months the mean subjective refraction was +0.46+/-1.00 D with 26 eyes (92.8%) within 1 D of emmetropia. Thirteen eyes (46.4%) achieved uncorrected visual acuity (UCVA) of 20/20 or better and all patients had an UCVA of > or = 20/32 or better. Best corrected visual acuity (BCVA) remained unchanged in 26 eyes (92.8%) and improved in 2 eyes (7.2%). On the seventh day from treatment, 17 eyes (25%) had a loss of 2 or more lines of BCVA. At 15 days this was reduced to 8 eyes (14.3%) and at one month to 3 eyes (3.6%). There were no cases of loss of 2 or more lines of BCVA at 18 months of follow-up. All patients expressed a high degree of satisfaction.

CONCLUSIONS

Photorefractive keratectomy safely and effectively reduced hyperopia in the patients studied. The technique was reliable and still offered good results at 18 months of follow-up.

'Minimal-change hypertensive retinopathy' and 'arterial pre-hypertension', illustrated via ambulatory blood-pressure monitoring in putatively normotensive subjects

PURPOSE

To investigate the 24 h blood-pressure (BP) pattern in subjects who were found to show some incipient signs of hypertensive retinopathy but had been diagnosed as normotensives by means of casual sphygmomanometry.

METHODS

Non-invasive ambulatory BP monitoring was performed in 25 caucasian subjects (16 M, 9 F; mean age 46 +/- 16 years) showing this type of retinal problem. A comparable number of controlled normotensive Caucasian subjects (15 M, 10 F; mean age: 48 +/- 15 years) without funduscopic signs of hypertensive retinopathy were investigated as a reference group. A series of BP tests over time was analysed by means of conventional biometry and chronobiological methods.

RESULTS

The biometric estimates suggest that the investigated subjects with incipient hypertensive retinopathy, although characterized by BP values below 140/90 mmHg, show a significantly higher daily systolic BP. The increase, however, is within WHO reference limits and is not associated with the abolition of the circadian BP rhythm.

CONCLUSIONS

The results suggest that the initial signs of hypertensive retinopathy may appear before BP elevation above WHO reference limits occurs. Because of this, it can be assumed that there is such a condition as 'minimal-change hypertensive retinopathy' associated with a haemodynamic picture of 'arterial pre-hypertension'.

Indocyanine green angiographic findings in idiopathic choroidal neovascularisation

PURPOSE

The authors report the cases of two patients affected with idiopathic choroidal neovascularisation studied with combined fluorescein angiography and indocyanine green (ICG) angiography. In particular the presence of choroidal abnormalities at ICG angiography which could not be detected by fluorescein angiography was studied.

METHODS

Both patients underwent a complete systemic and ocular assessment. Fluorescein angiography and ICG angiography were performed in a routine fashion at the time of presentation in both cases and after 14 months in the second patient.

RESULTS

Results of the systemic investigations were unremarkable. A distinct dark rim surrounding the choroidal neovascular net was evident until the late phases of ICG angiography despite the presence of subretinal blood. Dilated choroidal vessels were observed beneath the neovascular membrane in both cases. In the first patient a hyperfluorescent area beyond the primary lesion was detected in the affected eye and a distinct leaking subfoveal choroidal venous vessel was found in the fellow eye. The second patient never showed other angiographic alterations either in the affected or in the fellow eye.

CONCLUSIONS

ICG angiography has proved to be useful, both to better define and follow up the true extent of the pigment halo (healing response) around the neovascular membrane when subretinal blood and dye leakage at fluorescein angiography prevent its full appreciation, and to rule out other causes of choroidal neovascularisation in young healthy adults associated with either choroidal inflammatory focal lesions or choroidal vascular dynamic or inflammatory alterations.

Retinopathy in systemic lupus erythematosus: pathogenesis and approach to therapy

The starting point in the assessment of SLE-retinopathy is the clinical examination by ophthalmoscopy and retinal fluorescein angiography. It is noted that two major clinical forms of retinopathy may occur in SLE; (1st) the "classic" type characterized by cotton-wool spots with or without intraretinal hemorrhages, and (2nd) the thrombosis of larger retinal blood vessels, such as central or branch arteries/veins. However, a well-defined pathogenetic classification of SLE-retinopathy has still not been proposed as yet. A practical classification based on the pathogenesis could be of aid to commence a more appropriate treatment. The aims of this paper are; (1st) to focus on the most implicate mechanisms of retinal vascular disease in SLE, (2nd) to mention the most common features associated with the different forms of retinopathy, and finally (3rd) to assess the prevalence of retinopathy in SLE. In our opinion, it seems that two major types of retinopathy exist in SLE: firstly, the Hughes' retinopathy due to antiphospholipid-induced retinal vascular thrombosis, for which anticoagulation is the best treatment, and secondly, the "classic" retinopathy in which at least two major causes could be associated; vasculitis and accelerated atherosclerosis. In patients with "classic" retinopathy, the most appropriate treatment still needs to be established. If "classic" retinopathy is due to vasculitis, immunosuppressive drugs should be administered, while if atherosclerosis play an etiologic role, a prophylaxis with antioxidants or the use of low-dose aspirin should be assessed.

Optic neuropathy in systemic lupus erythematosus and antiphospholipid syndrome (APS): clinical features, pathogenesis, review of the literature and proposed ophthalmological criteria for APS diagnosis

Optic neuropathy is a well-known ocular manifestation occurring in patients with systemic lupus erythematosus (SLE), and it remains one of the major causes of blindness in these patients. We report data from six SLE patients with optic neuropathy, one of whom was considered to have antiphospholipid syndrome (APS). This patient had monolateral optic neuropathy, whereas the other five SLE patients had bilateral optic nerve disease. We believe that the monolateral occurrence of optic neuropathy in our patient can be considered as a 'focal' neurological disease due to a thrombotic event involving the ciliary vasculature. Conversely, bilateral optic nerve damage in SLE could be considered to be a 'general' neurological disease due to different immunological mechanisms, such as vasculitis. Additionally, the literature on SLE patients affected by optic neuropathy is reviewed to evaluate the major clinical features, particularly neurological features. In reviewing the literature, it appears that bilateral optic neuropathy in SLE occurs more frequently than monolateral optic neuropathy, and the main neurological manifestation seen in these patients is transverse myelitis, particularly in SLE patients with bilateral optic nerve disease. Finally, we propose a clinico-ophthalmological spectrum of APS and outline the ocular clinical manifestations that can be considered as diagnostic for the syndrome.

Excimer laser photorefractive keratectomy for high myopia and myopic astigmatism

BACKGROUND AND OBJECTIVE

To determine the efficacy, safety, and predictability of excimer laser photorefractive keratectomy of high myopia and myopic astigmatism.

PATIENTS AND METHODS

76 eyes of 52 patients with myopia from -8.00 to -23.50 diopters (D) with or without astigmatism up to -5.50D were treated with the VISX 20/20 excimer laser (VISK, Santa Clara, CA) and a multi-zone ablation technique. Visual acuity, manifest refraction, corneal haze, and topography were evaluated at 1 week and 1, 3, 6, 12, and 18 months postoperatively.

RESULTS

Postoperative refractions were generally stable after 12 months. At the last follow-up all patients were within - 1.96 D of the intended correction. Eighteen months postoperatively, 68% of patients undergoing photorefractive keratectomy (PRK), and 65% of patients undergoing photo astigmatic refractive keratectomy (PARK), were within 1 D of planned refraction. Furthermore, 87% of patients after PRK and 80% of patients after PARK had a visual acuity of 20/40 or better.

CONCLUSIONS

High myopia with or without astigmatism was successfully treated in most of the patients using PRK. The stability of the postoperative refraction during the first 18 months seems to be good. The incidence of adverse effects was low but improvements in the future should further reduce complications, thus increasing the safety of refractive procedures.

The clinico-ophthalmological spectrum of antiphospholipid syndrome

Antiphospholipid syndrome (APS) is a hypercoagulable disorder with highly variable symptomatology including ocular manifestations. Antiphospholipid antibodies (aPL) are the serologic markers of this clinical entity. Our aim was to note the main associated ocular features of APS and elucidate which pathogenic mechanisms may participate. Retinal vascular thrombosis and different neuro-ophthalmologic manifestations, such as optic neuropathy and amaurosis fugax, may be considered as the ocular hallmarks of this syndrome. Ocular features due to aPL-induced thrombosis should be treated with anticoagulant drugs. Conversely, for the treatment of ocular features due to immunological mechanisms such as vasculitis, immunosuppressive regimes seem to be more appropriate.

Catecholaminergic nerve fibres in normal and alkali-burned rabbit cornea

BACKGROUND

In recent years anatomic research has demonstrated the presence of various types of nerve fibre in the cornea. The purpose of this study was to investigate the distribution of catecholaminergic fibres in various corneal layers and to study the effects of an experimental superficial corneal lesion on the pattern of catecholaminergic nerve fibre distribution in the various corneal layers.

METHODS

Three weeks after the creation of an alkali burn in the centre of the right cornea of five albino rabbits, the animals were killed, and histologic sections from the cornea of both eyes were stained for observation of catecholaminergic nerve fibres and photographed on black-and-white film. The photographs were examined using the Quantimet image analyser (Leica).

RESULTS

Catecholaminergic nerve fibres were observed in the corneal epithelium and the deep stromal layers. Sections from injured cornea showed a drastic reduction in epithelial and superficial stromal catecholaminergic nerve fibres, whereas the nerve fibres in the endothelium and deep stroma were not damaged.

INTERPRETATION

Although catecholaminergic nerve fibres were observed in all corneal layers, the pattern of catecholaminergic fibres following the creation of a superficial lesion of the cornea seems to suggest that the superficial and deep nerve fibres may have a different distribution.

Ultrasound biomicroscopy in the clinical evaluation of ab externo holmium:YAG laser sclerostomies

High-frequency ultrasound biomicroscopy (UBM) has extensive powers of resolution. This makes it possible to explore and study some areas of the anterior segment with a clarity close to that of histologic preparations. High-frequency UBM was used in the clinical evaluation of 10 glaucomatous eyes subjected to ab externo holmium:yttrium-aluminum-garnet (Ho:YAG) laser sclerostomy. The anatomic characteristics of the fistular paths were viewed and compared with echographic images. The authors demonstrated that in the 5 cases where the filtering bleb, fistular path, and internal ostium were present, there was a reduction of intraocular pressure. UBM is a high-definition diagnostic instrument in the follow-up of fistular paths and filtering blebs after Ho:YAG laser sclerostomy, making it possible to reoperate at an early stage before the onset of clinical manifestations.

[Nonsteroidal anti-inflammatory agents: their topical use in the treatment of xerophthalmia secondary to Sjögren's syndrome]

The authors, in a case-control study, analyzed the topical application of nonsteroidal anti-inflammatory drug (flurbiprofene drops) in patients affected by keratoconjunctivitis sicca in Sjögren's syndrome. The variation of break-up-time values, and xerophthalmia grade were analyzed. A mild increase of mean values of break-up-time (two seconds in the treated group), and a mild decrease of xerophthalmia grade were found.

Ischemic optic neuritis in Churg-Strauss syndrome

There are few reports of neuro-ophthalmologic involvement in Churg-Strauss syndrome (CSs). We described a case of unilateral optic atrophy in a 46-year-old-white man with CSs. The patient had severe bronchial asthma, allergic rhinitis, hypereosinophilia (8%) and peripheral neuropathy. The visual acuity in his right eye was light perception. At the biomicroscopy there were no corneal and conjunctival lesions. Ophthalmoscopy showed a pale right optic disc and fluorangiography revealed a marked hypofluorescence of the disc at early phase of angiogram. We suggested that the optic atrophy was most probably due to vasculitis of the ciliary arteries.

Work-related accidents of ophthalmologic interest in Italy during 1986-1991

The authors analysed accidents of ophthalmological interest obtaining information from the database of the INAIL (National Insurance Institute for Professional Casualties) concerning the period of 1986-1991. The INAIL registers all casualties that cause work disabilities exceeding 3 days. The investigation included all job types grouped into two major categories: agriculture (16% of all insured labour) and industry/craftsmanship (84%). Over 78% of the cases examined were in the industry/craftsmanship category. Approximately 22% of the cases were in the agriculture category. Every year in Italy, about 6% of regularly employed workers suffer casualties. The incidence of casualties of ocular interest has been a stable 0.37% in the years examined; 2.88% of these casualties produce permanent consequences (1/10,000 workers per year). The risk in 3 times higher in agriculture.

Fox's modified technique using the Mersilene mesh sling in the management of blepharoptosis

BACKGROUND AND OBJECTIVE

Frontalis suspension is the best surgical procedure for severe ptosis with poor or absent levator muscle function. In addition to autologous fascia lata, a variety of materials are available for suspension. The authors describe the use of Mersilene mesh slings developed to overcome the problems of failure, slippage, and extrusion commonly associated with various suspensory materials.

PATIENTS AND METHODS

Brow suspension was performed in 20 ptotic eyelids of 14 patients. All patients had severe ptosis with levator function of 4 mm or less. The surgical technique used was a modified version of the method originally described by Fox using the Mersilene mesh sling.

RESULTS

The improvement in lid height was evaluated by preoperative and postoperative vertical aperture measurements and ranged from 2 to 5 mm (average 3.5 mm). The results were maintained in all cases during a follow-up period of 18 months.

CONCLUSION

The good functional and cosmetic results suggest that Fox's modified technique using the Mersilene mesh sling has a definite place in ptosis management.

Ocular toxicity of systemic chemotherapy with megadoses of carmustine and mitomycin

The use of chemotherapeutic agents in high doses in the treatment of advanced-stage cancer enhances drug toxicity, and ocular complications are not uncommon. In this article, we discuss the ocular toxicity in six patients with advanced nonpretreated colorectal cancer who received megadoses of carmustine and mitomycin with the support of autologous bone marrow transplantation. The results obtained did not reveal any subjective or objective pathologic conditions of the ocular apparatus with particular attention to orthoptic examinations, the anterior segment, and the fundus. No patient had changes in visual acuity. Tonometry did not demonstrate significant variations. There were, however, qualitative and quantitative changes in the tear films of all patients, leading to damage to the corneal and conjunctival epithelium.

Visual disturbances associated with primary empty sella syndrome in patients with chronic renal failure

After describing the main clinical features of primary empty sella syndrome and the main hormonal alterations in chronic renal failure, the authors report the results obtained in a group of 33 patients undergoing dialysis three times a week. Each patient had a complete ophthalmologic examination, with electroretinography and visual-evoked potentials, a complete radiologic examination, including skull stratigraphy (particularly of the sellar and parasellar bony structures), and a computed tomographic scan. In the whole group, visual acuity, ocular and lid motility, and visual fields were normal. In two patients, a slight bilateral papilledema, associated with a P100 latency increase and normal morphology and visual-evoked potentials, was reported. Two patients had initial unilateral papillary pallor associated with P100 amplitude alterations. In all four of these patients, radiologic examination showed a markedly pathologic sellar widening with thickening and double contour image of the floor. The report of a primary empty sella was confirmed by computed tomography in all four cases. The authors discuss the possible etiopathogenic mechanisms of the neuroophthalmologic symptoms associated with this syndrome.

Mitochondrial DNA mutation in an Italian family with Leber hereditary optic neuropathy

Mitochondrial (mt) DNA from a Southern Italian family with Leber hereditary optic neuropathy was analyzed for the presence of the reported mutation at position 11778 of the ND4 subunit gene. The point mutation was found in mt DNA extracted from peripheral blood in all members of the family with the exclusion of the father, and was present in a homoplasmic fashion, despite the phenotypic heterogeneity of disease presentation among family members.

Ocular manifestations in HIV-seropositive patients

A total of 153 patients with human immunodeficiency virus (HIV) infection underwent complete ophthalmologic examinations for the presence of any eye pathology. We wanted to show a correlation between such pathology and total CD4+ lymphocyte count, believed to be an indicator of immunologic status. The most frequently encountered lesions were cotton-wool patches, vascular congestion, hemorrhages, chorioretinitis, segmental vasculitis, and pallid papilla. Almost all of the patients with ocular anomalies also had a CD4+ count of less than 200 cells/mm3 suggesting that ocular lesions have a negative prognostic significance even in asymptomatic patients who present with a severe impairment of their immune system.