El ángulo papila-fóvea y la torsión ocular compensatoria, clave en su interpretación / Disc-foveal angle and ocular counterrolling as a key in its interpretation

OBJETIVO: Describir una técnica rápida para medir el ángulo papila-fóvea (APF), determinar sus valores normales y su relevancia a la hora de analizar retinografías apareadas. MÉTODOS: En 20 sujetos se realizaron 440 retinografías (3 D OCT-2000, Topcon Corporation, Tokio, Japón) en 11 posiciones diferentes de la cabeza (cervical range of motion [CROM], Performance Attainment Associates). Se analizó el APF mediante el programa Keynote v.6.2.2 y se estudió la reproducibilidad y correlación entre los retinógrafos 3 D OCT-2000 y TRC-50EX (Topcon Corporation, Tokio, Japón). RESULTADOS: La media del APF en el ojo derecho (OD) y en el ojo izquierdo (OI) fue de 5,5 ± 3,4° y de 8,6 ± 2,9°, con una diferencia de 3,1° (p = 0,001 test del signo-rango de Wilcoxon). La media de la diferencia absoluta del APF entre ambos ojos fue de 3,5 ± 2,6°; aumentando con la inclinación cefálica en el plano frontal (p = 0,000 test del signo-rango de Wilcoxon). La media de la suma del APF de ambos ojos fue de 14,1 ± 5,4°. La media de la torsión ocular compensatoria (TOC) con la cabeza inclinada 20 y 40° a la derecha fue de 7,1 y 12,2° en el OD y de 7,7 y 12,1° en el OI. Con la cabeza inclinada 20 y 40° a la izquierda, la media fue de 4,4 y 8° en el OD y de 4,2 y 8,7° en el OI (p = 0,000 test del signo-rango de Wilcoxon). Los retinógrafos mostraron alta correlación y reproducibilidad. CONCLUSIÓN: Nuestra técnica es rápida y reproducible. El OI muestra mayor APF que el OD. La TOC solo ocurre en el plano frontal. Estos aspectos son relevantes al analizar retinografías apareadas

PURPOSE: Describe a time-sparing technique to measure disc-foveal angle (DFA), determine normal values and its role when analyzing paired fundus photographs. METHODS: DFA was analysed using the software program Keynote v.6.2.2 on 440 fundus photographs (3 D OCT 2000, Topcon Corporation, Tokio, Japan) of 20 individuals. The 11 different head positions were determined with the cervical range of motion device (CROM, Performance Attainment Associates). A reproducibility and correlation study between two fundus cameras (OCT 3 D-2000 and TRC-50EX, Topcon Corporation, Tokio, Japan) was performed. RESULTS: Mean DFA of the right and left eye was 5.5 ± 3.4° and 8.6 ± 2.9°, with a difference of 3.1° (P = 0.001 Wilcoxon signed-rank test) in the upright head position. Mean absolute difference in DFA between eyes was 3.5 ± 2.6°; an increase was seen with increasing head tilt (p = 0.000 Wilcoxon signed-rank test). Mean sum of DFA in both eyes was 14.1 ± 5.4°. On head-tilt of 20° and 40° to the right, mean ocular counterrolling (OCR) was 7.1° and 12.2° in the right eye and 7.7° and 12.1° in the left eye. On head-tilt of 20° and 40° to the left, OCR was 4.4° and 8° in the right eye and 4.2° and 8.7° in the left eye (P = 0.000 Wilcoxon signed-rank test). The two cameras showed strong correlation and high reproducibility. CONCLUSIONS: Our DFA measurement technique is time-sparing and reproducible. Left eye shows higher DFA than right eye. OCR occurs only in the roll plane. This information is of value when analyzing paired fundus photographs

Management of Wet Age-Related Macular Degeneration in Spain: Challenges for Treat and Extend Implementation in Routine Clinical Practice.

PURPOSE: To ascertain wet AMD (wAMD) management patterns in Spain. METHODS: A two-round Delphi study conducted through a questionnaire-based survey designed from literature review and validated by an independent Steering Committee. RESULTS: Forty-nine retina specialists experienced in wAMD participated by answering the two-round study questionnaire. Retina specialists are the main responsible for wAMD diagnosis and monitoring, including visits and associated procedures, with a median time per visit of 15 minutes. Standard treatment strategies are based on anti-VEGF administration, including standard loading dose administration followed by maintenance with aflibercept or ranibizumab (81% of patients). Although treat and extend (T&E) dosing strategy is considered as optimal for wAMD management (78% of the panelists), the main routine healthcare limitations (i.e., visits overload, reduced staff, short visit time, coordination issues, lack of facilities) conduct to self-defined "flexible" strategies, based on T&E and pro-re-nata (PRN) protocols. CONCLUSION: Proactive treatment patterns (T&E) are the preferred ones by the retina specialists in Spain. However, their proper implementation is difficult due to healthcare resource limitations, as well as organisation and logistic issues. The use of anti-VEGF agents with longer duration of action could facilitate the use of strict T&E approaches according to routine clinical practices.

Disc-foveal angle and ocular counterrolling as a key in its interpretation. / El ángulo papila-fóvea y la torsión ocular compensatoria, clave en su interpretación.

PURPOSE: Describe a time-sparing technique to measure disc-foveal angle (DFA), determine normal values and its role when analyzing paired fundus photographs. METHODS: DFA was analysed using the software program Keynote v.6.2.2 on 440 fundus photographs (3D OCT 2000, Topcon Corporation, Tokio, Japan) of 20 individuals. The 11 different head positions were determined with the cervical range of motion device (CROM, Performance Attainment Associates). A reproducibility and correlation study between two fundus cameras (OCT 3D-2000 and TRC-50EX, Topcon Corporation, Tokio, Japan) was performed. RESULTS: Mean DFA of the right and left eye was 5.5±3.4° and 8.6±2.9°, with a difference of 3.1° (P=0.001 Wilcoxon signed-rank test) in the upright head position. Mean absolute difference in DFA between eyes was 3.5±2.6°; an increase was seen with increasing head tilt (P=0.000 Wilcoxon signed-rank test). Mean sum of DFA in both eyes was 14.1±5.4°. On head-tilt of 20° and 40° to the right, mean ocular counterrolling (OCR) was 7.1° and 12.2° in the right eye and 7.7° and 12.1° in the left eye. On head-tilt of 20° and 40° to the left, OCR was 4.4° and 8° in the right eye and 4.2° and 8.7° in the left eye (P=0.000 Wilcoxon signed-rank test). The two cameras showed strong correlation and high reproducibility. CONCLUSIONS: Our DFA measurement technique is time-sparing and reproducible. Left eye shows higher DFA than right eye. OCR occurs only in the roll plane. This information is of value when analyzing paired fundus photographs.

Eficacia del tratamiento inmunomodulador con interferón-β o acetato de glatirámero en las uveítis asociadas a esclerosis múltiple / Efficacy of immunomodulatory therapy with interferon-β or glatiramer acetate on multiple sclerosis-associated uveitis

Objetivo: Analizar la eficacia del interferón-β o acetato de glatirámero en reducir los episodios de inflamación intraocular en pacientes con uveítis asociada a esclerosis múltiple. Método: Estudio no aleatorizado, retrospectivo de serie de casos de 13 pacientes con diagnóstico definitivo de esclerosis múltiple y uveítis (seguimiento mínimo, 12 meses). Todos los pacientes fueron tratados con terapia inmunomoduladora (interferón-β o acetato de glatirámero) para controlar el curso de la esclerosis múltiple. Los pacientes fueron comparados con ellos mismos antes de iniciar el tratamiento inmunomodulador para valorar la diferencia en los episodios de uveítis. Variable principal de medida: número de episodios de uveítis con/sin tratamiento inmunomodulador. Resultados: Los brotes de uveítis fueron bilaterales en 10 de 13 pacientes (77%). Once pacientes fueron clasificados como uveítis intermedias, 3 pacientes como vasculitis retiniana y un paciente como uveítis posterior. Los pacientes tuvieron una media de 4,15±3,1 episodios de uveítis (rango 1-10) a lo largo del seguimiento (148,6±84,3 meses). Los pacientes bajo tratamiento con interferón-β o acetato de glatirámero mostraron una reducción significativa de 0,36 episodios de inflamación intraocular al año (p = 0,02) comparados con ellos mismos antes de iniciar el tratamiento. Seis pacientes (46%) mostraron efectos secundarios leves asociados al tratamiento inmunomodulador (3 pacientes [23%] síndrome seudogripal; 3 pacientes [23%] rash cutáneo). Conclusiones: El interferón-β o acetato de glatirámero podrían ser efectivos en reducir los brotes de inflamación intraocular en pacientes con uveítis asociada a esclerosis múltiple, siendo bien tolerados por la mayoría de los pacientes (AU)

Aim: To analyse the role of interferon-β or glatiramer acetate in reducing the inflammatory episodes of intra-ocular inflammation in multiple sclerosis-associated uveitis. Method: A study was conducted on a non-randomised, retrospective case series of 13 patients with proven multiple sclerosis and uveitis (minimum follow-up, 12 months). All patients were given immunomodulatory treatment (interferon-β or glatiramer acetate) to control the course of the multiple sclerosis. Patients were compared to themselves before initiating the treatment, in order to assess the difference in uveitis episodes. The main outcome measurements were the number of uveitis episodes with/without immunomodulatory treatment. Results: Uveitis was bilateral in 10 (77%) out of 13 patients. Intermediate uveitis was observed in 11 patients, retinal vasculitis in 3 patients, and one patient was classified as a posterior uveitis. The patients had a mean of 4.15±3.1 episodes of uveitis (range 1-10) during the follow-up period (148.6±84.3 months). When compared to their pre-treatment status, patients on treatment with interferon-β or glatiramer acetate showed a significant decrease of 0.36 episodes of ocular inflammation per year (P =.02). Mild side effects related to immunomodulatory treatment were observed in 6 (46%) patients, 3 (23%) patients with a flu-like syndrome, and 3 (23%) patients with a skin rash. Conclusions: Interferon β or glatiramer acetate could be effective in reducing the uveitis episodes in patients with multiple sclerosis-associated uveitis, and was well tolerated in most patients (AU)

Efficacy of immunomodulatory therapy with interferon-ß or glatiramer acetate on multiple sclerosis-associated uveitis. / Eficacia del tratamiento inmunomodulador con interferón-ß o acetato de glatirámero en las uveítis asociadas a esclerosis múltiple.

AIM: To analyse the role of interferon-ß or glatiramer acetate in reducing the inflammatory episodes of intra-ocular inflammation in multiple sclerosis-associated uveitis. METHOD: A study was conducted on a non-randomised, retrospective case series of 13 patients with proven multiple sclerosis and uveitis (minimum follow-up, 12 months). All patients were given immunomodulatory treatment (interferon-ß or glatiramer acetate) to control the course of the multiple sclerosis. Patients were compared to themselves before initiating the treatment, in order to assess the difference in uveitis episodes. The main outcome measurements were the number of uveitis episodes with/without immunomodulatory treatment. RESULTS: Uveitis was bilateral in 10 (77%) out of 13 patients. Intermediate uveitis was observed in 11 patients, retinal vasculitis in 3 patients, and one patient was classified as a posterior uveitis. The patients had a mean of 4.15±3.1 episodes of uveitis (range 1-10) during the follow-up period (148.6±84.3 months). When compared to their pre-treatment status, patients on treatment with interferon-ß or glatiramer acetate showed a significant decrease of 0.36 episodes of ocular inflammation per year (P=.02). Mild side effects related to immunomodulatory treatment were observed in 6 (46%) patients, 3 (23%) patients with a flu-like syndrome, and 3 (23%) patients with a skin rash. CONCLUSIONS: Interferon ß or glatiramer acetate could be effective in reducing the uveitis episodes in patients with multiple sclerosis-associated uveitis, and was well tolerated in most patients.

Bevacizumab intravítreo en neovascularización coroidea asociada a enfermedad de Best / Intravitreal bevacizumab for choroidal neovascularization associated with Best's disease

CASO CLÍNICO: Mujer de 27 años que presentaba disminución de visión en ojo derecho (20/200). El examen funduscópico reveló una hemorragia intrarretiniana macular con desprendimiento neurosensorial en ojo derecho, y un depósito de material viteliforme en el ojo izquierdo. La angiografía fluoresceínica y el electrooculograma confirmaron el diagnóstico de neovascularización coroidea asociada a enfermedad de Best. Cuatro semanas después de una única inyección de bevacizumab intravítreo, la agudeza visual a la normalidad (20/25) y se mantuvo estable tras 12 meses de seguimiento. DISCUSIÓN: El bevacizumab intravítreo puede ser una opción terapéutica eficaz en la neovascularización coroidea secundaria a enfermedad de Best

CASE REPORT: A 27-year old woman presented with loss of vision in the right eye (20/200). Ophthalmoscopic examination showed intrarretinal hemorrhage in the macular region with neurosensory detachment in the right eye, and viteliform deposit on the left eye. Fluorescein angiography and the electrooculogram confirmed the diagnosis of choroidal neovascularization associated with Best's disease. Four weeks after a single bevacizumab intravitreal injection, visual acuity was restored (20/25) and remained stable after a 12 month follow-up. DISCUSSION: Intravitreal bevacizumab appears to be an effective treatment for choroidal neovascularization associated to Best's disease

[Intravitreal bevacizumab for choroidal neovascularization associated with Best's disease]. / Bevacizumab intravítreo en neovascularización coroidea asociada a enfermedad de Best.

CASE REPORT: A 27-year old woman presented with loss of vision in the right eye (20/200). Ophthalmoscopic examination showed intrarretinal hemorrhage in the macular region with neurosensory detachment in the right eye, and viteliform deposit on the left eye. Fluorescein angiography and the electrooculogram confirmed the diagnosis of choroidal neovascularization associated with Best's disease. Four weeks after a single bevacizumab intravitreal injection, visual acuity was restored (20/25) and remained stable after a 12 month follow-up. DISCUSSION: Intravitreal bevacizumab appears to be an effective treatment for choroidal neovascularization associated to Best's disease.

Cyclodialysis induced persistent hypotony: surgical management with vitrectomy and endotamponade.

PURPOSE: To report novel surgical approaches to the management of persistent hypotony after cyclodialysis. METHODS: Retrospective review of the medical records of six eyes of six patients with persistent hypotony after traumatic cyclodialysis. The diagnosis accuracy of cyclodialysis was documented by ultrasound biomicroscopy in five patients. The other one underwent an anterior segment optical coherence tomography. The authors performed pars plana vitrectomy and silicone oil-assisted endotamponade in four patients. The remaining eyes underwent a gas tamponade after pars plana vitrectomy. RESULTS: Preoperative visual acuity (Snellen scale) ranged from count fingers to 20/50. The patients' visual acuity improved after the surgery. The intraocular pressure ranged from 2 mmHg to 6 mmHg (mean, 3.33 mmHg) before surgery. The authors did achieve an intraocular pressure normalization postoperatively. After surgery, the ciliary body was completely reattached in all cases. A slight angle recession was documented in one eye. CONCLUSION: The management of cyclodialysis clefts requires a stepwise approach. In cases where conservative management fails, wide ranges of options have been reported. Based on our results, we consider that silicone oil-assisted or gas-assisted endotamponade, after pars plana vitrectomy, can be an effective alternative approach to the cyclodialysis.

Rhegmatogenous retinal detachment treatment guidelines.

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience.

Guías de tratamiento del desprendimiento de retina rhegmatógeno / Rhegmatogenous retinal detachment treatment guidelines

El objetivo de esta guía es describir unas directrices generales del proceso seguido por el cirujano oftalmólogo desde el diagnóstico del desprendimiento de retina, pasando por su evaluación preoperatoria, hasta su tratamiento, complicaciones intra y postoperatorias, fracaso o recidiva del desprendimiento de retina rhegmatógeno, y las posibles alternativas terapéuticas en cada caso. También describiremos el tratamiento del desprendimiento de retina traumático por su importancia y peculiaridades. Se sugieren líneas de tratamiento o profilaxis para las diferentes situaciones del desprendimiento de retina en base a la variables encontradas, a la experiencia de los cirujanos oftalmólogos de la comisión que las ha redactado, y a la revisión bibliográfica con los distintos niveles de evidencia, pero no pretende establecer criterios de obligado cumplimiento, sobre todo considerando que el desprendimiento de retina tiene amplias posibilidades de tratamiento, y que la experiencia del cirujano en una u otra técnica va a ser fundamental en la obtención del mejor resultado quirúrgico. Como guías que son, solamente pretenden asesorar al cirujano en la práctica diaria, dejando en sus manos y en su experiencia la mejor opción terapéutica(AU)

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons’ experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience(AU)

De la evidencia científica a la práctica clínica: pautas de tratamiento del edema macular secundario a oclusión venosa retiniana / From scientific evidence to clinical practice: treatment regimens for macular edema secondary to retinal vein occlusion

Las oclusiones venosas de la retina (OVR) son la segunda causa más frecuente de enfermedad vascular de la retina después de la retinopatía diabética. A pesar de la existencia de varias opciones terapéuticas posibles, ninguna resultó del todo satisfactoria, y muchos pacientes sufrían una pérdida visual irreversible. Como resultado de los ensayos BRAVO,CRUISE y GENEVA, ranibizumab y los implantes intravítreos biodegradables de dexametasona han sido recientemente aprobados por la Food and Drug Administration en los Estados Unidos y por la Agencia Europea del Medicamento para el tratamiento del edema macular secundario a OVR. En este trabajo comenzamos describiendo las opciones actuales de tratamiento para el edema macular secundario a oclusión venosa retiniana y continuamos con la descripción de la pauta de tratamiento con ranibizumab(AU)

Retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease after diabetic retinopathy. Despite the existence of several possible treatment options, none was entirely satisfactory and many patients suffered irreversible visual loss. As a result of the BRAVO, CRUISE and GENEVA trials, ranibizumab and the intravitreal biodegradable implants of dexamethasone has recently been approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of RVO secondary edema. In this paper we begin by describing the current treatment options for RVO associated macular edema and continue with the description of the treatment regimen with ranibizumab(AU)

[Best's vitelliform macular dystrophy associated with choroidal neovascularization]. / Distrofia macular viteliforme de Best asociada a neovascularización coroidea.

CASE REPORT: We report the case of a child with a sudden loss of vision of the left eye. Ophthalmoscopic examination revealed vitelliform lesions in both foveal centers, as well as an adjacent hemorrhage in his left eye. Fluorescein angiography confirmed the presence of a neovascular membrane in his left eye. The electrooculogram showed disease. According to complementary studies the patient was diagnosed with Best's disease associated with choroidal neovascularization. DISCUSSION: The diagnosis of Best's vitelliform macular dystrophy is often a casual finding as visual acuity tends to remain stable for long periods of time. A sudden deterioration in vision may suggest complications, such as choroidal neovascularization.

Distrofia macular viteliforme de Best asociada a neovascularización coroidea / Best’s vitelliform macular dystrophy associated with choroidal neovascularization

Caso clínico: Se presenta el caso de un niño con pérdida súbita de visión en ojo izquierdo. El examen funduscópico revela una lesión foveal viteliforme bilateral, y una hemorragia adyacente en ojo izquierdo. La angiografía con fluoresceína confirma la presencia de una membrana neovascular en ojo izquierdo. El electrooculograma resulta patológico. Tras completar el estudio, es diagnosticado de enfermedad de Best asociada a neovascularización coroidea. Discusión: El diagnóstico de enfermedad de Best puede ser casual dado que la agudeza visual suele permanecer estable. Una pérdida súbita de visión ha de sugerirnos la aparición de complicaciones tales como neovascularización coroidea(AU)

Case report: We report the case of a child with a sudden loss of vision of the left eye. Ophthalmoscopic examination revealed vitelliform lesions in both foveal centers, as well as an adjacent hemorrhage in his left eye. Fluoresce in angiography confirmed the presence of a neovascular membrane in his left eye. The electrooculogram showed disease. According to complementary studies the patient was diagnosed with Best’s disease associated with choroidal neovascularization. Discussion: The diagnosis of Best’s vitelliform macular dystrophy is often a casual finding as visual acuity tends to remain stable for long periods of time. A sudden deterioration in vision may suggest complications, such as choroidal neovascularization(AU)

Vitreous levels of somatostatin in patients with chronic uveitic macular oedema.

PURPOSE: Intravitreal somatostatin (SST) levels are decreased in patients with diabetic macular oedema. This deficit may be involved in the pathogenesis of this condition. The aim of the present study was to determine SST concentration in the vitreous fluid of patients with chronic uveitic macular oedema (CUMO) and quiescent intraocular inflammation. METHODS: Plasma and vitreous fluid samples were obtained during vitrectomy from 11 eyes of patients with CUMO and from 42 eyes of control subjects (idiopathic epiretinal membrane, macular hole). SST concentration was measured by radioimmunoassay. STATISTICS: χ(2)-square test, Mann-Whitney U-test, Wilcoxon test, Spearman's rank correlation coefficient, and multivariant linear regression models. RESULTS: Plasma SST concentrations were similar in uveitic patients and controls (28.25 pg/ml (21.3-31) vs 28.7 pg/ml (22-29.5); P=0.869). A higher vitreous concentration of proteins was found in uveitic patients (1.59±0.38 mg/ml vs 0.73±0.32 mg/ml, P<0.0001). Vitreous SST was markedly lower in uveitic patients, both in absolute terms and after adjusting for total intravitreous protein concentration (39.37 pg/ml (6.16-172) vs 486.73 pg/ml (4.7-1833), P<0.0001; 33.1 pg/mg (3.9-215.74) vs 629.75 pg/mg (6.91-2024), P<0.0001). No correlations were found between plasma and vitreous concentration of SST in either group (ρ=0.191, P=0.57 and ρ=0.49, P=0.66). There were no correlations between vitreous SST concentration and visual acuity or macular thickness in uveitic patients (ρ=0.302, P=0.31 and ρ=0.45, P=0.13). CONCLUSIONS: Intravitreous SST is decreased in patients with CUMO and quiescent intraocular inflammation. The deficit of SST may have a role in the pathogenesis of this condition.

[From scientific evidence to clinical practice: treatment regimens for macular edema secondary to retinal vein occlusion]. / De la evidencia cientifica a la practica clinica: pautas de tratamiento del edema macular secundario a oclusion venosa retiniana.

Retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease after diabetic retinopathy. Despite the existence of several possible treatment options, none was entirely satisfactory and many patients suffered irreversible visual loss. As a result of the BRAVO, CRUISE and GENEVA trials, ranibizumab and the intravitreal biodegradable implants of dexamethasone has recently been approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of RVO secondary edema. In this paper we begin by describing the current treatment options for RVO associated macular edema and continue with the description of the treatment regimen with ranibizumab.

Vitreous levels of interleukine-8 and monocyte chemoattractant protein-1 in macular oedema with branch retinal vein occlusion.

PURPOSE: To investigate whether interleukine-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) are related with macular oedema in patients with branch retinal vein occlusions (BRVOs). DESIGN: Retrospective case-control study. PARTICIPANTS: Nineteen patients who had macular oedema due to BRVO and nine patients with non-ischaemic ocular diseases (control group). METHODS: Macular oedema was examined by optical coherence tomography. Both venous blood and vitreous samples were obtained at the time of vitreoretinal surgery. IL-8 and MCP-1 levels in vitreous fluid and plasma were determined with enzyme-linked immunosorbent assay kits. Variables were compared with the Mann-Whitney U-test, Wilcoxon's signed-ranked test, and the chi2-test, when appropriate. To examine correlations, Spearman's rank-order correlation coefficients were calculated. Statistical significance was set at P<0.05. RESULTS: The vitreous fluid levels of IL-8 (median: 63.5 pg/ml) and MCP-1 (median: 1522.4 pg/ml) were significantly higher in the patients with BRVO than in the control group (median: 5.1 and 746.5 pg/ml respectively; P<0.001 and <0.001 respectively). Vitreous IL-8 and MCP-1 were significantly correlated in patients with BRVO (P=0.009). CONCLUSIONS: Both IL-8 and MCP-1 were elevated in the vitreous fluid of patients with BRVO and macular oedema. Both chemokines may contribute to the pathogenesis of macular oedema in patients with BRVO.

Interphotoreceptor retinoid-binding protein (IRBP) is downregulated at early stages of diabetic retinopathy.

AIMS/HYPOTHESIS: Interphotoreceptor retinoid-binding protein (IRBP) plays a major role in the visual cycle and is essential to the maintenance of photoreceptors. The aim of this study was to determine whether a decrease in IRBP production exists in the early stages of diabetic retinopathy. METHODS: Vitreous samples from diabetic patients with proliferative and non-proliferative diabetic retinopathy (PDR, NPDR), and from non-diabetic patients with macular hole (control group) were selected for IRBP quantitative assessment by proteomic analysis (fluorescence-based difference gel electrophoresis) and western blot. Human post mortem eyes (n = 16) from diabetic donors without clinically detectable retinopathy and from non-diabetic donors (n = 16) were used to determine IRBP (also known as RBP3) mRNA levels (RT-PCR) and protein content (western blot and confocal microscopy). Retinal neurodegeneration was assessed by measuring glial fibrillar acidic protein (GFAP) and the apoptotic rate. Y79 human retinoblastoma cells were used to test the effects of glucose, TNF-alpha and IL-1beta on IRBP expression and IRBP levels. RESULTS: Intravitreous IRBP concentration was significantly lower in PDR < NPDR < control in proteomic and western blot analysis. IRBP mRNA levels and IRBP protein content were significantly lower in the retinas from diabetic donors than in those from non-diabetic donors. Increased GFAP and a higher degree of apoptosis were observed in diabetic retinas compared with non-diabetic retinas. A dose-dependent downregulation of IRBP mRNA expression and IRBP content was detected with glucose, TNF-alpha and IL-1beta in cultures of Y79 human retinoblastoma cells. CONCLUSIONS/INTERPRETATION: Underproduction of IRBP is an early event in the human diabetic retina and is associated with retinal neurodegeneration. The mechanisms leading to this deficit deserve further investigation.