Management della retinopatia diabetica e dell'edema maculare diabetico: linee guida "Euretina 2017".

Si prevede che la malattia diabetica con tutte le sue complicanze avrà un forte aumento di incidenza con un grosso impatto socioeconomico nei prossimi decenni in tutto il mondo. Pertanto ben si comprende l'importanza di individuare attraverso una fine diagnostica quanto più precocemente la comparsa dei sintomi diabetici, migliorare lo stile di vita ed impostare cure efficienti. Riportiamo la serie di raccomandazioni EURETINA 2017, dei maggiori esperti in Europa per la gestione della malattia diabetica e delle complicanze della retina. Per combattere questa "pestilenza" occorre un team medico preparato. Il trattamento laser è stato considerato sino a non molto tempo fa il Gold standard della retinopatia diabetica e dell'edema diabetico (RD e EMD). Recenti studi hanno dimostrato, invece, che si possono raggiungere risultati migliori mediante l'iniezione diretta di farmaci nella cavità vitreale. In particolare è emerso terapia di prima linea, molecole in grado di inibire il fattore di crescita endoteliale vascolare (anti VEGF) mentre non è più raccomandata la fotocoagulazione laser per il trattamento del DME. Nell'ambito delle molecole farmacologiche gli steroidi hanno mantenuto un ruolo nella gestione del DME cronicamente persistente.

[Masuda's Central Serous Chorioretinopathy (C.S.C.R.) and its somatic investment in Narcissism: our observations on new psychiatric nosography]. / Corioretinopatia sierosa centrale (C.R.S.C.) di Masuda quale investimento somatico nel Narcisismo: nostra rifl essione sulla nuova nosografi a psichiatrica.

Case report. Co-morbidity between central serous chorioretinopathy (C.R.S.C.) and narcissistic personality disorder. A reflection on the importance of an integrated approach to this ophthalmological disease through the description of its psychosomatic aspects and the evaluation of the nosographic definition in psychiatry. The central serous chorioretinopathy (C.R.S.C.) is a transudative disease affecting the posterior pole of the eye, that rapidly compromises the visual acuity, although it is a self-limited disease. Narcissism is a personality disorder characterised by an extreme gratification of self, without actually taking care of other people. In the current work both the diseases, along with the respective psychosomatic consequences the patient received, are examined.

Botulinum toxin treatment in glaucomatous patients: a pilot study.

PURPOSE: The purpose was to evaluate the efficacy of the treatment of iatrogenic entropion (IE), in patients affected by primary open angle glaucoma (POAG), by botulinum toxin injections (BTI). PATIENTS AND METHODS: 20 patients of the "Glaucoma Center" of the Hospital "Umberto I" (Rome) were examined. These patients had POAG and used prostaglandin analogues (PA). Mean age was 75.5 years old (range 68-83); they had been suffering from PAOG since 10 years and were not affected by other relevant systemic diseases. One to three BTI were made into the lower orbicularis muscle using a 0.3 G needle (0.025 to 0.05 units for each injection site). RESULTS: The results were particularly significant in 18 out of 20 patients. Two patients showed slight improvements. A rating scale ranging from 0 to 6 points (0 corresponded to 'no effect' and 6 to the 'complete' resolution of the entropion) was used to evaluate the goals of the treatment. The average rating was 5.37 points. CONCLUSIONS: The entropion due to glaucoma therapy with PA can be successfully treated with BTI in the orbicularis muscle, despite offering temporary therapeutic effects.

[Posterior vitreous detachment and cystoid macular oedema post-cataract surgery: a case report]. / Distacco posteriore di vitreo e edema maculare cistoide post intervento di cataratta: caso clinico.

The posterior vitreous detachment consists in the separation between the posterior vitreal cortex and internal limiting membrane of the retina. This is the peak of the vitreal para-physiological age-related modifications. This problem occurs in 6% of normal people of age between 45 and 65 years and in 65% of individuals between 65 and 85 years. Several elements can be responsible for vitreous modifications, such as senility, myopia, aphakia, pseudophakia, diabetes, degeneration vitreous retinal hereditary, traumatisms, inflammation. A 75 year old male patient has come to our attention for a left eye cataract. He has undergone to a series of OCT: the first before surgery showed a perifoveal vitreous detachmen; the following ones until six months after surgery put in evidence the DPV progression accompanied by EMC, relating it with visual symptomatology. Therefore, OCT is a useful tool for a clinical analysis but also for the contribution to research concerning the pathogenesis of diseases due to vitreo-retinal modification.

[Ophthalmological signs in thyroid pathology: our experience]. / Semeiotica oftalmologica in pazienti affetti da distiroidismo: nostra esperienza.

AIM: The aim of our study was to highlight the palpebral and ocular signs in patients with thyroid dysfunction. These patients are sometimes poorly evaluated in routine check ups. This information is useful both to the practicing ophthalmologist but also to the specialist in endocrinology. PATIENTS AND METHODS: 100 patients were enrolled. The patients had been diagnosed with the Basedow-Graves-Flajani syndrome or had hypothyroidism or thyroidits. Orbital, adnexal and ocular signs were recorded in all patients. RESULTS: Seventeen oculopalpebral signs were observed in a total of 100 patients (73 females and 27 males). These were as follows: Dalrymple, Von Graefe, Rosenbach, Inglese, Gifford, Enroth, Jellinek, Stellwag, Jeffroy, Topolansky, Moebius, Suker, Sattler, Sainton, Ballet, Cowens, Exphothalmos. DISCUSSION: The specialist in endocrinology has many laboratory and clinical tools in the diagnosis of patients with thyroid dysfunction. However, with a better awareness of the oculopalpebral signs both the ophthalmologist and the endocrinologist can work together in a multidisciplinary team towards the management of these patients.

Effectiveness of vision rehabilitation treatment through MP-1 microperimeter in patients with visual loss due to macular disease.

PURPOSE: To evaluate the effectiveness of biofeedback treatment for low-vision rehabilitation in patients affected by macular disease. MATERIALS AND METHODS: 171 eyes of 99 patients (42 female and 57 male) between 50 to 75 years old (mean age: 64.6) were included in this study. All patients were suffering from age-related macular degeneration (AMD) (122 eyes) or macular myopic degeneration (MMD) (49 eyes). All patients underwent an assessment of examinations including visual acuity, reading speed test, slit lamp examination and tonometry, ophthalmoscopic fundus examination, microperimetry, fixation test, retinal sensitivity, fluorangiography (FAG), optical coherence tomography (OCT). The treatment was divided in 16 sessions, the patients underwent other examination assessment at 6 and 12 months, except for FAG and OCT. Statistical analysis was performed using Student's t-test, and p-value <=0.05 was considered statistically significant. RESULTS: After training 130 eyes of 171 in the study group (76.02%) had a statistically significant improvement of the distant visual acuity (p<0.01): 38 eyes suffering from MMD and 92 eyes suffering from AMD. After 12 months of follow-up a group of 25 eyes of 130 (19.23%) had a loss of benefits that were observed at the end of the treatment sessions: 16 eyes and 9 eyes were suffering from MMD and AMD respectively. Examination assessment during follow-up showed that 4 eyes and 2 eyes of the group that lost benefits had a worsening of MMD and AMD primary disease respectively. CONCLUSIONS: It is not yet understood how biofeedback produces amelioration of visual function. According to the 'Eccentric fixation' theory, with biofeedback rehabilitation patients are trained to use the non-damaged retina areas to develop a new preferred retinal locus. In our study group we found a significant improvement in both visual acuity and fixation.

[Atypical retinitis pigmentosa in Laurence-Moon-Biedl-Bardet syndrome. Report of a case of chronic renal insufficiency under periodic hemodialysis treatment]. / La retinite pigmentosa atipica nel quadro della sindrome di Laurence-Moon-Biedl-Bardet. Osservazione di un caso in trattamento emodialitico periodico per insufficienza renale cronica.

A case of Laurence-Moon-Biedl-Bardet syndrome in a patient undergoing hemodialysis is reported. The principal characteristics of this congenital syndrome are described. A possible pathogenetic mechanism of the atypical form of retinitis pigmentosa (sine pigmento) is discussed.

Atypical retinitis pigmentosa: a report of three cases.

We report three cases of patients with atypical retinitis pigmentosa (RP): sector bilateral, sector unilateral, and inverse. Clinical and functional features of perimetry, color vision testing, adaptometry, electroretinography, fluorangiography, and audiometry are described. One patient had isolated RP; the others had syndromic RP, combined with defective hearing and celiac disease. Two of these patients were followed for three years and one for 13 years. Their disease courses during the period of observation are discussed.

[A case of Fiessinger-Leroy-Reiter syndrome. Etiopathogenic, diagnostic and therapeutic problems]. / Su un caso di sindrome di Fiessinger-Leroy-Reiter. Problemi eziopatogenetici, diagnostici e terapeutici.

The Authors report the case of a young man with urethritis, conjunctivitis and oligoarticular arthritis. These symptoms are characteristic of Reiter's syndrome. Our patient also presented an inversion of CD4/CD8 ratio but the number and the activity of natural killer cells were normal and the research for HIV was negative. On the contrary the research for Chlamydiae by fluorescein-binding antibodies in urethral fluid was positive while the human leukocyte antigen HLA B27 was absent. The patient has been successfully treated by tetracycline and steroids. The Authors discuss the diagnostic, etiopathogenetic and therapeutical problems of this case, matching their findings to the up-to-date knowledge of Reiter's syndrome.

Conjunctival provocation test as a model for the study of allergy and inflammation in humans.

The clinical response after allergen challenge and immunologic mechanisms leading to tissue inflammation have been extensively studied in the skin, nose and lung of allergic subjects. The present paper reviews personal studies aimed at evaluating clinical, cellular and humoral events after administration of specific allergen to the eye. Specific conjunctival provocation tests performed in grass-sensitive patients caused persisting inflammatory changes in conjunctival scrapings and tear fluid with a significant accumulation of different inflammatory cells depending on the time of observation (neutrophils, 20 min; eosinophils, 6 h; neutrophils, eosinophils and lymphocytes, 12-24 h after provocation). Increasing the dose of allergen resulted in a dose-dependent increase in the number of inflammatory cells recruited. When high doses of allergen were used, the challenge not only induced late-phase histological changes, but also clinical symptoms 6-10 h after provocation. Several mediators of allergic inflammation, such as histamine, C3a des-Arg, leukotrienes B4 and C4, were also present and could be measured in tears after allergen challenge. Our studies represent the first evidence in humans that a late phase of allergic reaction occurs in the eye. They also suggest that the conjunctival provocation test may represent a model for the study of cells and mediators involved in the pathophysiology of allergic inflammation as well as of its pharmacologic modulation.