Subclinical visual field alterations are commonly present in patients with Graves' Orbitopathy and are mainly related to the clinical activity of the disease

The present study was aimed to investigate optic nerve involvement by computerized perimetry in 40 (29 women, 11 men) consecutive GO patients not showing definite dysthyroid optic neuropathy (DON). All patients presenting visual acuity defects, pallor or swelling of the optic nerve, concomitant eye disease, evidence of apical crowding or optic nerve stretching at either MRI or CT imaging were excluded. Normal perimetry occurred in 7 patients (17.5%), 5 patients (12.5%) had "indeterminate" results and 28 patients (70%) presented abnormal perimetry. Particularly, 7 isolated paracentral, 5 pericentral and 16 combined peri and paracentral scotomas were found. On the contrary, 15/20 patients in the group without GO had normal perimetry, isolated scotomas were found in 5 cases (1 pericentral and 4 paracentral) and no case of combined scotoma occurred. The difference between the 2 groups was statistically significant (x2 = 9.17; p = 0.025). Overall, the sensitivity resulted 70%, the specificity 75% and the positive predictive value 84.8%. In patients with GO, the proportion of visual field alterations was significantly increased for Clinical Activity Score > or = 3 (p = 0.0005), while no relationship occurred with proptosis degree (p = 0.115). In conclusion, a great proportion of GO patients without clinically evident DON presents visual field defects, mainly related to GO activity.

Curcumin treatment protects rat retinal neurons against excitotoxicity: effect on N-methyl-D: -aspartate-induced intracellular Ca(2+) increase

Curcumin, an extract from the plant Curcuma longa with well-known antioxidant and anti-inflammatory activities, was tested as protective agent against excitotoxicity in rat retinal cultures. A 24 h-treatment with curcumin reduced N-methyl-D: -aspartate (NMDA)-mediated excitotoxic cell damage, estimated as decrease of cell viability and increase in apoptosis. The protection was associated with decrease of NMDA receptor-mediated Ca(2+) rise and reduction in the level of phosphorylated NR1 subunit of the NMDA receptor. These results enlighten a new pharmacological action of the plant extract, possibly mediated by a modulation of NMDA receptor activity.

Perfluorohexyloctane (F6H8) induces structural modifications and increases apoptosis in rat primary retinal cultures

The effects of perfluorohexyloctane (F6H8), recently investigated as a long-term artificial vitreous substitute, were studied in vitro, with the use of rat retinal cultures seeded on microporous inserts that allow the cell layer to be in contact with the material to be tested, on the apical side, and with the nutrient medium, on the basal side. After 72 h of treatment with F6H8, retinal cultures lost the characteristic two-layered organization with glial cells at the bottom and neuronal cells on top of them. They appeared to be composed of only one layer of polyhedrical, flattened, and disconnected cells. TUNEL assay revealed an evident increase in the percentage of apoptotic cells in F6H8-treated cultures (30.1 +/- 4.5), compared to control (10.3 +/- 2.6) and perfluoroctane-treated cultures (10.1 +/- 1.7). Immunolabeling of MAP-2, a protein of neuronal cytoskeleton, evidenced a marked loss of neurites. The results suggest that F6H8 is harmful to retinal cells in vitro and can therefore be potentially noxious to the retina as an artificial vitreous substitute.

Alteration of organized structure of biofilm formed by Staphylococcus epidermidis on soft contact lenses

The effect of a nonsteroidal antiinflammatory drug commercially available in eye drop form (sodium diclofenac) was assayed for its ability to affect biofilms formed by clinical Staphylococcus epidermidis isolates. Biofilms produced by one strain positive for a slime-associated antigen, suggested to be expressed by more virulent strains, was not affected by sodium diclofenac treatment. On the other hand, biofilm produced by the slime-positive, antigen-negative strain showed dramatic alterations already after short treatments with sodium diclofenac as reported for salicylate and other nonsteroidal drugs. Such results suggest further investigation of the possible use of sodium diclofenac drops in the treatment of ophthalmic infections in soft contact lens wearers.

Perfluorodecalin modifies the pattern of cell arrangement and induces loss of neurites in rat retinal cultures

Perfluorodecalin (PFD), a high specific weight, water-immiscible perfluorocarbon, previously studied as a potential blood substitute, now is used widely in the field of ophthalmic surgery as a tool for maneuvering intraocular tissues and as a short- or medium-term vitreous substitute. In in vivo experiments, several types of lesions in retinal tissue have been described in conjunction with long-term PFD treatment. To better evaluate the biological effects of PFD on retinal cells, we tested it on primary cultures of rat retina seeded on special cyclopore wells that allow the culture to be fed from the bottom side while the top side is in contact with the water-immiscible compound. We found that PFD changed the pattern of cell arrangement and induced loss of neurites. The modification of cell arrangement was less evident at the periphery of the wells where the amount of PFD, and consequently the pressure exerted, was lower. This observation suggests that the changes may be due more to a physical than to a toxic effect of PFD.

PEDF (pigment epithelium-derived factor) promotes increase and maturation of pigment granules in pigment epithelial cells in neonatal albino rat retinal cultures

Pigment Epithelium-Derived Factor (PEDF), purified from human retinal pigment epithelial (RPE) cell culture medium, is a neurotrophic factor which potentiates the differentiation of human Y-79 retinoblastoma cells and increases the survival of cerebellar granule cells. To investigate the effects of PEDF on non-transformed retinal cells, we used primary cultures of neonatal albino rat retinas, where the three principal cell types of the retinal layers (neuronal, glial and epithelial) were all present and focussed our attention on RPE cells, which are of special relevance for retinal pathophysiology. PEDF had a dramatic effect on these cells. They showed a modified phenotype, with larger dimensions, higher cytoplasmic spreading, presence of phagocytic vacuoles, development of wide intercellular contacts, and increase and maturation of pigment granules. These results suggest that PEDF may have a role in regulating RPE cell differentiation.

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.