Clinical effectiveness of a new oral curcumin formulation in acute non-infectious uveitic macular edema: a 12-month observational study.

OBJECTIVE: Oral supplementation with curcumin demonstrated a beneficial effect on some ocular diseases, including uveitis and macular edema. This study aimed to evaluate the effectiveness and safety of a curcumin formulation with the hydrophilic carrier (CHC; Diabec®, Alfa Intes, Italy) as an adjuvant to standard steroid treatment in adults suffering from acute non-infectious uveitic macular edema (NIUME). PATIENTS AND METHODS: This was a monocenter prospective observational study carried out between January 2019 and May 2020 on consecutive patients with a new diagnosis of NIUME. Patients were treated with standard therapy or with a CHC add-on to standard treatment. The observation period for each patient was 12 months. The Best Corrected Visual Acuity (BCVA) and the Central Macular Thickness (CMT) were the primary outcomes; Foveal Avascular Zone (FAZ) and intraocular pressure (IOP) were also assessed, along with safety data. RESULTS: A total of 43 eyes of 26 patients were analyzed. CHC-treated eyes showed an improvement in mean BCVA from baseline (0.34 logMar) to T6 (0.20 logMar) and T12 (0.19 logMar; p≤0.05 and p≤0.01, respectively); CMT decreased from a mean of 320 µm (T0) to 278 µm (T6; p≤0.05) and 272 µm (T12; p≤0.01). A significant improvement of mean BCVA in the CHC group at T6 and T12 was reported compared to the control group (p≤0.01). FAZ and IOP showed no statistically significant variations in both groups. No adverse events were recorded. CONCLUSIONS: CHC as an adjuvant treatment improved the anatomical and functional outcomes, without significant side effects in eyes affected by the recent onset of NIUME, compared to the sole standard therapy.

Diagnostic tools in ocular allergy.

Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists. This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests, and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding, and inspire further investigations. Tools, recommendations, and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.

Conjunctival allergen provocation test : guidelines for daily practice.

Conjunctival allergen provocation test (CAPT) reproduces the events occurring by instilling an allergen on the ocular surface. This paper is the compilation of a task force focussed on practical aspects of this technique based on the analysis of 131 papers. Main mechanisms involved are reviewed. Indications are diagnosing the allergen(s)-triggering symptoms in IgE-mediated ocular allergy in seasonal, acute or perennial forms of allergic conjunctivitis, especially when the relevance of the allergen is not obvious or in polysensitized patients. Contraindications are limited to ongoing systemic severe pathology, asthma and eye diseases. CAPT should be delayed if receiving systemic steroids or antihistamines. Local treatment should be interrupted according to the half-life of each drug. Prerequisites are as follows: obtaining informed consent; evidencing of an allergen by skin prick tests and/or serum-specific IgE dosages; being able to deal with an unlikely event such as acute asthma exacerbation, urticaria or anaphylaxis, or an exacerbation of allergic conjunctivitis. Allergen extracts should be diluted locally prior to administration. Positive criteria are based on itching or quoted according to a composite score. An alternative scoring is based on itching. CAPT remains underused in daily practice, although it is a safe and simple procedure which can provide valuable clinical information.

Deflazacort in the treatment of uveitis: a comparative study versus prednisone.

Since corticosteroids represent a fundamental tool in the treatment of uveitis, we evaluate the clinical efficacy and possible appearance of side effects of deflazacort, a new corticosteroid of third generation, versus prednisone at equiactive dosages. Sixty six patients suffering from recurring acute anterior uveitis (RAAU) and/or chronic anterior uveitis (CAU) were treated with deflazacort or alternatively prednisone in an "open" study. Clinical efficacy, ophthalmological parameters and haemato-bioassays were evaluated on admission and during the treatment period. All patients showed a complete remission of clinical signs and symptoms with both treatment and no statistically significant difference was evidenced between the studied groups. Concerning the possible appearance of side effects, the comparison between deflazacort and prednisone a statistically significant difference. These preliminary results are strongly encouraging and suggest further controlled studies on the employment of deflazacort in the treatment of uveitis.

Grid laser treatment of occult choroidal neovascularization in age related macular degeneration.

Laser photocoagulation treatment of occult choroidal neovascularization (CNV) in age related macular degeneration has been up to now discouraging. We report a randomized clinical trial comparing 'grid' laser treatment versus the natural course in 24 eyes with this kind of neovascularization. In 12 eyes a low energy scatter photocoagulation was applied to the areas of presumed CNV and abnormal retinal pigment epithelium, sparing the fovea. The follow-up ranged from 1 to 3 years. At the three months follow-up visit, the subretinal exudation appeared reduced in 40% of the treated eyes and in none of the control eyes. During the period of follow-up the occult CNV turned to classic CNV in 4 treated and in 4 untreated eyes. At the last examination (average follow-up 18 months), anatomical and functional conditions were not significantly different in the two groups. Our data fail to show a beneficial long-term effect of grid laser treatment for occult CNV; no iatrogenic complications were seen in our series.

Fundus angiography with fluorescein-labelled peptide fraction from bovine factor VIII: correlation with histologic findings.

A peptide fraction (VUEFFE) obtained from bovine factor VIII, with a high affinity for vessel endothelium, was bound to fluorescein and used for angiography in rabbits. Several eyes had undergone laser photocoagulation on the retina. The location of the dye was studied histologically with fluorescence microscopy on the enucleated, freeze-dried eyes. The angiographic and histologic findings were compared with findings obtained using sodium fluorescein. Fluorescein-labelled VUEFFE gave a longer lasting fluorescence of the retinal vessels with histologic evidence of dye deposition on the vessel wall. It also showed marked affinity for the photocoagulated tissues, giving intense and prolonged staining of the laser burns. Possible clinical applications are discussed.

[Myocardial infarct before 45 years of age: significance of the coronarographic study in asymptomatic patients]. / Infarto miocardico sotto i 45 anni: significato dello studio coronarografico in pazienti asintomatici.

The aim of our study was to evaluate the significance of coronary arteriography in young asymptomatic patients after myocardial infarction. Among a total of 586 consecutive patients who underwent left ventriculography and coronary angiography because of coronary heart disease during the period from January 1984 to June 1986, we selected 51 patients (8.7%) under 45 years of age (range 28-45 years) and without angina, dyspnea or electrocardiographic signs of myocardial ischemia during bicycle ergometric stress test. These patients, 50 males (98.0%) and 1 female (2.0%) were angiographically evaluated from 1 to 12 months after a first myocardial infarction. Coronary occlusions greater than or equal to 70% were found in 44 patients (86.3%): 36 of them (70.6%) had single-vessel disease, 6 (11.8%) double-vessel disease and only 2 (3.9%) triple-vessel disease; no coronary obstructions greater than or equal to 50% of the left main coronary artery were found. Among the 7 patients without critical stenoses (13.7%) 3 had "normal" coronary arteries, 3 noncritical stenoses and one presented an anomalous origin of the left circumflex artery from the right sinus of Valsalva. Only 1 patient underwent surgery. In conclusion, in young asymptomatic patients after a myocardial infarction coronary arteriography may identify a small group either without or with minor atherosclerotic involvement of the coronary tree, while the presence of a localized disease is confirmed in most patients. Therefore, in this selected subgroup, coronary angiography has a limited usefulness in defining high-risk patients possibly requiring surgical treatment.

Changes in cardiovascular function induced by verapamil in healthy subjects and in patients with ischemic heart disease.

Alterations in cardiovascular function induced by the acute intravenous administration of verapamil (5 or 10 mg) in 52 patients (29 with ischemic heart disease and 23 without heart disease) were evaluated with use of invasive techniques (right and left heart catheterization, left ventricular cineangiography, and coronary arteriography). The most significant changes were represented by a decrease in systemic vascular resistance and systemic arterial pressure, and an increase in heart rate and cardiac output. Contractility indexes were not depressed in either group, and altered ventricular wall motion tended to improve to a slightly smaller degree than in patients treated with nitroglycerin. The use of verapamil in patients with ischemic heart disease appears to be safe, and concern about the negative inotropic influences in humans no longer seems justified.

[Behaviour of serum CPK curves in acute myocardial infarction treated with digitalis, verapamil and combined verapamil-digitalis (author's transl)]. / Comportamento della curva della creatinfosfochinasi sierica nell'infarto acuto del miocardio trattato con digitale, verapamil e l'associazione verapamil-digitale.

In order to compare the effectiveness of different therapeutic regimens in reducing infarct size serial determinations of CPK activity (at 4 hourly intervals in the first 48 hours from the admission to CCU, at the 72th and at 120th hours) were performed in 100 patients with transmural AMI (53 anterior and 47 inferior) with no obvious evidence of LV failure and basal CPK levels lower than 50 U/L. 20 patients (control group) have been treated with glucose-insulin-potassium (GIK). 20 patients have been treated with GIK plus Verapamil (GIK + V). Verapamil was administered at the dose of 50 mg in continuous drip. 20 patients received GIK plus digoxin at the dose of 0.25 mg b.i.d. (GIK + D). 40 patients received GIK, Verapamil and digoxin at the above doses (GIK + V + D). Different values of CKr and infarct size (IS.) show a statistically significant difference between the various regimens, which is more evident if we consider the whole series. Infarct size was greater in patients treated with digoxin with respect to controls, while it was smaller in patients treated with Verapamil. Combined Verapamil-digoxin therapy is associated to an enzymatic behaviour not different from controls. Authors emphasize that in uncomplicated AMI digoxin causes an increase in infarct size while Verapamil reduces significantly it. Association of Verapamil allows the use of digoxin, if clinically justified, without increase in infarct size.

[Changes in left ventricular regional wall motion induced by Verapamil (author's transl)]. / Modificazioni indotte dal verapamil sulla cinetica zonale ventricolare sinistra.

28 subjects with atherosclerotic lesions of coronary arteries were studied by means of cineventriculography both before and after IV administration of verapamil Regional wall motion has been analyzed by means of two different methods. Imporvement of regional wall motion has been demonstrated in about 65% of cases. No significant result has been achieved in segments corresponding to previous infarctions. Such a response does not differ substantially from that evoked by nitroglycerin or other calcium antagonist drugs.

[Behaviour of some serum enzymes after permanent pacemaker implantation (author's transl)]. / Considerazioni sul comportamento di alcuni enzimi sierici dopo impianto di pacemaker permanente.

The behaviour of some serum enzymes (CPK, LDH, alpha HBDH, SGOT) in 50 patients after permanent pacemaker implantation is outlined. Changes of each enzyme were analyzed statistically by applying Student's t test. Most significant changes are represented by the increase in CPK serum concentrations (19 cases). In 14 of them LDH isoenzymes were evaluated and in 4 patients alteration of LDH1/LDH2 ratio suggestive of cardiac "injury" were observed.

Hemodynamic effects caused by i.v. administration of verapamil in healthy subjects.

The hemodynamic data obtained after rapid i.v. administration of verapamil (Isoptin) (7.5-12.5 mg) to 7 healthy subjects are presented and discussed. The drug caused an early and statistically significant increase in heart rate and output with concomitant decrease of blood pressure (mainly diatolic) and peripheral resistance. Negative inotropic effects were not observed by the decreased peripheral resistance probably masks any possible negative inotropic effects of the drug.