Prostaglandin analogs and blood-aqueous barrier integrity: a flare cell meter study.

PURPOSE: To study, with an objective method, inflammation of the anterior segment of the glaucomatous eye after treatment with latanoprost, travoprost and bimatoprost. MATERIALS AND METHODS: Sixty patients with chronic open-angle glaucoma aged between 38 and 76 years (mean 64.0 +/- 12.2) were randomly assigned to latanoprost 0.005, travoprost 0.004 and bimatoprost 0.03%. The study period lasted 6 months. Intraocular pressure (IOP) was measured every 2 weeks. We studied the intraocular inflammation before and after 3 and 6 months of therapy with an instrument composed of a He-Ne laser beam system, a photomultiplier mounted on a slitlamp microscope and a computer. This flare meter allows objective determination of the flare and the number of cells in the aqueous of the anterior chamber. RESULTS: At the baseline, IOP was 26.4 +/- 3.6 mm Hg. After 3 months of treatment, mean IOP in the latanoprost group was 17.9 +/- 0.3 mm Hg (p < 0.001) with a mean cellularity of 12.638 +/- 3.284 photons/ms (p < 0.001). The travoprost group had an IOP of 17.2 +/- 0.3 mm Hg (p < 0.001) with a cellularity of 9.719 +/- 1.927 photons/ms (0.001). Finally, IOP in the bimatoprost group was 17.6 +/- 0.5 mm Hg (p < 0.001) with a cellularity of 6.138 +/- 1.475 photons/ms (p < 0.032). After 6 months of treatment, IOP in the latanoprost group was 18.1 +/- 0.3 (p < 0.001), in the travoprost group 17.3 +/- 0.3 (p < 0.001) and in the bimatoprost group 17.7 +/- 0.5 mm Hg (p < 0.001), whereas cellularity was 11.838 +/- 3.218 (p < 0.001), 8.950 +/- 3.692 (p < 0.001) and 7.617 +/- 2.603 photons/ms (p < 0.001), respectively. After 3 months, the travoprost (p < 0.013) and the bimatoprost groups (p < 0.001) had less flare compared with the latanoprost group and this remained so even at 6 months. When we compared the travoprost group with the bimatoprost group, we found significantly less flare at 3 months in the bimatoprost group (p < 0.001) but not at 6 months (p < 0.246). CONCLUSIONS: The flare meter analysis shows that the eyes treated with bimatoprost and travoprost have a less significantly broken blood-aqueous barrier and their anterior chamber is also significantly less inflamed.

Dryness symptoms, diagnostic protocol and therapeutic management: a report on 1,200 patients.

PURPOSE: To report the diagnostic and therapeutic data obtained from 1,200 patients suffering from dry eye symptoms not due to Sjögren's syndrome or other auto-immune diseases. METHODS: Schirmer test I, ferning test, breakup time, vital dye staining, brush and imprint cytology were performed; data were grouped into diagnostic profiles, and the therapy was prescribed according to these. RESULTS: Eight diagnostic profiles were identified. Dry eye was diagnosed in 57.1% of patients; the remaining 42.9% were found to suffer from eye discomfort or conjunctivitis of different aetiologies. CONCLUSIONS: Subjective symptoms of dryness can hide diseases other than dry eye; combined clinical and laboratory tests are requested to make a diagnosis. Our experience indicates that a therapy prescribed on the basis of diagnostic profiles provides relief in 79.1% of cases.

The biocompatibility of silicone, fluorosilicone and perfluorocarbon liquids as vitreous tamponades. an ultrastructural and immunohistochemical study.

PURPOSE: To investigate the interactions occurring at the interface between some currently used vitreous tamponading substances and the ocular tissues, in an early follow-up after surgery. METHODS: Adult albino rabbit eyes underwent vitrectomy and were injected intravitreally with silicone oils at 1,000 or 3,000 cSt, fluorosilicone oil and perfluorodecalin. Different morphological techniques (light microscopy, scanning and electron microscopy, immunohistochemistry) were applied. RESULTS: All the tested materials, although non-toxic, penetrate the ocular tissues also at the anterior segment level, and in the long-term follow-up this can yield functional impairment. No massive inflammation has been detected in the zones in contact with the materials, but immunoglobulins and complement fractions are anyway present in the stroma of various tissues and around the droplets of emulsified materials, suggesting a local immune reaction. CONCLUSIONS: Data from this study confirmed that a permanent vitreous substitute, showing a perfect biocompatibility, still does not exist. The indication to remove the tamponading substance within 2 months after the surgery emerges from this investigation, confirming previous studies. Despite some negative features, silicone oil still appears the most biocompatible material for vitreous replacement.

Frequent replacement and conventional daily wear soft contact lens symptomatic patients: tear film and ocular surface changes.

We analyzed tear film changes, ocular surface tissue alterations and inflammatory conditions in Frequent Replacement Soft (FRS) Contact Lens (CL) or Conventional Soft (CS)-CL wearers suffering from eye discomfort, by applying complementary diagnostic tests. Our data suggest the following conclusions: i) eye discomfort symptoms begin after 1-3 years of successful wear, mainly in FRS-CL wearers; ii) tear film stability is affected by CL wear, mainly in FRS-CL wearers; iii) CL wear produces a subclinical moderate inflammation based on mononuclear cell recruitment in 3 out of 4 patients of both types of lenses; iv) CL wear induces dry eye conditions, more pronounced in FRS-CL users; v) discomfort symptoms, presence of subclinical inflammation, degree of dryness are not directly related to a clinical presentation of intolerance, mainly in FRS-CL wearers; vi) CL wear-related discomfort symptoms should never be underestimated, since a hidden inflammation or dryness can be present beyond an apparently good clinical picture.

Color doppler imaging of ocular blood flow after topical ketanserin.

The authors investigated the effect of ketanserin 0.5% eye drops on intraocular pressure and orbital blood flow in some healthy volunteers. Ketanserin is a selective antagonist of serotonin S(2) receptors; moreover, it produces an alpha(1)-blocking effect. It causes a systemic reduction of blood pressure and capillary vasodilatation. Three hours after topical administration of ketanserin 0.5%, the intraocular pressure was decreased by about 14% from the baseline. At the same time, we observed by color Doppler imaging that the mean percent increase in the peak systolic velocity in the ophthalmic artery (OA) was 5.18% (p < 0.161) and 23.18% (p < 0.001) in the posterior ciliary arteries (PCAs). The mean resistance index of the OA was in contrast reduced by 1.16% (p < 0.669) and by 32.14% (p < 0.003) in the PCAs. These data show that ketanserin 0.5% eye drops may be useful not only to decrease intraocular pressure but also to improve blood flow in the PCAs that supply the optic nerve head.

Adhesion mechanisms of human lens epithelial cells on 4 intraocular lens materials.

PURPOSE: To evaluate lens epithelial cell (LEC) adhesion on different intraocular lens (IOL) materials with particular attention to the distribution of proteins located in the focal contacts. SETTING: Center of Biotechnological and Clinical Research in Ophthalmology, University of Bologna, Italy. METHODS: The IOL materials tested were poly(methyl methacrylate) (PMMA), heparin-surface-modified PMMA (HSM PMMA), polyHEMA, and silicone. Primary cultures of human LECs were established from human anterior capsules obtained during cataract surgery. The mean number of cells attached per square millimeter was calculated for each material after 24 and 72 hours. Transmission electron microscopy and immunocytochemical analysis were performed to detect the proteins actin, vinculin, and talin. RESULTS: Mean adhesiveness of human LECs increased over time with PMMA and decreased with the other materials. At 72 hours, mean LECs ranged from 54.8 cells/mm2 +/- 12.8 (SD) on PMMA to 2.1 +/- 0.7 cells/mm2 on silicone. The means for HSM PMMA and polyHEMA fell in between. The cytoskeletal proteins were arranged to produce focal contacts in only the LECs cultured on PMMA. The LECs cultured on polyHEMA, HSM PMMA, and silicone attached but failed to develop focal contacts or stress fibers. CONCLUSION: This study confirms the multifactorial pathogenesis of posterior capsule opacification and suggests its incidence will be reduced by improving surgical techniques and using IOL surfaces that discourage cell adhesion.

Eye discomfort and air pollution.

Discomfort eye syndrome (DES) comprises a series of 'minor' subjective symptoms in patients where no relevant clinical signs are observed suggesting ocular disease. Our study includes 100 DES patients, excluding video terminal users, selected from the First Aid Service of our Department over two peak periods in both winter and summer time. The Schirmer test I, ferning test, breakup time and conjunctival cytology (scraping and imprint) were performed and data were related to sex, age and air pollution indexes, recorded in the patients' living zones. Our results demonstrate that: (i) the ocular surface cytology and the analysis of tear film changes provide significant information in those patients where no other clinical signs are evident; (ii) DES symptoms are more frequent in women than in men (ratio about 2:1), both with ages over 51 years; (iii) DES is significantly associated with ocular surface inflammation, as detected by cytological methods, and (iv) ocular surface subclinical inflammation and ocular dryness are related to high concentrations of atmospheric polluters, in both sexes.

Applications of Raman spectroscopy to ophthalmology: spectroscopic characterization of disposable soft contact lenses.

Disposable soft contact lenses based on HEMA-MAA hydrogels are examined using Raman and ATR/FTIR vibrational spectroscopies and thermal analysis. The main factors dealing with physical, chemical, and biological biocompatibility are evaluated in relation to those of long-wear soft contact lenses with the aim of individuating the most biocompatible lens. The Raman spectra of HEMA-MAA lenses show that some biocompatibility factors are affected by environmental conditions and, in particular, by changes in pH and ionic strength values.

Inhibition of bacterial adherence to a high-water-content polymer by a water-soluble, nonsteroidal, anti-inflammatory drug.

Deposition and aggregation of lachrymal proteins on the contact lens surface can promote bacterial adherence. Lysozyme is the major tear protein and is also mainly responsible for the formation of protein deposits on contact lenses. Nonsteroidal anti-inflammatory drugs (NSAID) prevent protein aggregation. The effect of a water-soluble NSAID drug on bacterial adherence to high-water-content/ionic disposable contact lenses was examined in a radiolabeling study. Dose-related inhibition of adherence of Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa on both pretreated lenses and after adding the drug to the medium was investigated. When the drug was added to the media, maximal inhibition of S. aureus adherence was observed in trypticase soy broth (59-98% at the lower and higher drug concentrations, respectively); inhibition progressively decreased in calf aqueous humor (48-75%), lysozyme (34-63%), and saline (12-20%) solutions. Inhibition of adherence varied with the three bacterial species; it was maximal with S. aureus, intermediate with S. epidermidis, and minimal with P. aeruginosa. When lenses were pretreated with the drug, consistent, and even higher, inhibitory effects were observed. The results suggest that water-soluble NSAIDs could be used in preventive treatments for conjunctivae and corneal infections in contact lens wearers, and may provide a clue as to which compounds might inhibit protein interaction and bacterial adhesion.

Fatty acid use in glaucomatous optic neuropathy treatment.

The authors have studied the efficacy of an association of DHA, vitamin E and vitamin B complex (TROFINERV) in glaucomatous patients. The parameters evaluated were computerized visual field (CVF) and retinal contrast sensitivity (RCS). Thirty chronic simple glaucoma patients in good tensional compensation with local therapy were given TROFINERV oral therapy. The results show significant differences after 90 days of treatment both in the perimetric indices (MD, SF, CPSD; p < 0.05) and in the RCS frequency values (p < 0.05). In the light of the results obtained, the authors consider the use of such association to be a useful support in glaucomatous patient therapy for preventing or delaying the progress of damage.

Color Doppler imaging and plasma levels of endothelin-1 in low-tension glaucoma.

Endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by vascular endothelin cells There are reports in the literature that ET-1 plasma levels are raised in low tension glaucoma (LTG). ET-1 plasma concentration and Color Doppler Imaging (CDI) evaluation in ophthalmic and posterior ciliary arteries were measured in 15 LTG patients and in 15 healthy subjects. The blood flow index recorded for the ophthalmic artery in normal subjects was a PSV of 36.646 +/- 6.611 cm/sec with RI of 0.717 +/- 0.019 while in the LTG patients it was 32.961 +/- 3.045 cm/sec (p < 0.003) with RI of 0.789 +/- 0.018 (p < 0.001). For the posterior ciliary arteries in the same two groups, we obtained a PSV of 13.878 +/- 4.149 cm/sec vs 8.720 +/- 1.645 cm/sec (p < 0.001) and an RI of 0.679 +/- 0.039 vs 0.722 +/- 0.024 (p < 0.001). The plasma ET-1 level in normal subjects was 1.720 +/- 0.174 pg while in LTG patients it was 2.947 +/- 0.217 pg (p < 0.001). On the basis of our experience, we think that GON and the visual field damage found in LTG can be attributed to an alteration in the endothelial self-regulating sections and consequent vascular insufficiency, particularly pronounced in the posterior ciliary arteries which, since it is these that provide the blood supply to the optic nerve head, leads to irreversible functional damage.

The use of flunarizine in the management of low-tension glaucoma: a color Doppler study.

The authors assess the efficacy of flunarizine in improving blood flow and perimetric indices in low-tension glaucoma (LTG). A group of 20 patients with LTG well-compensated by medical treatment underwent Color Doppler Imaging (CDI) of the ophthalmic artery and posterior ciliary arteries with peak systolic velocity (PSV) and Purcelot's index (PI) evaluation. Computerized perimetry was also performed to assess MD, SF and CPSD. The parameters were measured before and after three months' therapy with flunarizine. Data before and after flunarizine treatment were: Ophthalmic artery- PSV 33.261 +/- 1.628 cm/sec vs 35.746 +/- 0.800 cm/sec (p < 0.001); PI 0.697 +/- 0.017 vs 0.627 +/- 0.031 (p < 0.001); Posterior ciliary arteries- PSV 9.385 +/- 0.751 cm/sec vs 10.738 +/- 1.566 cm/sec (p < 0.005); PI 0.673 +/- 0.056 vs 0.589 +/- 0.023 (p < 0.001). The perimetric indices were modified as follows: MD -11.002 +/- 6.574 vs -6.604 +/- 6.426 (p < 0.006); SF 5.05 +/- 5.717 vs 2.937 +/- 1.780 (p < 0.193); CPSD 10.198 +/- 13.392 vs 3.445 +/- 2.709 (p < 0.093). Oral administration of flunarizine, a calcium channel-blocker which acts at a vascular and neuronal level, improves the blood flow indices for the optic nerve, improving thereby the perimetric indices in LTG.

Interferon alpha in the therapy of conjunctival lymphoma in an HIV+ patient.

The authors evaluated the efficacy of interferon-alpha used intralesionally in the therapy of low-grade conjunctival non-Hodgkin lymphoma in an HIV-positive patient. The patient received one intralesional injection of 1,000,000 U of interferon-alpha three times a week for a total of twelve doses. The remission of conjunctival involvement was seen three months from the end of therapy. The intralesional use of interferon-alpha can be considered an efficacious therapy for low-grade conjunctival non-Hodgkin lymphoma.

Preparation and activity of complexes of transition metals and thiolic heterocyclic ligands.

The study on the co-ordination chemistry of the complexes with thiolic heterocyclic ligands is based on the ion metals binding precisely to the sulphur atom. Studies were consequently carried out on the complexes with some thiolic ligands, such as: 2-imidazolidine-thione (IMT), hydantoin (ID), 2-thiohydantoin (TIOID), rhodanine (RD), 2-mercaptoimidazole (MI), 2-mercapto-1-methylimidazole (MMI) and 2-mercaptopyridine (MPYR), supposing that the co-ordination bond between sulphur and metal is stronger than the possible bond between nitrogen or oxygen and metal due to the minor difference in electronegativity existing between sulphur and metal compared with that existing between nitrogen or oxygen and metal. Complexes of the kind we prepared generally present relatively low constants of instability, marking a strong bond between the metal and the ligand. This would seem to be in direct correlation with the anti-bacterial and herbicidal activity. The activity of the complex in fact proves to be more marked than that of the pure ligand, and the increase appears to be in proportion to the strength of the bond between the metal and the ligand, as seen by the low values of the relative constants of instability. We may imagine that the decrease in the constants of instability corresponds to an increase in the strength of the co-ordination bond and to a parallel increase in the activity and the hypothesis is in accordance with the premised correlation between the strength of the metal-ligand bond and the biological activity.

Colour Doppler analysis of the choroidal circulation in chronic open-angle glaucoma.

PURPOSE: To assess any alteration of the blood flow in the ophthalmic artery, in the posterior ciliary arteries and in the choroid of the glaucomatous eye. METHODS: We studied 15 patients, 11 males and 4 females (mean age 62.4 years), with chronic open-angle glaucoma in good tonometric control by medical therapy. All patients underwent colour Doppler examination of the ophthalmic artery, posterior ciliary artery and choroid. The data for peak systolic velocity (Pv) and resistance index (RI) were compared with those of healthy control subjects. RESULTS: The Pv in the ophthalmic artery of glaucomatous patients was 32.961 +/- 3.045 cm/s (p < 0.033) and RI 0.789 +/- 0.018 (p < 0.001). The Pv of posterior ciliary arteries was 8.720 +/- 1.645 cm/s (p < 0.001) and RI 0.722 +/- 0.024 (p < 0.005). In the choroid the Pv was 10.637 +/- 1.401 cm/s (p < 0.001) and RI 0.643 +/- 0.051 (p < 0.022). CONCLUSIONS: Our data indicate that in a chronic open-angle glaucoma there is an alteration in the eye blood flow especially in the posterior ciliary arteries and the choroid.

Seven surgical silicones retain Staphylococcus aureus differently in vitro.

In an in vitro study, we have quantitatively evaluated the capability of seven different types of silicone to retain a Staphylococcus aureus strain, isolated from a surgical wound. All the silicone specimens were taken from prostheses already used in plastic or ophthalmological surgery. Two polymers were used as controls: polystyrene, because of its known capability to favour in vitro bacterial recovery, and nylon, for its bacterial repellence. The results show that all silicones are suitable substrata for Staphylococcus aureus. However, there are some differences among silicone types. The amounts of bacteria retained from silicone oils are greater than or equal to those obtained from the positive control material.

In vitro adhesion of Staphylococcus epidermidis on heparin-surface-modified intraocular lenses.

This quantitative study assessed the in vitro adhesion of Staphylococcus epidermidis on two types of intraocular lenses: conventional poly(methyl methacrylate) (PMMA) and heparin-surface-modified PMMA. Level adhesion was measured by microbiological turbidimetry. We also measured modifications in the bacterium's structural fatty acids after adhesion using gas chromatography.

Corneal endothelium cell adhesion on intraocular lenses in vitro.

An in vitro evaluation was conducted of the adhesion capabilities of rabbit corneal endothelial cells on intraocular lenses (IOLs) made of heparin-coated polymethylmethacrylate (HSM-PMMA). The concave endothelial surfaces of albino rabbit corneas were placed in contact in vitro with the convex surfaces of the optical side of HSM-PMMA IOLs in 4-day cultures. PMMA IOLs served as controls. After an incubation period, the preparations were examined via phase-contrast microscopy and via inverted microscopy after staining with vital dye (neutral red), both with and without the cornea in place. After fixation and staining with Giemsa, the cells adherent on the lens were counted on five different microscopic fields. It was observed that the corneal endothelial cells adhered equally to heparin-coated and untreated PMMA IOLs.

Retinitis pigmentosa, ataxia, and mental retardation associated with mitochondrial DNA mutation in an Italian family.

An Italian pedigree including two sisters and their mother affected by a neuro-ophthalmic disease characterised by retinitis pigmentosa, ataxia, and psychomotor retardation is reported. Molecular analysis of mitochondrial DNA showed the presence of heteroplasmic 8993 point mutation in the subunit 6 of the ATPase gene. The clinical features and genetic findings in this family were comparable with those recently described in an English family. The mitochondrial DNA analysis of the family showed a correlation between the amount of mutated DNA and the disease severity in the probands, and indicated the presence of a threshold amount of mutated genome inducing ophthalmic defects. Moreover, the comparative analysis of blood, hairs, muscle, and urinary tract epithelia of two probands revealed an essentially similar distribution of mutated and wild type mitochondrial genomes. Our results suggest that the 8993 mitochondrial DNA mutation characterises a disease with similar clinical features in different populations.