Secondary glaucoma induced by bilateral acute depigmentation of the iris / Glaucoma secundário à despigmentação bilateral aguda da íris

Abstract We report a case of a middle-aged woman who developed acute, bilateral, symmetrical, slightly transilluminating depigmentation of the iris and pigment discharge into the anterior chamber following the use of oral moxifloxacin for bacterial sinusitis. She had been misdiagnosed as having autoimmune uveitis, treated with steroids and tropicamide, and underwent severe ocular hypertension and glaucoma despite posterior correct diagnosis.

Resumo Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentação bilateral simultânea aguda com dispersão de pigmentos na câmara anterior e discreta transiluminação após o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide tópico e tropicamida e evoluiu com hipertensão ocular grave e glaucoma apesar de ,posteriormente, o diagnóstico ter sido correto.

Frequency of fibromyalgia syndrome in patients with central serous chorioretinopathy / Frequência de síndrome de fibromialgia em pacientes com coriorretinopatia serosa central

ABSTRACT Purpose: To ınvestigate frequency of fibromyalgia syndrome (FMS) among patients with central serous chorioretinopathy (CSCR). Methods: The study included 83 patients with CSCR and 201 age- and sex-matched healthy controls; the mean age was 47.5 ± 11.3 years in the CSCR group (18 women; 21.7%) and 47.2 ± 11.2 years in the control group (44 women; 21.9%). All participants were assessed for FMS based on 2010 American College of Rheumatology diagnostic criteria and for depression and anxiety with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Results: FMS was diagnosed in 35 patients (42.2%) from the CSCR group and in 21 individuals (10.4%) from the control group (p<0.001). It was found in 77.77% of the women (14/18) and 32.3% of the men (21/65) in the CSCR group and in 22.7% of the women (10/44) and 7.0% of the men (11/157) in the control group. Familial stress, BDI and BAI scores were higher in the patients with FMS than in those without. When independent risk factors were evaluated by logistic regression analysis, it was found that only the presence of familial stress was a significant risk factor for FMS. Conclusions: Patients with CSCR should be assessed for the presence of FMS, and this should be taken into consideration when developing a treatment plan. Further studies with a larger sample size are needed to clarify the relationship between FMS and CSCR.

RESUMO Objetivo: Investigar a frequência da fibromialgia (FMS) entre os pacientes com coriorretinopatia serosa central (CSCR). Métodos: O estudo incluiu 83 pacientes com CSCR e 201 controles saudáveis pareados por idade e sexo. Todos os participantes foram avaliados com base nos critérios de diagnóstico de FMS do American College of Rheumatology de 2010 (ACR), Beck Anxiety Inventory (BAI) e Beck Depression Inventory (BDI). Resultados: A idade média foi 47,53 ± 11,33 anos no grupo CSCR (18 mulheres; 21,7%) e 47,19 ± 11,19 anos (44 mulheres; 21,9%) no grupo controle. FMS foi diagnosticada em 35 pacientes (42,2%) do grupo CSCR e em 21 indivíduos (10,4%) do grupo controle (p<0,001). FMS foi encontrado em 77,77% das mulheres (14/18) e 32,3% dos homens (21/65) no grupo CSCR e em 22,7% das mulheres controles (10/44) e 7,0% dos homens controles (11/157). Estresse familiar, BDI e BAI foram maiores nos pacientes com FMS em comparação com aqueles sem FMS. Quando os fatores de risco independentes foram avaliados por análise de regressão logística, verificou-se que apenas a presença de estresse familiar foi um fator de risco significativo para FMS. Conclusões: Os pacientes com CSCR devem ser avaliados para presença de FMS e a FMS deve ser levada em consideração durante o desenvolvimento de um plano de tratamento. São necessários mais estudos com maior tamanho da amostra para esclarecer relações entre FMS e CSCR.

Mediated effects of endoplasmic reticulum stress on light-induced apoptosis and inflammation of human retinal pigment epithelial cell / 中华实验眼科杂志

Background The light damage model of retinal pigment epithelium (RPE) cells is a research direction of retinal degeneration diseases,and RPE cell apoptosis induced by light damage and inflammation is an important pathologic basis of light-induced RPE cell damage.However,whether endoplasmic reticulum stress (ERS) paticipates in light-induced RPE cell damage is rarely reported.Objective This study was to explore the effects of ERS on light-induced RPE cell damage.Methods Human RPE cell line (ARPE-19) was cuhured,and light damage models were created by irradiating the cells for 3-,6-,12-and 24-hours with white fluorescent lamp with the intensity of (2 000±500)lx for the selection of optimal irradiating time,and the cells in the normal control group were cultured in the dark environment.The cells were divided into normal control group,light exposure group and 4-phenylb utyric acid (4-PBA) pretreated +light exposure group.The cells from 4-PBA pretreated +light exposure group were cultued firstly with 4-PBA for 30 minutes and followed by light exposure for 12 hours.The apoptisis rate of the cells and intracellular reactive oxygen species (ROS) content were detected by flow cytometry;the concentrations of interleukin 1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the cell supernatant were assyed by ELISA.The relative expressing levels of activating transcription factor 6 (ATF-6),C/enhancer binding protein homologous protein (CHOP) and caspase-12 mRNA and protein in the cells were detected by real-time quantitative PCR and Western blot,respectively.Results The cultured cells showed a long spindle shape,the border was not clear,the cytoplasm was degranulation,and the cell fragments increased.Flow cytometry showed that compared with the normal control group,the ROS content in the cells and the apoptosis rate were evidently increased with the lapse of light exposure time (F=763.00,119.30,both at P＜0.01).ELISA results showed that the concentrations of IL-1β and TNF-α in the cell supernatant were significantly higher in the light exposure 6-hour group than those in the normal control group with the peak value in the light exposure 12-hour group.Compared with the normal control group,the relative expression levels of ATF-6,CHOP and caspase-12 mRNA and protein in the cells were elevated in the light exposure group and peaked in the light exposure 12-hour group.In addition,the relative expression levels of ATF-6 mRNA,CHOP mRNA and caspase-12 mRNA in the cells were significantly reduced in 4-PBA pretreated+light exposure group compared with the light exposure group (F=281.69,473.88,308.45,all at P＜0.01),and their proteins were also significantly reduced (F =47.86,57.93,106.59,all at P ＜ 0.01).The apoptosis rate,concentrations of IL-1β and TNF-α in the cell supernatant were significantly reduced in 4-PBA pretreated+light exposure group compared with the light exposure group (F =88.64,245.47,101.01,all at P＜0.01).Conclusions The light exposure at (2 000 ± 500)lx induces intracellular ROS accumulation and activates the ERS response,which results in apoptosis and inflammatory process of human RPE cells.4-PBA,a inhibitor of ERS,can suppress light-induced ERS response and therefore reduces the apoptosis rate and inhibits inflammatory process.

Promoting effect of p75NTR receptor overexpression on oxidative stress injury in human retinal pigment epithelium cells / 中华实验眼科杂志

Background Choroidal neovascularization (CNV) is the primary pathogenic cause of many fundus diseases.Oxidative stress injury of retinal pigment epithelial (RPE) cells plays important role in angiogenesis of choroid new blood vessels.Oxidative stress injury can active p75NTR receptor, a member of tumor necrosis factors family,resulting in the proliferation of vascular endothelial cells.However, the mechanisms of vascular endothelial cell proliferation remain unclear.Objective This study was conducted to investigate the effect of p75NTR overexpression on CNV and the relative mechanism.Methods The ARPE-19 cell line was used in this study.RPE cells were transfected with p75NTR receptor overexpressed plasmid, and untransfected cells served as the control group.The transfected results were verified by reverse transcription-PCR and Western blot assay.Viability of the cells over time was determined in the p75NTR receptor plasmid transfected group by using BrdU assay.The percentage of apoptotic cells was detected by flow cytometry using Annexin V-FITC/PI fluorescence staining.The percentage of reactive oxygen species (ROS) expression in the cells was detected by using H2 DCFDA fluorescence and flow cytometry.Mitochondrial membrane potential and cytochrome C expression were examined under the confocal microscope.The protein expressions of cleaved caspase-3, Fas and VEGF were determined by Western blot assay.Results The relative expression level of p75 NTR receptor mRNA was (6.11 ±0.77) times higher than that of the control group, and relative expression level of p75NTR receptor protein in the cells in the p75NTR receptor plasmid transfected group was (7.42±0.48) times higher than that in the control group (t=11.49 and 23.17 ,both at P＜0.01).The absorbency values of the p75NTR receptor plasmid transfected group were (93.12±0.56) ％ , (86.30±0.66) ％ , (72.53-±0.86) ％ and (60.77 ±2.81) ％ in 12,24,36 and 48 hours after plasmid transfection, which were significantly lower than 100％ in the control group, and the apoptotic percentages were evidently higher than that in the control group (all at P＜0.05).The relative fluorescence intensity of ROS fluorescence in the p75NTR receptor plasmid transfected group was 2.4 times higher than that in the control group,showing significant difference (t=16.45, P＜0.01).The positive expressing rate of mitomarker (mitochondrial membrane potentials) was 100％ in the control group and (37.30± 2.06)％ in the p75NTR receptor plasmid transfected group, with significant difference between them (t =57.71,P＜0.01).The fluorescence intensity of cytochrome C expression was elevated in the p75NTR receptor plasmid transfected group compared with the control group.Compared with the control group,the expressing levels of cleaved caspase-3 ,Fas and VEGF165 proteins in the cells were significantly raised in the p75NTR receptor plasmid transfected group (all at P＜0.01).Conclusions Overexpression of p75NTR receptors in RPE cells leads to mitochondrial damage and cellular apoptosis and the secretion of VEGF protein, which sequentially promote CNV.P75NTR receptor may be another important regulation pathway in RPE oxygen damage.

Bilateral acute iris transillumination (BAIT) initially misdiagnosed as acute iridocyclitis / Transiluminação de íris aguda bilateral (BAIT) inicialmente diagnosticada como iridociclite aguda

Bilateral acute iris transillumination (BAIT) is a relatively new clinical entity characterized by bilateral acute loss of iris pigment epithelium, iris transillumination, pigment dispersion in the anterior chamber, and sphincter paralysis. We report the case of a 30-year-old male who was initially diagnosed with acute iridocyclitis in a different clinic and treated with topical and systemic corticosteroids. He was referred to our clinic to seek another opinion because his symptoms did not improve. An ocular examination revealed bilateral pigment dispersion into the anterior chamber, diffuse iris transillumination, pigment dusting on the anterior lens capsule, atonic and distorted pupils, and increased intraocular pressure, suggesting a diagnosis of BAIT rather than iridocyclitis. Clinicians should be aware of the differential diagnosis of syndromes associated with pigment dispersion from iridocyclitis to avoid aggressive anti-inflammatory therapy and detailed investigation for uveitis.

A transiluminação de íris aguda bilateral (do inglês, bilateral acute iris transillumination, BAIT) é uma entidade clínica relativamente nova, caracterizada pela perda aguda bilateral do epitélio pigmentado da íris, transiluminação iriana, dispersão de pigmentos na câmara anterior, e paralisia do esfíncter pupilar. Nós relatamos o caso de um homem de 30 anos que foi diagnosticado com iridociclite aguda e tratado com corticosteroides tópicos e sistêmicos. Ele foi encaminhado ao nosso serviço para outra opinião, porque seus sintomas não melhoram com a terapia. Um exame oftalmológico revelou dispersão bilateral de pigmentos para a câmara anterior, transiluminação difusa de íris, pigmento difusa na cápsula anterior do cristalino, pupilas atônicas e distorcidas, e um aumento da pressão intraocular, o que sugere um diagnóstico de BAIT em vez de iridociclite. Os médicos devem estar cientes do diagnóstico diferencial das síndromes associadas à dispersão de pigmento com a iridociclite para evitar a terapia antiinflamatória agressiva e investigação detalhada para uveíte.