Persistent severe visual field impairment is associated with obesity and tumour invasiveness, but not with pituitary dysfunction, in patients with craniopharyngioma.

PURPOSE: Craniopharyngiomas (CP) are benign tumours of the sellar region. Hypopituitarism, visual deficits, hypothalamic damage with consequent obesity and related increased cardiovascular risk, are complications due to the tumour itself or secondary to treatment strategy. We retrospectively correlated visual field status with clinical, neuroradiological, histopathological features and management strategy, in a single-centre cohort of patients with CP. METHODS: Thirty-four patients (16 M; median age 27.2 ± 21.8 yrs) with CP were included. We evaluated visual field status, assessed by means of standard automated perimetry and expressed as mean deviation (MD), at last follow-up visit (median 14 ± 11.7 yrs). MD has been correlated with clinical, radiological, histological data and treatment modalities. RESULTS: In univariate analysis worst eye MD was significantly associated with panhypopituitarism (p 0.010). In multivariable linear regression, panhypopituitarism (p 0.008), CP recurrence (p 0.020) and DI (p 0.004) were found to be the main independent predictors of a worse visual field outcome. When stratifying patients according to the degree of visual field impairment (MD < -12 dB Vs MD > -12 dB), the main independent predictors of worse visual field outcome were older age at diagnosis (p 0.010), CP histological subtype (p 0.004), invasiveness (p 0.04), CP recurrence (p 0.035), DI (p 0.002) and weight at last follow-up (p 0.012). CONCLUSION: In CP patients the long-term ophthalmological impairment is frequent, especially at older age, and strictly related to tumour invasiveness and recurrence, and associated to pituitary disfunction and obesity.

Multidisciplinary Management of Pituitary Apoplexy.

Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2-12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team's skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

Scanning laser polarimetry and confocal scanning laser ophthalmoscopy: technical notes on their use in glaucoma.

The mere intraocular pressure (IOP) measurement and the visual field (VF) examination do not allow early primary open-angle glaucoma (POAG) diagnosis. At present, the morphological and morphometric analysis of the optic disk is considered very important for an early diagnosis and follow-up of the disease. The recent introduction of laser systems equipped with new polarimetry techniques (GDx) and confocal tomography (HRT) allows an objective, quantitative, and reproducible evaluation of the morphometry and morphology of the optic disk and retinal nerve fiber layer (RNFL). The GDx, scanning laser polarimetry, studies the RNFL. The HRT, confocal scanning laser tomography, examines several optic disk and peripapillar area parameters. These devices allow obtaining objective and quantitative data concerning RNFL and optic nerve head. They represent complementary and important examinations in case of uncertain POAG diagnosis. The correct evaluation of the parameters studied by these techniques and the knowledge of the instruments' limits are needed for an adequate interpretation of the results obtained.

Effects of tear substitutes on conjunctival epithelium of mice.

AIM: The effects of the administration of three tear substitutes on normal conjunctival epithelium of the mouse, with particular regard to goblet cells, were studied. METHODS: Three-month-old Swiss CD 1 mice were divided into four groups of 7 animals each. Group 1 was untreated (control). The other animals were treated with the instillation of 5 drops/day for 10 days as follows: group 2, 0.2% sodium hyaluronate (SH); group 3, 0.5% hydroxypropylmethylcellulose (HPMC); group 4, 0.9% NaCl. The entire conjunctiva was processed for light and electron microscopy. A morphometric study was performed to evaluate: the number and size of goblet cells and the number, size and optical density of mucin granules. Furthermore, Alcian blue/periodic acid-Schiff (AB/PAS) staining for goblet cells was carried out. RESULTS: The SH-treated group showed that the area and number of goblet cells were similar to the untreated group; the mucin granules were reduced in number and optical density but increased in size. The HPMC-treated group showed a reduced area of goblet cells with reduced optical density of mucin granules. The saline-treated group showed that goblet cells were reduced in area and number; mucin granules showed a reduction in number and optical density and an increased size. The AB/PAS stain showed that each treatment was able to induce a treatment-specific modification of the staining characteristics of goblet cells. CONCLUSION: Our results strongly suggest that tear substitutes can induce treatment-specific modifications of the conjunctival epithelium with particular regard to goblet cell structure and ultrastructure.

Age-related modifications of corneal sensitivity.

PURPOSE: To evaluate central and peripheral corneal sensitivity (CS) in relation to age. METHODS: Five hundred eyes of 320 healthy subjects (185 males and 135 females) were examined. The age of participants ranged from 20 to 90 years. All subjects were divided into 3 groups according to age. CS was assessed with the Cochet-Bonnet esthesiometer in the central cornea and in 8 peripheral points. The averages were used as the values of central and peripheral CS. RESULTS: In the young population, CS was equal in both examined zones (p > 0.05); although, with respect to the periphery after the fifth decade, it was significantly higher in the centre (p < 0.05). Both central and peripheral sensitivity decreased with age (p < 0.05), and such variations are represented by parabolic curves. No differences were observed between males and females. CONCLUSIONS: The age-related decrement of CS involves at first the corneal periphery and successively spreads toward the central zone. Topographical distribution and age-related modifications should be considered in clinical investigations of CS, especially in patients who underwent any corneal surgical procedure.

Postural modifications of the oscillatory potentials of the electroretinogram in primary open-angle glaucoma.

The postural variations in the retinal microcirculation in glaucomatous patients were studied by evaluation of the oscillatory potentials (OPs) of the ERG. The OPs in scotopic adaptation were examined in subjects with primary open-angle glaucoma and in an age- and sex-matched normal control group in different body positions (seated, supine, anti-Trendelenburg, Trendelenburg). In the seated position, the difference of mean OP amplitude between the control group and the glaucomatous patients was highly significant (p < 0.001). In the normal subjects the OP amplitude in the Trendelenburg position was statistically lower with respect to the values obtained in all other positions (p < 0.05). In the glaucomatous patient group, the OP amplitude in the anti-Trendelenburg position was increased as compared to the other positions (p < 0.05). The study showed a reduction in amplitude of OPs in glaucomatous patients and their different behaviour in both groups with changes in body position.