Graves' disease: measurement of the extraocular muscle thickness with the echobiometer.

The authors measured extraocular muscle thickness in normal subjects and in patients affected by Graves' disease, using a Sonomed A-2000 echobiometer (probe with 10-MHz frequency); Hertel's exophthalmometry was also performed. Statistically significant differences in muscle thickness between normals and patients were found. This technique seems to be sufficiently useful and reliable in extraocular thickness evaluation, showing data similar to those of the recent literature.

Effect of betaxolol on primary open-angle glaucoma and normal-tension glaucoma patients.

This study is aimed at establishing the efficacy of the therapeutic agent, betaxolol, in diurnal control of IOP (intraocular pressure). Therapy was performed on 32 eyes affected by POAG (primary open-angle glaucoma) and 16 eyes affected by NTG (normal-tension glaucoma). Two preparations of betaxolol were utilized: betaxolol hydrochloride 0.50% (Betoptic) was administered to 15 POAG and 7 NTG eyes; betaxolol hydrochloride 0.25% ophthalmic suspension (Betoptic S) was administered to 17 POAG and 9 NTG eyes. IOP measurements were taken every two hours from 8 a.m. to 8 p.m. IOP was measured before therapy and at 12 hours, 30 days, and 3 months of therapy. Betaxolol hydrochloride 0.50% was more effective at lowering IOP during the day. Diurnal pressure peaks, which are a risk factor concerning the maintenance of visual field in glaucoma patients, were also reduced using 0.50% betaxolol hydrochloride.

Fluctuations of intraocular pressure during the day in open-angle glaucoma, normal-tension glaucoma and normal subjects.

PURPOSE: The aim of the present paper is to describe the variations in intraocular pressure (IOP) during the day in normals, in patients with primary open-angle glaucoma (POAG) and in patients with normal-tension glaucoma (NTG). IOP represents one of the most important risk factors for glaucoma. However the IOP value is not constant during the day and IOP fluctuation could influence the diagnostic and prognostic evaluation of the glaucomatous disease. METHODS: For this purpose IOP was evaluated every 2 h from 8 a.m. to 8 p.m. in one randomized eye of 33 normal subjects, 95 POAG and 50 NTG patients. RESULTS: The results show that the highest IOP values were detectable in the morning in all three groups. The lowest values were found in the early afternoon hours. These variations were most evident in POAG patients. The daily IOP fluctuations were directly proportional to IOP level. CONCLUSION: The study evidents that a single tonometric evaluation, especially if done in the first hours of the afternoon, is not sufficient to correctly evaluate the IOP-related risk in glaucoma patients. If the pressure peaks are important in determining the extent of glaucomatous damage in NTG patients IOP should not have an important role in optic nerve head damage. The use of diurnal curves seems to be mandatory for the assessment of IOP-related risk and of efficiency of the therapeutic approach.

Intraimage reproducibility of measurements in the macular area using a computerized system.

An accurate analysis of the morphological changes which take place during pathological processes of the posterior pole is important for a correct diagnosis and therapeutic approach. The purpose of the study was to determine the intraobserver and interobserver reproducibility of the Image-net system 100 (Topcon, Japan) to take measurements on the retina. The program 'Linear/Areal Measurement functions' of Image-net system 100 which is an image digitalization technique, was tested. Twelve patients were consecutively selected from the patients of the Retina Center of the Department of Ophthalmology, University of Genoa. Three images of each eye were taken from each subject and only the best image was used in this study. The intraobserver and interobserver reproducibility of both the distance between two pre-set points (linear measurement), and the perimeter and area of preselected retinal zones were calculated. The repeatability (or intraobserver reproducibility) of the linear sizes was measured by the coefficient of variation and ranged from 0.32% to 7.38%, while the interobserver reproducibility ranged from 0.46% to 5.22%. The repeatability and reproducibility of the perimeters ranged from 0.72% to 9.63% and from 0.6% to 5.7%, respectively, while the repeatability and reproducibility of the areas ranged from 0.72% to 9.63% and from 0.6% to 5.7%, respectively. Although the results were quite good, the quality of the image of the fundus and the number of observers influenced the coefficient of variation; furthermore, the anatomy of the areas to be measured and the computer 'mouse' could increase the value of the coefficient of variation.

Congenital glaucoma associated with an arginase deficit: a case report.

PURPOSE: Argininemia is a rare congenital disease caused by deficiency. We present here a case in which argininemia and buphthalmos are associated. CASE REPORT: This female patient, who died at eighteen, had intraocular pressure correlated with her blood levels or arginine. Hyperammoniemia causes a change in pH that could explain an increase in aqueous humor (from the ciliary body). Ammonium ions could also damage the matrix of the trabecular meshwork. CONCLUSIONS: The association of argininemia and buphthalmos have never been described. This might be because of the different expressions of the disease, or because nobody has ever looked for ocular hypertension in these patients unless they had subjective symptoms.

The mixed leukocyte reaction may promote the growth of human pericorneal fibroblasts in primary culture.

Keratitis of the cornea is believed to be the leading cause of loss of vision due to external eye disease in the United States and in Europe. At present, primary and secondary cell cultures obtained from corneal explants are the most suitable system to study the role of drug-resistant viruses in severe recurrences of infections leading to irreversible corneal scarring. In this work, the growth of human pericorneal fibroblasts in primary and secondary cultures has been obtained by cocultivation with a mixed leukocyte reaction.

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.

Non-steroidal treatment of pollen-induced conjunctivitis: comparison of different pharmacological protocols.

Pharmacological treatment of allergic conjunctivitis may be based on the therapeutic use of topical steroids; however, because of the side effects, steroids are not clinically suitable in either prolonged treatment, or pollinosis. Because non-steroidal topical drugs are suitable in prolonged treatment, this single-blind study evaluated the following topical drugs: cromoglycate plus chlorphenamine, cromoglycate plus tetryzolin and imidazolin plus nafazolin, compared with placebo. The results confirm significant clinical efficacy of these drugs on signs and symptoms compared with placebo. Thus, "non-steroidal" topical drugs should be the preferred choice in prolonged forms of pollen-induced (e.g. Parietaria and/or grasses) conjunctivitis.

[Changes in the internal limiting retinal membrane after epiretinal peeling]. / Altérations de la lame limitante interne de la rétine après pelage des membranes épirétiniennes.

The authors describe the histological features of an extensive epiretinal membrane surgically removed from an eye with posterior penetrating ocular trauma. A pars plana vitrectomy and removal of the epiretinal membrane were performed. Histological preparations revealed a large segment of internal limiting membrane (ILM) adherent to the epiretinal membrane. This case report illustrates two points: the adherence between ILM and Muller cells is quite weak; removal of extensive portions of ILM could encourage rapid re-proliferative phenomena.

A new therapeutical approach to central serous retinopathy, a hypothesis.

The authors report two cases of patients affected by Central Serous Retinopathy (C.S.R.) lasting few days; they were immediately started with an antiviral therapy (Acycloguanosine) for few days and in both cases the regression of symptoms and a flat retina were observed after a very shorter time than the spontaneous course. A fluorescein angiography confirmed a healing of the leaking points very few days after the therapy was discontinued. The authors discuss their finding in relation to the latest hypothesis on C.S.R. pathogenesis.

[Senile macular degeneration: surgical management and histopathologic features]. / Dégénérescence maculaire sénile: traitement chirurgical et aspects histopathologiques.

Choroidal neovascularization often complicates senile macular degeneration; argon and krypton laser photocoagulation are very useful to stop visual acuity decrease caused by extrafoveal choroidal neovascular membrane (NVM) in a large group of patients. Unfortunately, in a large number of cases, NVM causes haemorrhagic serous detachment, disciform scar and, sometimes, vitreous hemorrhage. In these patients it is impossible to perform laser treatment. A three ports pars-plana vitrectomy has been performed for the treatment of intravitreal hemorrhage in a case of haemorrhagic disciform lesion and in two cases of extensive subretinal haemorrhage secondary to subretinal NVMs. Posterior pole focal retinotomies have been created to remove the NVMs in order to prevent further hemorrhages; an internal tamponade has been performed and the retinotomies closed with endophotocoagulation or endocryo. The specimen of the membranes, stained for light microscopy, have been studied. During the months of follow-up (9 months) no subretinal membrane no retinal detachment developed but fibrosis at the retinotomy sites led to traction on the macula. The functional aim of this surgery is limited to the restoration of a clear vitreous and to a reduction in the diameter of the central scotoma in the cases of a recent subretinal haemorrhage.

Effect of luminance on perceptual alternation of ambiguous patterns.

The perceptual alternation of the Necker cube, in its stationary phase, is studied as a function of the stimulus luminance down to the extreme condition in which the cones are completely inactivated so that the pattern of neural excitation reaching the primary visual cortex is very different from the normal one. No evident effect of luminance was found under passive observation either on the reversal rate or on the features of data distributions. Moreover, the complementary situation in which perception is based only on the cones does not affect the phenomenon either. These results permit the assumption that the perceptual alternation in its stationary phase, is a passive and automatic process, that is affected neither by a satiation of the first levels of the visual system nor by the psychological attitude of the subject consequent on dazzling the retina.

The fellow eye in retinal detachment.

The examination findings of the fellow eye of 534 patients affected by a unilateral retinal detachment are reported. Nearly 90% of these eyes showed degenerative areas and about 20% showed one or more retinal breaks. These findings are quite different from those reported in examinations of 'random eyes' and suggest that fellow eyes are 'high risks' that often need prompt prophylactic treatment.