ABSTRACT
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.
Subject(s)
Diabetic Retinopathy/therapy , Macular Edema/therapy , Diabetic Retinopathy/pathology , Female , Humans , MaleABSTRACT
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.
Subject(s)
Central Serous Chorioretinopathy/psychology , Narcissism , Adult , Central Serous Chorioretinopathy/physiopathology , Humans , Male , Visual AcuityABSTRACT
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.
Subject(s)
Botulinum Toxins/therapeutic use , Entropion/chemically induced , Entropion/drug therapy , Glaucoma, Open-Angle/complications , Glaucoma, Open-Angle/drug therapy , Aged , Aged, 80 and over , Eyelids/physiology , Female , Humans , Iatrogenic Disease , Male , Oculomotor Muscles/drug effects , Pilot Projects , Prostaglandin Antagonists/adverse effects , Prostaglandin Antagonists/therapeutic useABSTRACT
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.
Subject(s)
Cataract Extraction/adverse effects , Macular Edema/etiology , Vitreous Detachment/etiology , Aged , Humans , MaleABSTRACT
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.
Subject(s)
Eye Diseases/etiology , Eyelid Diseases/etiology , Thyroid Diseases/complications , Adult , Female , Humans , Male , Middle Aged , OphthalmologyABSTRACT
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.
Subject(s)
Macular Degeneration/complications , Myopia, Degenerative/complications , Vision, Low/etiology , Vision, Low/rehabilitation , Aged , Biofeedback, Psychology , Female , Humans , Male , Middle AgedABSTRACT
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.
Subject(s)
Kidney Failure, Chronic/etiology , Laurence-Moon Syndrome/complications , Retinitis Pigmentosa/physiopathology , Adult , Female , Humans , Kidney Failure, Chronic/therapy , Laurence-Moon Syndrome/therapy , Renal Dialysis/adverse effectsABSTRACT
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.
