The Relationship between Intraocular Pressure and Optic Nerve Structural and Functional Damage in Patients with Optic Nerve Head Drusen.

The aim of this retrospective study was to evaluate if, in ocular normotensive patients, at the time of diagnosis of optic nerve head drusen (ONHD), perimetric mean deviation (PMD) on visual field (VF) examination and retinal nerve fibre layer (RNFL) thickness on optical coherence tomography correlated with intraocular pressure (IOP). There was a significant association between IOP and PMD (Spearman's rho = -0.863, p < .01) and between IOP and RNFL thickness (Spearman's rho = -0.630, p < .01). A higher IOP was associated with a greater functional loss in the VF and a reduction in the RNFL thickness. These results suggest that a clinical trial of IOP reduction should be considered in patients with ONHD to decrease the progression of optic nerve damage over time.

Efectividad de los regímenes tratar y extender vs. pro re nata para el tratamiento de degeneración macular neovascular vinculada a la edad: una comparación en un entorno real / Effectiveness of treat-and-extend versus pro re nata regimens in the treatment of Neovascular Age Macular Degeneration: A Real World Comparison

OBJETIVO: Evaluar y comparar los resultados visuales y morfológicos de regímenes de tratamiento pro re nata (PRN) y tratar-y-extender (T&E) a tres años en la práctica clínica real. MÉTODOS: Un estudio retrospectivo de pacientes con degeneración macular vinculada a la edad neovascular (DMEN) tratadas con anti-VEGF con tres años de seguimiento continuo y sin tratamientos anti-VEGF anteriores. Se midieron la mejor agudeza visual corregida (MAVC), el espesor foveal central (EFC) y el número de inyecciones intravítreas para determinar diferencias estadísticas entre ambos grupos al inicio y a lo largo del seguimiento. RESULTADOS: Se incluyeron en el estudio un total de 240 ojos, 170 en el grupo PRN y 70 en el grupo T&E. A los 12 meses la ganancia media con respecto al inicio de MAVC (en letras ETDRS) llegó a su punto más alto en el grupo T&E (+ 6,38 ± 13,32; p = 0,25). En el grupo PRN, MAVC llegó al máximo a los tres meses y disminuyó lentamente hasta el final del seguimiento. Con ambos regímenes, desde el inicio el EFC continuó disminuyendo hasta el segundo año (PRN -138,81 [-846,7 a +162,77] y T&E -81 [-604 a +100] μm, p = 0,06). Posteriormente, el grupo T&E mantuvo esta tendencia, llegando al nivel más bajo de EFC a los 36 meses, mientras que el grupo PRN mostró un aumento en los valores de EFC (PRN -104 [-807,7 a +297] μm y T&E -103 [-575 a +244], μm p = 0,63). Los pacientes tratados con el régimen T&E recibieron un número significativamente mayor de inyecciones (PRN 16,3 ± 7,6 vs. T&E 23,9 ± 9,4, p <0,01). CONCLUSIÓN: Los resultados demostraron una tendencia de T&E a conseguir valores más altos de MAVC, llegando al máximo a los 12 meses, y grosores menores de EFC al final de tres años. A pesar del mayor número de inyecciones en el grupo T&E, la media de MAVC revirtió a los valores de base a los tres años

PURPOSE: Evaluate and compare the visual and morphological results of Pro re nata (PRN) and treat-and-extend (T&E) treatment regimens at 3 years in real world clinical practice. METHODS: Retrospective study of patients with neovascular age macular: degeneration (AMD) treated with anti-VEGF with 3 years of continuous follow-up and no previous anti-VEGF treatment. Best corrected visual acuity (BCVA), central foveal thickness (CFT) and number of intravitreal injections outcomes were tested for statistical differences between the two groups at baseline and during follow-up. RESULTS: A total of 240 eyes were included in the study, 170 in the PRN group and 70 in the T&E group. At 12 months, mean BCVA (ETDRS letters) gain from baseline was at its highest point in the T&E group (+6.38 ± 13.32; p = 0.25). In the PRN group, BCVA peaked at 3 months and slowly decreased until end of follow-up. With both regimens, from baseline, CFT continued to decrease until the second year (PRN -138.81 [-846.7 to +162.77] and T&E -81 [-604 to +100] μm, p = 0.06). After that, T&E group maintained this tendency, reaching the lowest CFT value at 36 months, whereas PRN group showed an increased in CFT values (PRN -104 [-807.7 to +297] μm and T&E -103 [-575 to +244], μm p = 0.63). Patients treated with T&E regimen received a significantly higher number of injections (PRN 16.3 ± 7.6 vs T&E 23.9 ± 9.4, p < 0.01). CONCLUSION: Our results demonstrated a trend towards for T&E to achieve higher marks in BCVA, peaking at 12 months, and lower CFT thickness at the end of three years. Despite the higher number of injections performed in the T&E group the mean BCVA reverts to baseline values at 3 years

Effectiveness of treat-and-extend versus pro re nata regimens in the treatment of Neovascular Age Macular Degeneration: A Real World Comparison. / Efectividad de los regímenes tratar y extender vs. pro re nata para el tratamiento de degeneración macular neovascular vinculada a la edad: una comparación en un entorno real.

PURPOSE: Evaluate and compare the visual and morphological results of Pro re nata (PRN) and treat-and-extend (T&E) treatment regimens at 3 years in real world clinical practice. METHODS: Retrospective study of patients with neovascular age macular degeneration (AMD) treated with anti-VEGF with 3 years of continuous follow-up and no previous anti-VEGF treatment. Best corrected visual acuity (BCVA), central foveal thickness (CFT) and number of intravitreal injections outcomes were tested for statistical differences between the two groups at baseline and during follow-up. RESULTS: A total of 240 eyes were included in the study, 170 in the PRN group and 70 in the T&E group. At 12 months, mean BCVA (ETDRS letters) gain from baseline was at its highest point in the T&E group (+6.38±13.32; p=0.25). In the PRN group, BCVA peaked at 3 months and slowly decreased until end of follow-up. With both regimens, from baseline, CFT continued to decrease until the second year (PRN -138.81 [-846.7 to +162.77] and T&E -81 [-604 to +100] µm, p=0.06). After that, T&E group maintained this tendency, reaching the lowest CFT value at 36 months, whereas PRN group showed an increased in CFT values (PRN -104 [-807.7 to +297] µm and T&E -103 [-575 to +244], µm p=0.63). Patients treated with T&E regimen received a significantly higher number of injections (PRN 16.3±7.6 vs T&E 23.9 ±9.4, p<0.01). CONCLUSION: Our results demonstrated a trend towards for T&E to achieve higher marks in BCVA, peaking at 12 months, and lower CFT thickness at the end of three years. Despite the higher number of injections performed in the T&E group the mean BCVA reverts to baseline values at 3 years.

Choroidal Thickness and Urinary Albumin Excretion in Type 2 Diabetic Patients without Retinopathy.

The role of retinal vasculature's dysfunction in the physiopathology of Diabetic Retinopathy (DR) has been extensively described. Recently, the existence of a diabetic choroidal vasculopathy has been proposed. The purpose of this study was to compare choroidal thickness (CT) in nondiabetic patients and in type 2 diabetic patients without retinopathy, using EDI SD-OCT. Additionally, considering the diabetic patient group, compare CT in patients with and without microalbuminuria. This retrospective study selected patients sent from primary health-care centers as part of the national screening of diabetic retinopathy. Inclusion criteria were diagnosis of type 2 diabetes mellitus, absence of diabetic retinopathy, and a 24 hours urinary albumin measurement in the last 3 months at the primary health-care center. Nondiabetic patients were selected from a database in the ophthalmology department, and only healthy patients were included. At the screening visit, all patients performed a complete ophthalmologic examination by the same examiner. All eyes were examined with SD- OCT, and all scans were performed in the EDI mode. Measurements were made at three points: subfoveal, 1500 µm temporally and nasally to the foveal center. We included 110 eyes of 110 diabetic patients without diabetic retinopathy and 30 eyes of 30 healthy controls. Mean subfoveal CT was greater in diabetic patients without retinopathy (with normoalbuminuria or microalbuminuria) when compared with nondiabetic patients (p < 0.05). In diabetic patients without retinopathy, the subfoveal and temporal choroid was thicker among patients with microalbuminuria when compared with those of normoalbuminuric patients (p < 0.05). The subfoveal and temporal choroid was thicker among diabetic patients with microalbuminuria compared with nondiabetic patients. (p < 0.05). This study suggests that choroidal changes are present in type 2 diabetic patients even before the clinical development of retinopathy.

Microbiological Profile of Infectious Keratitis in a Portuguese Tertiary Centre.

The microbiological profile of infectious keratitis has shown great differences across the world. Due to the continuous shifting trends in microbiological profile and antibiotic resistance patterns reported in several studies, constant local updates are crucial to provide an adequate treatment. The propose of this study was to analyze the incidence of infectious keratitis, possible changing trends in microbiological profile, and bacteria sensitivity to commonly used antibiotics, in our tertiary center, in the last 10 years. A retrospective study was performed, based on the survey review of electronic medical records of all patients with presumed infectious keratitis, between January 1, 2009, and December 31, 2018. Microbial cultures were performed, and patients were treated according to an internal protocol. A total of 1360 samples were included. We obtained a 35.1% culture-positive rate. Bacteria accounted for 76.78% of all positive scrapes (53.34% were Gram positive and 23.44% were Gram negative), Acanthamoeba for 12.13%, fungi for 8.16%, and virus for 2.93%. The most frequent agent identified was Corynebacterium macginleyi (18.41%), followed by Staphylococcus aureus (17.78%), Streptococcus pneumoniae (9.41%), and Pseudomonas aeruginosa (9.00%). We identified at least one ophthalmologic risk factor in 410 patients (85.77%). Trauma and contact lens wear were the most common risk factors found, accounting for 34.94% (n = 167) and 33.47% (n = 160) of cases. Sensitivity to fluoroquinolones and aminoglycosides was tested in all bacterial isolates, presenting values of 96.66% and 98.12%. In our region, the most common bacteria are Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa, and they showed high sensitivity rates to first-line antibiotics, without any modification or emergence of antibiotic resistance trends during the 10 years of the study. For this reason, we decided to maintain the same internal protocol in our tertiary centre.

Retinoblastoma: experience of a referral center in the North Region of Portugal.

PURPOSE: To describe the experience of the Ophthalmology Department of Hospital São João (HSJ), a tertiary health care center in North Region, Portugal, in terms of the diagnosis, treatment, and follow-up of retinoblastoma. METHODS: This was a retrospective study of patients diagnosed with retinoblastoma in Hospital São João, between 1978 and 2012. RESULTS: Fifty patients with retinoblastoma were evaluated in our institution between 1978 and 2012. Four patients were excluded due to loss of follow-up. Among the 46 retinoblastoma cases, 33 (71.7%) were unilateral and 13 (28.3%) bilateral, with a mean age at diagnosis of 22.19 months and 6.92 months, respectively (P<0.001). Leukocoria was the most common presenting sign (36.9%), followed by strabismus (19.6%), a combination of leukocoria and strabismus (8.7%), and buphthalmia (2.2%). Between 1978 and 1992, nine retinoblastoma cases were referred to our hospital, all of them unilateral, and, in each case, enucleation was performed, with or without salvage therapy. Between 1993 and 2012, 18 eyes with retinoblastoma were successfully managed with conservative treatment. CONCLUSION: Demographic results were generally coincident with previous reports. It is crucial to screen leukocoria in pediatric practice, even in asymptomatic children. The outcome of retinoblastoma treatment in our hospital is similar to other series in developed countries.

Identification of the ghrelin-GHSR 1 system and its influence in the modulation of induced ocular hypertension in rabbit and rat eyes.

Recent studies evidenced a decrease in ghrelin's aqueous humor levels in patients with glaucoma. The goal of our investigation was to study the effect of the ghrelin-GHSR-1a system in the modulation of intraocular pressure in acute ocular hypertension models and its expression and distribution in ocular tissues. Two animal models of acute ocular hypertension were used to study the effect of the ghrelin-GHSR-1a system in the modulation of intraocular pressure: the rabbit and the rat. Ocular hypertension was induced by an intravitreal injection of 20% NaCl. Ghrelin or des-acyl ghrelin were delivered subconjunctivally and the intraocular pressure was assessed by a rebound tonometer that was calibrated for each species. In addition, we have studied the influence of nitric oxide and prostaglandins on ghrelin's effect in the rabbit animal model. Finally, we determined by immunofluorescence the expression of ghrelin and GHSR-1 in the rat's ocular tissue. Ghrelin decreased the intraocular pressure in both animal models (maximum decrease: 43.8±12.0% in the rabbit and 29.0±7.46% in the rat). In the rabbit, this effect was blunted in the presence of l-NAME and ketorolac. Des-acyl ghrelin only decreased the intraocular pressure in the rat (maximum decrease: 34.9±8.15%). Ghrelin expression was detected in the ciliary processes and GHSR-1 expression was detected in the trabecular meshwork and ciliary body. The ghrelin-GHSR-1 system is expressed in the anterior segment of the eye. Ghrelin and des-acyl ghrelin are responsible for a hypotensive effect in acute ocular hypertension animal models.

Congenital Aniridia: Clinic, Genetics, Therapeutics, and Prognosis.

Congenital aniridia is a rare condition related to a deficiency in the PAX6 gene expression, which may occur as a result of a family inheritance or a sporadic occurrence. Additionally, this condition may occur as an isolated ocular phenotype or in association with a systemic syndrome. The most common abnormality is iris hypoplasia; however, a panocular disease which also affects the cornea, anterior chamber of the eye, lens, and the posterior segment with presence of optic nerve and foveal hypoplasia is also evident. The development of keratopathy, glaucoma, and cataract is frequent and its presence has implications in the patient's visual acuity. Managing aniridia is challenging since the focus is on treating the previously mentioned disorders, and the outcomes are often disappointing. In this paper, we shall review the epidemiology, pathophysiology, and clinical characteristics of patients with aniridia. We shall also make a review of the therapeutic options for the several conditions affecting this syndrome and consider the genetics and prognostic factors.

Characterization of neovascular age-related macular degeneration patients with outer retinal tubulations.

PURPOSE: To characterize the neovascular lesions of patients with age-related macular degeneration (AMD) and outer retinal tubulations (ORTs). METHODS: A retrospective study of 377 eyes with exudative AMD, submitted to intravitreal anti-angiogenic treatment. Patients were divided into 2 groups according to the presence or absence of ORTs on spectral-domain optical coherence tomography (SD-OCT; group 1 - with ORTs; group 2 - without ORTs). Age, best corrected visual acuity (BCVA), fluorescein angiography characteristics, presence of subretinal fibrosis and subfoveal photoreceptor integrity on SD-OCT were analyzed. RESULTS: Although both groups had a BCVA gain during the follow-up period, initial and final BCVA were lower in group 1 (p = 0.020 and p = 0.042, respectively). There was no statistically significant difference in the BCVA variation between the 2 groups (p = 0.907). Regarding the initial angiographic lesion type, there was a statistically significant difference between the 2 groups (p = 0.008): group 1 had more lesions with a classic component and group 2 had more occult lesions with no classic component. There was a statistically significant difference concerning the loss of subfoveal photoreceptor integrity (p = 0.0007). CONCLUSIONS: Even though AMD patients with ORTs were associated with poor visual outcomes, we reported BCVA improvement. AMD patients with a classical component in their lesions are prone to develop ORTs.

Cytomegalovirus retinitis in an immunocompromised infant: a case report and review of the literature.

PURPOSE: To describe a case of bilateral cytomegalovirus retinitis (CMVR) in an immunocompromised infant. METHODS: A 4-month-old male infant with severe combined immunodeficiency syndrome was examined for the presence of CMVR. Ocular involvement was recorded and monitored by digital imaging. RESULTS: The child had bilateral CMVR, with a fine granular pattern, present both in the peripheral retina and posterior pole. There was no vitritis. The active areas of retinitis progressively resolved with intravenous ganciclovir treatment. At the 3-month follow-up examination, no recurrence was observed. CONCLUSION: Ganciclovir treatment was effective in this case. The prognosis depends on rapid institution of effective antiviral therapy and on a patient's systemic immunocompetence.

ETB2 receptor subtype stimulation relaxes the iris sphincter muscle.

Effects of ET(B) receptor stimulation and its subcellular pathways were evaluated in carbachol pre-contracted rabbit iris sphincter muscles (n=51). ET(B) stimulation with sarafotoxin (SRTX-c; 10(-10)-10(-6) M) was tested in the absence (n=7) or presence of 10(-5) M of: BQ-788 (ET(B2) receptor antagonist; n=6), L-NA (NOS inhibitor; n=7) or indomethacin (cyclooxygenase inhibitor; n=10). Effects of ET(B) stimulation by endothelin-1 (ET-1; 10(-10)-10(-7) M) in the presence of an ET(A) receptor antagonist (BQ-123; 10(-5) M; n=7) and of ET(B1) stimulation by IRL-1620 (10(-10)-10(-7) M; n=7) were also tested. Finally, the effects of SRTX-c (10(-9)-10(-7) M) in electric field stimulation (EFS) contraction were evaluated (n=7). ET(B) receptor stimulation by SRTX-c or ET-1 in presence of BQ-123 promoted a concentration-dependent relaxation of the rabbit iris sphincter muscle by 10.8+/-2.0% and 9.4+/-1.8%, respectively. This effect was blocked by BQ-788 (-2.3+/-2.0 %), L-NA (4.5+/-2.3 %) or indomethacin (2.3+/-2.9 %). Selective ET(B1) stimulation by IRL-1620 did not relax the iris sphincter muscle (0.9+/-5.4 %). EFS elicited contraction was not altered by SRTX-c. In conclusion, ET(B) receptor stimulation relaxes the carbachol precontracted iris sphincter muscle, an effect that is mediated by the ET(B2) receptor subtype, through NO and the release of prostaglandins.

The obestatin/ghrelin system as a novel regulatory mechanism of iris muscle contraction.

PURPOSE: To evaluate obestatin and ghrelin effects on iris muscle contraction. MATERIALS AND METHODS: Obestatin (10(-5) M) or ghrelin (10(-5) M) were tested on two consecutive carbachol-or epinephrine-elicited contractions of iris rabbit sphincter or dilator muscles. Ghrelin and obestatin effects on iris muscles basal tension were also tested, and their effects on iris sphincter EFS-elicited contraction were evaluated. RESULTS: Compared with the first, tension of the second carbachol-induced contraction of the iris sphincter decreased 11.5+/-5.5% in the vehicle group, increased 19.0+/-10.2% in presence of obestatin, and remained unchanged by ghrelin. Epinephrine-induced contractions were not affected by obestatin or ghrelin. EFS-elicited contractions were decreased 9.3+/-3.2% by ghrelin. Basal tension of the iris sphincter decreased 21.7+/-3.7% in presence of ghrelin (10(-5) M), while that of the dilator decreased 14.1+/-5.0% in presence of obestatin (10(-5) M). CONCLUSION: This study suggests that obestatin potentiates the cholinergic contraction of the iris sphincter and relaxes the iris dilator muscles.

Ghrelin as a novel locally produced relaxing peptide of the iris sphincter and dilator muscles.

Ghrelin is a recently described acylated peptide, which works as a somatosecretagogue and has described effects on the smooth, skeletal and cardiac muscle. We examined the production and effects of ghrelin on relaxation of the iris muscles. Contractile effects of 1-5 human ghrelin (frGhr, 10(-9)-6 x 10(-5)M) and 1-5 human des-octanoyl-ghrelin (d-frGhr; 10(-9)-6 x 10(-5)M) were tested on iris rabbit sphincter (n=11 frGhr; n=7 d-frGhr), dilator (n=6 frGhr; n=6 d-frGhr) and rat sphincter (n=6 frGhr; n=8 d-frGhr) precontracted muscles. On rabbit sphincter the effect of frGhr was also tested in presence of: i) L-NA (10(-5)M; n=7); ii) indomethacin (10(-5)M; n=7); iii) DLys(3)GHRP6 (10(-4)M; n=6); and iv) apamin+carybdotoxin (10(-6)M; n=6). Furthermore, on rabbit dilator the effect of frGhr was tested in presence of DLys(3)GHRP6 (10(-4)M; n=7). Finally, ghrelin mRNA production was assessed by "in situ" hybridization in Wistar rat eyes (n=8). In all muscles, frGhr promoted a concentration-dependent relaxation, maximal at 6 x 10(-5)M, 1.5-3 min after its addition, decreasing tension by 34.1+/-12.1%, 25.8+/-4.8% and 52.1+/-10.3% in the rabbit sphincter, dilator and rat sphincter, respectively. In the rabbit sphincter the relaxing effects of frGhr were: (i) enhanced in presence of DLys(3)GHRP6 (118.1+/-21.1%); (ii) blunted by indomethacin; and (iii) not altered by apamin+carybdotoxin (36.4+/-14.4%) or L-NA (52.4+/-11.4%). Relaxing effects of d-frGhr in rabbit (43.3+/-5.2%) and rat (77.1+/-15.3%) sphincter muscles were similar to those of frGhr. In rabbit dilator muscle, d-frGhr did not significantly alter active tension and the relaxing effect of frGhr was blunted by GHSR-1a blockage. Ghrelin mRNA was identified in iris posterior epithelium. In conclusion, ghrelin is a novel, locally produced, relaxing agent of iris dilator and sphincter muscles, an effect that is mediated by GHSR-1a in the former, but not in the latter. Furthermore, in the sphincter it seems to be mediated by prostaglandins, but not by NO or K(Ca) channels.

Identification of XLRS1 gene mutation (608C > T) in a Portuguese family with juvenile retinoschisis.

PURPOSE: To characterize electroretinogram (ERG) and molecular genetic findings in a family with XLRS1 mutation. The authors present two cases of a Portuguese family with juvenile retinoschisis with a mutation in exon 6. METHODS: Two brothers and their parents, grandmother, and uncle underwent a full ophthalmic examination. The two brothers with ophthalmic disease were evaluated with color fundus photography, fluorescein angiography, optical coherence tomography (OCT), molecular genetic study (Group VI of Retinoschisis Consortium), pattern visual evoked potential (PVEP), and full field ERG. RESULTS: Both patients presented funduscopic manifestations of vitre o retinal degeneration. They presented peripheral schisis and retinal detachment. However, foveal schisis had never been observed at funduscopy. A negative ERG was recorded in both. Six months after that, the younger brother showed a typical foveal schisis at fundus examination. A retinoschisis gene (XLRS1) mutation with transition of cytosine by thymine at position 608 (608C > T) had been identified in both. CONCLUSIONS: Negative ERG is the most secure clinical marker to establish the diagnosis of juvenile retinoschisis. XLRS1 gene 608C > T mutation was described for the first time in a Portuguese family.

Congenital dacryocystocele with intranasal extension.

PURPOSE: Congenital dacryocystocele is a rare anomaly in the newborn child. The swelling of lachrymal sac is observed by birth and it is associated with obstruction of lachrymal system either above or below lachrymal sac. METHODS: Diagnosis was made by clinical observation. Some ancillary examinations, such as ultrasonography, tomography, and rhinoscopy, were useful. RESULTS: The authors describe the clinical case of a newborn with a unilateral congenital dacryocystocele. This anomaly was successfully treated with probing and marsupialization of the nasal cyst. CONCLUSIONS: Treatment of this congenital anomaly is by light compressive massage, probing with silicone intubation of lachrymal system to assure prolonged permeability of the system, or with marsupialization of the nasal cyst. In some cases with intranasal extension of dacryocystocele, collaboration with an otolaryngologist may be necessary.

Identification of XLRS1 gene mutation (608C>T) in a Portuguese family with juvenile retinoschisis.

PURPOSE: To characterize electroretinogram (ERG) and molecular genetic findings in a family with XLRS1 mutation. The authors present two cases of a Portuguese family with juvenile retinoschisis with a mutation in exon 6. METHODS: Two brothers and their parents, grandmother, and uncle underwent a full ophthalmic examination. The two brothers with ophthalmic disease were evaluated with color fundus photography, fluorescein angiography, optical coherence tomography (OCT), molecular genetic study (Group VI of Retinoschisis Consortium), pattern visual evoked potential (PVEP), and full field ERG. RESULTS: Both patients presented funduscopic manifestations of vitre o retinal degeneration. They presented peripheral schisis and retinal detachment. However, foveal schisis had never been observed at funduscopy. A negative ERG was recorded in both. Six months after that, the younger brother showed a typical foveal schisis at fundus examination. A retinoschisis gene (XLRS1) mutation with transition of cytosine by thymine at position 608 (608C>T) had been identified in both. CONCLUSIONS: Negative ERG is the most secure clinical marker to establish the diagnosis of juvenile retinoschisis. XLRS1 gene 608C>T mutation was described for the first time in a Portuguese family. (Eur J Ophthalmol 2005; 15: 638-40 ).

Amiodarone and optic neuropathy.

PURPOSE: To investigate the clinical, perimetric, contrast sensitivity and visual evoked potentials findings in patients on longterm treatment with amiodarone. METHODS: We enrolled 14 patients (age range 47-78 years, mean age 62.7 years) on chronic amiodarone therapy (mean cumulative dose of 519 g), and 14 age-matched control subjects. Participants were submitted to ophthalmological examination, kinetic visual field testing (Goldmann), standard achromatic automated perimetry (central 30-2, Humphrey), computerized isoluminant chromatic contrast sensitivity (CCS) and pattern visual evoked potentials evaluation (VEP). Data from baseline, 6-month and 1-year follow-up examinations were analysed. The main outcome measures were: initial and final corrected visual acuity; corneal, optic disc and fundus abnormalities; mean deviation (MD) and pattern standard deviation (PSD) central 30-2 perimetry parameters; visual field loss on kinetic perimetry; indices of CCS (tritan, protan and deutan axes), and pattern VEP latency (L-VEP) and VEP amplitude (a-VEP). RESULTS: We found a statistically significant difference between the patients and controls' baseline L-VEP and a-VEP measurements (p < 0.001). We found no significant correlation between prolonged L-VEP and duration of amiodarone use (r = 0.07). After a 1-year follow-up, we evidenced an average increment in L-VEP of 1.96 ms and a-VEP measurements showed a decline of 0.69 micro V. In cumulative dose-specific analyses, mean differences between baseline and 12-month L-VEP measurements were more evident in those taking higher than 200 g cumulative amiodarone doses (p = 0.03). We found abnormal tritan CCS results in 19 eyes (68%). Of these, four eyes belonged to patients with no ocular disease (diabetes, cataracts). No significant differences were observed between the baseline and 12-month clinical eye examinations, central 30-2 perimetry and CCS results. CONCLUSION: We found a significant prolongation in pattern L-VEP and a significant reduction in pattern a-VEP in patients on longterm treatment with amiodarone compared to control subjects. Nevertheless, current data are insufficient to recommend appropriate methods of visual screening.