The contrast sensitivity test in early detection of ocular changes in the relation to the type I diabetes mellitus compensation in children, teenagers, and young adults.

UNLABELLED: An alteration of contrast sensitivity (CS) might be connected with structural and functional changes in foveolar and perifoveolar regions caused by different etiologies. We tested the hypothesis, that disturbances of CS can precede the typical changes in macular area in nonproliferative diabetic retinopathy (NPDR) in young patients with diabetes type 1 (T1DM). MATERIAL AND METHODS: One hundred and twenty one (121) patients (63 girls and young women and 58 boys and young men) were included in the study; their age ranged 7 to 36 years, (median: 17.6 years). The T1DM duration was 6 to 21 years (median: 9.8 years), and it was diagnosed at the age from 2 to 30 years (median: 10.5 years). CS was examined in all patients repeatedly after one year (range, 11 - 15 months, median: 12.5 months) by means of CSV-1000 instrument in 3, 6, 12, and 18 cycles/degree (c/deg) respectively. In 42 patients older than 18 years of age, the simultaneous CS and fluorescein angiography (FA) were performed; in all of them, the T1DM duration was longer than 10 years. The compensation of the metabolic state was evaluated from average yearlong values of the glycolysated hemoglobin (Hb1Ac). RESULTS: The value of pathologically decreased CS in most of the cases was found in four spatial frequencies and the difference increased depending on the T1DM duration and was from 5 % to 8 % between 6 and 10 years of diabetes duration and from 17 % to 25 % after 15 years of diabetes duration. The total decrease of CS, especially in middle and higher frequencies (6, 12, and 18 c/deg), was determined by the increase of changes at the posterior pole. The early changes at the fundus related to the alteration of CS were of two types: (1) the dilatation of the capillaries with their possible obliteration and tortuosity (DCT) and (2) the changes of the macular structure (CMS) by means of the irregularity of the foveolar reflex and relative retinal thickening without significant macular edema and with increased pigmentation of this region. The combination of these two findings was considered as diabetic preretinopathy (DpR) with preserved visual acuity and decrease of CS in 65 % of cases. The authors also compared the decrease in every single space frequency marked on the CS curvature for NPDR and DpR (distinguished by means of FA). Comparing the NPDR with the norm, the authors found important and fundamental pathological defect of the CS (p = 0.0058). Comparing the DpR with the norm showed significant defect of the CS (p = 0.0197). Comparing NPDR and DpR, the difference was found in more noticeable pathological defect of the CS (p = 0.0228). The T1DM metabolic status during study (actual blood sugar and one year level of Hb1Ac) did not affected the CS positively nor negatively. The regressive study concerning the average Hb1Ac level (norm: 6.5 - 7.5 % by DCCT) during the 10 years' period found, that in NPDR patients the Hb1Ac level was pathologically increased during three quarters (7.5 years) of the follow up period and in DpR patients during one half of the same period (5 years). CONCLUSIONS: The CS test by means of the CSV - 1000 device can already detect the first retinal changes in patients with normal visual acuity and is positive in patients with still normal ophthalmologic macular finding.

Phenotype analysis of tumour-infiltrating lymphocytes and lymphocytes in peripheral blood in patients with renal carcinoma.

INTRODUCTION: When checking tumour growth, a number of observations indicate that the immune system plays a significant role in patients with renal cell carcinoma (RCC). Infiltration by lymphocytes (tumour infiltrating lymphocytes, TILs) is more prevalent in RCC than any other tumours. T lymphocytes are the dominant population of TIL cells. Views concerning the role of T lymphocytic subpopulations, B lymphocytes and NK cells in an anti-tumour response are not established. AIM: The aim is to determine the phenotype and activation of T and B lymphocytic subpopulations and NK cells and to compare their representation in tumour stroma and peripheral blood lymphocytes (PBL) in patients with RCC. MATERIAL AND METHODS: Samples of peripheral blood taken from the cubital and renal veins and tumour stroma cells were obtained from 44 patients in the course of their surgeries carried out due to primary RCC. TILs were isolated from mechanically disintegrated tumour tissue. Immunophenotype multiparametric analysis of PBL and TILs was carried out. Their surface and activation characteristics were determined by means of flow cytometer. RESULTS: CD3+ T lymphocytes (69.7%) were the main population of TILs. The number of CD3+/CD8+ T lymphocytes was significantly higher in TILs, 42.6% (p < 0.01), while CD4+ T lymphocytes were the majority population in peripheral blood, 41.35% (p < 0.001). The representation of CD3+/69+ T lymphocytes was significantly higher in TILs, 32.9%, compared to PBL (p < 0.001). On the contrary, the numbers of CD3+/CD25+, CD8+/57+ and CD4+/RA+ (naive CD4+ T lymphocytes) were higher in PBL (p < 0.001). The differences in representation of (CD3-/16+56+) NK cells and CD3+/DR+ T cells in TILs and PBL were not significant. CONCLUSION: The above-mentioned results prove that the characteristics and intensity of anti-tumour responses are different in compared compartments (tumour/PBL). CD3+/CD8+ T lymphocytes are the dominant lymphocytic population of TILs. The knowledge of the phenotype and functions of effector cells, which are responsible for anti-tumour response, are the basic precondition for understanding the anti-tumour immune response and the cause of its failure.

Photodynamic therapy with Verteporfin in subfoveal choroidal metastasis of breast carcinoma (a controlled case).

A 55-year old woman with growing unilateral subfoveal choroidal metastasis of breast carcinoma was treated by photodynamic therapy (PDT) with verteporfin. Best corrected visual acuity remained stable during the whole follow-up of 6 months. Tumor flattened from 2.2 mm to 0 mm on ultrasound one month after the therapy. PDT with verteporfin appears to be the best tolerated method for palliative treatment of growing subfoveal choroidal metastasis of the breast carcinoma.

Uveal melanoma in congenital ocular melanocytosis mimicking malignant transformation of the optic disc melanocytoma (a controlled case).

A case of a 57-year old woman with uveal melanoma of the posterior pole arising in the congenital ocular melanocytosis mimicking clinically malignant transformation of the optic disc melanocytoma is presented.

Photodynamic therapy with verteporfin in subfoveal amelanotic choroidal melanoma (A controlled case).

A 57-year old man with 2.7 mm thick subfoveal amelanotic choroidal melanoma of the right eye was indicated for photodynamic therapy with verteporfin. The tumor fully disappeared 1 month after the treatment, the visual acuity improved from 4/16 to 4/4. The disease did not recur during 24-month follow-up.

Evaluation of subretinal fluid absorption by optical coherence tomography in circumscribed choroidal hemangioma after photodynamic therapy with Verteporfin.

PURPOSE: To determine if optical coherence tomography (OCT) measurements of retinal thickness at the fixation point (RTFP) can be used to confirm the effectiveness of photodynamic therapy (PDT) with verteporfin in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). METHODS: Nine eyes of nine patients with subretinal fluid under foveal centre were treated by PDT with a dose of 6 mg/m2 of intravenous verteporfin administered 5 minutes before a laser irradiation at 689 nm. Visual outcomes, initial, and final findings were evaluated using biomicroscopy, OCT, ultrasound, fluorescein angiography, and indocyanine green angiography. RESULTS: After a mean follow-up of 8 months (range, 3-18 months) OCT showed absorption of subretinal fluid in all cases (100%). Maximal decrease of RTFP was seen within first month after treatment. Average RTFP decreased from 378 microm (range, 221 microm-849 microm) preoperatively to 190 microm (range, 118 microm-321 microm) postoperatively (p=0.017, paired t-test). Mean best corrected visual acuity (BCVA) improved from 4/16 (range, 4/5-1/20) preoperatively to 4/8 (range, 4/3-1/15) postoperatively (p=0.0046, paired t-test). An improvement in BCVA was observed in all cases (100%, one to seven lines on Early Treatment Diabetic Retinopathy Study charts). BCVA returned to 4/5 or better in six patients (67%). Mean tumor height decreased from 3.2 mm (range, 1.5 mm-4.0 mm) preoperatively to 0.9 mm (range, 0 mm-2.4 mm) postoperatively (p=0.00003, paired t-test). There was no measurable tumor height in four cases (44%), there were marked reduction in the other five cases (56%) on ultrasound. CONCLUSIONS: OCT appears to be useful method for evaluation of subretinal fluid absorption after the treatment of CCH by PDT with verteporfin. RTFP value can be used for quantification of subretinal fluid under the foveal centre. Functional results of PDT with verteporfin in CCH are limited in pre-existing retinal alterations. Randomised trial with single versus repeated sessions of PDT with verteporfin is needed.

The function of the blood aqueous barrier in eyes with emulsified silicone oil.

PURPOSE: To evaluate the function of the blood aqueous barrier(BAB) in the eyes with silicone oil emulsification (SOE). METHODS: Protein concentrations, expressed in albumin equivalents,were determined in aqueous humor of the eyes with SOE in 11 consecutive patients by means of proton nuclear magnetic resonance (1H NMR) spectroscopy. Correlations with various clinical factors were studied. RESULTS: Normal function of the BAB (albumin equivalents 1mg/ml and less was found in 8 eyes (73%) independently on underlying disease, early postoperative reaction after pars plana vitrectomy with SO implantation, degree of SOE and late postoperative complications. Increased permeability of the BAB (albumin equivalents equal 2, 3 and 6.5 mg/ml) was found in 3 eyes (27%) with recent acute complication (retinal detachment after SO removal in 2 eyes, and secondary angle closure glaucoma in 1 eye). CONCLUSION: SOE in vivo was associated with increased permeability of the BAB in the minority of the eyes. Other factors should be studied to explain the variability of SOE. 1H NMR spectroscopy might be a valuable method for the study of SOE.

Treatment of macular degeneration (a controlled case).

Our controlled case describes the drug possibility to stabilize the exudative form of Age-related Macular Degeneration. The new approach of selective destruction of choroidal neovascularization (CNV) can be applied in patients with subfoveal lesions. Photodynamic therapy (PDT) is based on the reaction of photoactivable drug with the light of low-energy laser beam. So far only verteporfin [Visudyne, Novartis] as sensitizer is marketed and laser with wavelength of 689 nm is used. But it is questionable whether to apply this very costly treatment to extremely old people. An example of treatment of 90-year old woman with AMD with classic form of CNV is presented. Her BCVA was 0.05 OD. She underwent four session of PDT. At the last visit (eighteen months after initial and ten months after last session of PDT) the BCVA remained 0.05 OD. The patient is using a special magnifying lens for reading achieving near vision of 0.32. The presented example indicates the necessity of detailed study of every case to promote the therapeutic decisions for the benefit of progress in the field.