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Purpose: As a progressive condition, glaucoma may impair health-related quality of life (HRQoL), due to vision loss and other factors. This study evaluated HRQoL in a cohort of patients treated for primary open-angle glaucoma (POAG) and assessed its association with clinical features., Methods: This was an Italian, multicentre, cross-sectional, observational study with the subgroup of newly diagnosed patients with POAG prospectively followed up for one year. Patients with previous or new diagnosis (or strong clinical suspicion) of POAG aged >18 years were considered eligible. Information was collected on demographic characteristics, medical history, clinical presentation and POAG treatments. HRQoL was measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and Glaucoma Symptom Scale (GSS). Subscale and total scores were obtained and a Pearson correlation coefficient between instruments' scores calculated., Results: A total of 3227 patients were enrolled from 2012 to 2013 and 3169 were analysed. Mean age was 66.9 years. A total of 93.8% had a previous diagnosis (median duration: 8.0 years). Median values for mean deviation and pattern standard deviation were 3.9 and 3.6 dB, respectively. Mean scores on most subscales of the NEI-VFQ-25 exceeded 75.0 and mean GSS subscale scores ranged between 70.8 and 79.7 (with a total mean score of 74.8). HRQoL scores on both scales were significantly inversely associated with POAG severity., Conclusion: In this large sample of Italians treated for POAG, disease severity was limited and HRQoL scores were high. QoL decreased with advancing disease severity. These findings confirm the role of vision loss in impairing QoL in POAG, underlying the importance of timely detection and appropriate treatment., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Aim: To review indications and corneal tissue use for penetrating and lamellar surgery between 2002 and 2011., Methods: The surgical reports of corneal grafts performed during 2002-2011, using tissues supplied by the Eye Bank of Piedmont (Italy), were reviewed retrospectively. Patient demographic data, date of intervention, indication for surgery, and surgical technique used were recorded. Surgical techniques included penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK). The χ (2) test was used to compare the distribution of indications and types of surgical technique used, for corneal grafts done during 2002-2006 versus those done during 2007-2011., Results: The number of corneal grafts increased by 30.7% from 2002-2006 to 2007-2011 (from 1567 to 2048). Comparing the two periods, both main indications and surgical techniques changed significantly. In 2007-2011, the proportion of interventions for aphakic/pseudophakic bullous keratopathy (from 16.8% to 21.3%), graft failure (from 16.4% to 19.1%) and Fuchs endothelial dystrophy (from 12.8% to 16.7%) all increased significantly (P<0.05), while those for keratoconus decreased significantly (from 35.6% to 27.3%; P<0.001). In 2007-2011, the proportion of PK decreased significantly (from 92.4% to 57.2%; P<0.001) while that of EK and DALK went from 0.4% to 30.2% (P<0.001) and from 7.2% to 12.6% (P<0.001) respectively., Conclusion: During 2002-2011 the number of interventions increased significantly for corneal endothelial diseases and graft failure. The growing demand for interventions for these diseases corresponded to the widespread adoption of EK techniques. The use of DALK also increased, but more moderately than EK procedures.

Introduction: A coronal seal is fundamental for a positive outcome to endodontic therapy. In this in vitro study, we evaluated the adaptation of composite resins in postendodontic restorations using optical coherence tomographic (OCT) imaging. Our null hypothesis was that there would be no difference in marginal adaptation to the pulp chamber floor between resin composites of different viscosities., Methods: Thirty intact upper molars extracted for periodontal reasons were selected, endodontically treated, and filled with gutta-percha. The excess gutta-percha was entirely removed from the pulp chamber floor, and teeth were randomly divided into 3 groups (n = 10) according to the material used for the restoration: group 1: 0.5-mm horizontal layer of flowable composite followed by nanohybrid composite, group 2: bulk layering of bulk fill flowable composite; and group 3: oblique layering of nanohybrid composite. The degree of adaptation to the cavity floor was assessed using OCT imaging, and images were analyzed with the software program ImageJ (National Institutes of Health, Bethesda, MD) to assess the marginal gap between the composite and the pulp chamber floor. Collected data were statistically analyzed using analysis of variance testing, and statistical significance was set at P < .05., Results: Flowable composites showed significantly better adaptation than traditional packable nanohybrid composites (P < .05). All significant differences were found between groups 1 and 2., Conclusions: Within the limitations of this OCT imaging-based in vitro study, it was concluded that the flowable composite (flow + nanofilled; flow bulk fill composite) adapted better to the pulp chamber floor than the packable nanohybrid composite resin. Further studies are necessary to confirm these results., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the distribution of corneal spherical aberration in patients with cataract using the Pentacam HR., Methods: Consecutive cataract patients were examined using the Pentacam HR high-resolution rotating Scheimpflug camera (Oculus, Wetzlar, Germany). In one eye of each patient, the root-mean-square (RMS) of anterior, posterior, and total corneal spherical aberration Z4(0) was calculated by ray-tracing on an area of 6 mm diameter. The Pearson correlation coefficient (r) was used to assess correlations between Z4(0) RMS values and age/total corneal refractive power. The χ2 test was used to compare the proportion of eyes qualifying for spherically neutral or negatively aspheric (-0.17 and -0.27 μm) intraocular lenses (IOLs) by targeted level of residual spherical aberration., Results: Fifty-seven men and 92 women were included (mean [±SD] age, 71.73 [±9.12] years). The RMS mean (±SD) values of Z4(0) were +0.353 (±0.132) μm, -0.121 (±0.034) μm, and +0.328 (±0.132) μm, respectively, for the anterior, posterior, and total cornea. The anterior, posterior, and total Z4(0) were on average significantly higher (p < 0.001) in women than in men. In both sexes, statistically significant (p < 0.05) age-related changes were found for the anterior and total Z4(0) but not for the posterior Z4(0) (p > 0.05). The total Z4(0) and total corneal refractive power were significantly correlated in men (p = 0.01) but not in women (p = 0.14). For postoperative targets of 0 ± 0.05/+0.10 ± 0.05 μm residual Z4(0), the proportion of eyes that would have qualified for implantation of negatively aspheric IOLs with -0.17 and with -0.27 μm was similar (61.1 and 56.3%, respectively; p = 0.09); significantly fewer eyes (6.7%) would have qualified for implantation of neutrally aspheric IOLs (p > 0.05)., Conclusions: Total corneal Z4(0) measured by Pentacam HR might be higher than that reported in previous studies. In most patients, the implantation of commercially available negatively aspheric IOLs would partially compensate for the positive total corneal Z4(0).

In the periorbital the major aging changes are a drooping of the brow (brow ptosis), excessive accumulation of skin in the upper lid (dermatochalasis), and a prolapse of orbital fat, in the upper and lower lids caused by weakening of the septum and orbital connective tissues. The specific anatomical abnormalities of each individual patients should be identified and the relationship between each other should be identified in order to determine a correct surgical plan. In this review we will analyze different surgical techniques.

Orbital region may be divided into four sectors: medial canthus, lateral canthus, lower lid and upper lid. A vertical section of a lid shows 5 layers: skin, subcutaneous tissue with orbicularis muscle, fibrous layer (tarsus-aponeurosis), plain fibers muscle layer (Muller's), conjunctiva. The first two layers form the "anterior lamella" and the other ones the "posterior lamella", divided by the grey line. In this review Authors describe with all details the orbital region and the eyelid layers, considering the most important concepts for surgery. Finally they resume basics of local anesthesia in ophthalmoplastic surgery.

Aim of this review was to describe ectropion, entropion and trichiasis and their therapy. These eyelid pathologies are characterised by common symptoms (redness, excessive tearing and irritation of the eye) and by altered balance of the anterior and posterior lamellae of the eyelids. They involve more frequently the inferior eyelid and the therapy is mainly surgical. Parasurgical therapy may play a role as a temporary measure.

In the orbital region the variety of tumors is so vast that even an expert oculoplastic surgeon may be deceived. The various tumors may be classified as benign, precancerous and malignant. Approximately 5-10% of all skin cancers occur in the eyelids. Incidence studies indicate that basal cell carcinoma is the most frequent malignant eyelid tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma and malignant melanoma. Malignant neoplasms represent the leading cause of plastic reconstruction in orbital region, followed by cicatricial retraction, post-traumatic loss of tissue, congenital colobomas. Aim of this review is to classify benign and malignant lesions; to consider the surgical removal approach to the lesion (Mohs micrographic surgery, frozen sections, biopsy, immediate removal and reconstruction with permanent sections) and finally to consider reconstruction techniques with grafts and flaps.

Blepharoptosis of the upper eyelid is a common condition among patients presenting for oculoplastic surgery. Although there are many types of ptosis, the two most frequent clinical cases are simple congenital ptosis in young patients and senile ptosis in adults. Patient examination is important to distinguish these from other more infrequent types of ptosis, such as those neurogenic, myogenic and posttraumatic. These latter cases may require specific therapeutic strategies. Ptosis can usually be corrected surgically. The article discusses guidelines for the choice of intervention. Various different surgical techniques are also presented, together with results and complications.

Purpose: To assess refractive error after cataract surgery combined with Descemet stripping automated endothelial keratoplasty using adjusted keratometric (K) readings to calculate intraocular lens (IOL) power., Design: Prospective, interventional case series., Methods: One eye of 39 consecutive patients with Fuchs endothelial dystrophy and cataract were included. To calculate IOL power before surgery, the Javal steep and flat K readings (Haag-Streeit) were adjusted by reducing their value by -1.19 diopters (D); the axial length was measured by immersion biometry, and the standard A-constant was used. Surgery included phacoemulsification, IOL (Acrysof SN60AT; Alcon) implantation within the capsular bag, and Descemet stripping automated endothelial keratoplasty using posterior lamella prepared with a 300-μm head microkeratome (Moria). The absolute prediction error (absolute difference between predicted and achieved refraction) was assessed 6 months after surgery., Results: The mean power of the implanted IOL was 23.22 ± 2.90 D. The mean predicted and achieved refractions were -0.27 ± 0.26 D and -0.23 ± 0.73 D, respectively. The mean absolute prediction error was 0.59 ± 0.42 D (range, 0.05 to -1.52 D). The postoperative spherical equivalent fell within ±0.50 D, ±1.00 D, and ±2.00 D of the predicted refraction in 55.5%, 83.3%, and 100% of cases, respectively. Had the IOL power been calculated without adjusting the K readings, the mean absolute prediction error would have been significantly higher (0.86 ± 0.62 D; P = .04)., Conclusions: In this study, in which posterior lamellae were prepared using a 300-μm head microkeratome, adjusting preoperative K readings by -1.19 D led to accurate IOL power calculation and highly predictable refractive error after cataract surgery combined with Descemet stripping automated endothelial keratoplasty., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To compare the efficacy of posterior corneal elevation, measured by 2 methods, in discriminating subclinical keratoconus from normal corneas., Methods: In 30 consecutive patients with subclinical keratoconus, and 37 candidates for refractive surgery, posterior corneal elevation was measured using Pentacam's rotating Scheimpflug camera (Oculus, Wetzlar, Germany) with the standard method [maximal elevation above the best fit sphere (BFS)] and with the enhanced-BFS (E-BFS) method (difference in elevation measured above the E-BFS and that measured above the BFS). Using cutoff points selected a priori (≥ 29 and ≥ 12 µm, respectively, for the standard and E-BFS methods) the sensitivity, specificity, and overall accuracy, determined through the area under the receiver operating characteristic curves, were assessed for each method and then compared., Results: Mean posterior elevation values were statistically higher (P < 0.001) in corneas with subclinical keratoconus than in normal corneas, using either the standard (38 ± 15.9 µm vs. 20.3 ± 7.1 µm) or the E-BFS (15 ± 9.5 µm vs. 7.8 ± 5.5 µm) methods. Sensitivity and specificity rates were slightly higher with the standard method than with the E-BFS method (sensitivity, 73.3% vs. 60%; specificity, 86.5% vs. 83.8%), but neither difference was statistically significant (P > 0.05). The overall accuracy of the tests was similar (P = 0.19): the area under the curve was 0.80 for the standard and 0.72 for the E-BFS method., Conclusions: Posterior corneal elevation measured using either standard or E-BFS method has similar efficacy in discriminating corneas with subclinical keratoconus from normal corneas. As a single parameter, posterior elevation can be considered quite effective with either method, but it cannot be used alone to identify patients with subclinical keratoconus.

Purpose: To describe a peculiar postoperative complication of Descemet stripping automated endothelial keratoplasty (DSAEK), characterized by wave-like opacities at the donor-recipient interface., Methods: Wave-like opacities at the interface were observed a few days after surgery, in 1 eye of 2 patients who had undergone uneventful DSAEK for Fuchs endothelial dystrophy. DSAEK was performed using microkeratome-prepared lamellar grafts obtained from organ culture-preserved corneas. In the recipient, the 8.50-mm graft was inserted using a pull-through technique. Postoperative follow-up was 12 months in case 1 and 6 months in case 2., Results: The wave-like opacities were whitish and involved the central cornea in both cases; in case 2, they were associated with hyperreflective dots. Despite intensive topical therapy with dexamethasone 0.2%, the opacities at the interface persisted during follow-up. However, visual acuity progressively improved; at last examination, uncorrected and corrected distance visual acuity were, respectively, 20/40 and 20/25 in case 1 and 20/30 and 20/20 in case 2. Optical coherence tomography showed that the interface reflectivity was slightly higher than it was in DSAEK cases without opacities. The central thickness of the whole cornea and the lamella were 563 and 93 μm in case 1 and 603 and 140 μm in case 2. Postoperative endothelial cell loss was 37% in case 1 and 24% in case 2., Conclusions: Wave-like opacities at the donor-recipient interface are a rare complication of DSAEK surgery of unclear origin. Although interface opacities involve the central cornea and persist after surgery, good postoperative visual recovery can be achieved.

Purpose: To investigate changes of corneal power after descemet stripping automated endothelial keratoplasty (DSAEK)., Methods: Anterior, posterior, and true-net (anterior + posterior) power of post-DSAEK and contralateral transparent corneas were measured, using the Pentacam rotating Scheimpflug camera (Oculus Wetzlar, Germany), 6 months after surgery in 23 consecutive patients who had undergone unilateral DSAEK at the same medical center. Moreover, in each cornea, Pentacam pachimetry was measured at the vertex and at 3 mm from the vertex, to calculate corneal thickness increase (CTI)., Results: In post-DSAEK corneas, the anterior power on average decreased by -0.24 ± 0.61 diopters (D), the negative posterior power increased by -0.96 ± 0.42 D, and the true-net power decreased by -1.19 ± 0.74 D (range: +0.17 to -2.23 D). Differences vs. contralateral transparent corneas did not reach statistical significance for anterior (p = 0.09) but were significant (p < 0.001) for posterior and true-net corneal power. CTI at 3 mm from the vertex was statistically larger (p < 0.0001) in post-DSAEK corneas (mean values 0.27 ± 0.07 vs. 0.12 ± 0.05); CTI values showed a statistically significant (p < 0.05) correlation with negative posterior corneal power values in post-DSAEK (r = -0.55) and in contralateral corneas (r = -0.67)., Conclusions: In comparison with contralateral corneas, post-DSAEK corneas show a moderate reduction of the true-net corneal power measured by Pentacam. Knowledge of true-net corneal power changes might be useful in adjusting K values and calculating intraocular lens power, in eyes scheduled for DSAEK combined with intraocular lens implantation/exchange.

Unlabelled: Phacoemulsification and implantation of a hydrophilic acrylic toric intraocular lens (IOL) (T-flex 623T) with customized cylindrical power was performed in 1 eye in 3 consecutive patients with cataract and high postkeratoplasty astigmatism (range 6.75 to 8.75 diopters [D]). Twelve months postoperatively, the uncorrected distance visual acuity improved from 20/200 to 20/30 in Case 1, from 20/400 to 20/40 in Case 2, and from 20/200 to 20/25 in Case 3 and the corrected distance visual acuity was 20/25 or better in all 3 eyes. The spheroequivalent was within ± 0.50 D of the intended value and the refractive astigmatism was less than 1.00 D. The corneal grafts were transparent, and the endothelial cell loss range was 6% to 12%. Rotation of the toric IOL was less than 5 degrees. The toric IOL with customized cylindrical power provided good postoperative rotational stability and very satisfactory postoperative visual recovery. This type of toric IOL is appropriate to correct high postkeratoplasty astigmatism in eyes operated on for cataract., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the effect of dorzolamide hydrochloride 2%, timolol maleate 0.5%, and their fixed combination on intraocular pressure (IOP)and retinal and optic nerve head haemodynamics in primary open-angle glaucoma patients., Methods: Twenty-eight patients with early moderate glaucomatous damage treated with β-blockers (>6 months) with IOP values ranging from 18 to 22 mmHg at trough participated in this trial. After a 4-week washout period,patients were randomised in two groups: group I started with dorzolamide 2% monotherapy and group II with timolol 0.50% monotherapy for 4 weeks. After this period, both groups switched to dorzolamide/timolol fixed combination for 4 weeks. IOP, ocular diastolic perfusion pressure, heart rate, and Scanning Laser Doppler Flowmetry measurements at the peripapillary retina and neuroretinal rim were taken at T0 (enrolment), T1 (wash out), T2(monotherapy), and T3 (dorzolamide/timolol).Data were compared between different study times. Statistical analysis was conducted using a paired t-test., Results: Between T1 and T3, IOP decreased significantly in group I (-21.40%) (P<0.001)and in group II (-21.25%) (P<0.001). At the same time intervals, blood flow increased significantly at rim level for group I (+30.03%)(P<0.05) and also when all patients were considered (rim +20.81%) (P<0.05). Between T1 and T3, we also observed a significant increase of ODPP in group I (+7.24%) (P<0.01)and in group II (+6.08%) (P<0.05) and when all patients were considered (+6.71%)(P<0.001) [corrected]., Conclusions: Dorzolamide/timolol fixed combination increased blood flow significantly at the neuroretinal rim showing a combination of hypotensive and haemodynamic effects.

Background: Optic disc anomalies are frequently associated with Alagille syndrome. We report here the first case of a patient with Alagille syndrome combined with optic pit and serous macular detachment., Methods: A male patient with Alagille syndrome was referred from the pediatric hepatology department for investigation of visual loss in the right eye. Anterior segment examination showed evidence of posterior embryotoxon, confirmed by gonioscopic evaluation. Dilated fundus examination revealed serous macular detachment and optic pit., Results: OCT 3 scans confirmed the clinical findings., Conclusions: Optic pit is uncommon and should prompt a search for genetic disorders or development abnormalities. The association between the two syndromes in this patient might be due to failure of correct neuroectodermal development, for which a common genetic pathway is likely.

Purpose: Eye alignment is a serious concern when performing corneal surface ablation. Although several excimer lasers monitor horizontal and vertical movements, little is known about the potential impact of cyclotorsional movements. Dynamic cyclotorsions have been measured on 10 emmetropic subjects during a simulated PRK treatment., Methods: Cyclotorsional eye movements were measured using a 3D videoculographic system (SMI) in 10 emmetropic subjects in upright and supine position. The subjects were wearing an eyelid speculum and were asked to fixate on a 1 degrees red spot. The fixation target was either in focus or optically degraded by electronic filters. Data were collected at the University Eye Clinic, Torino, Italy, and the different setting measurements were compared using Student's t-test for paired data., Results: Cyclotorsions were significantly higher when subjects were fixating an optically degraded stimulus (upright: P=0.04; supine: P=0.0002). The cyclotorsional movements ranged from -13 to 17 degrees. A significant difference in eye orientation was present when changing from the upright to the supine position (P=0.03). Even when correcting for this positional error, significantly higher cyclotorsional movements were detected in the supine position (in focus: P=0.0043; optically degraded: P=0.0008). The torsional range was from -14.85 to 14.55 degrees., Conclusions: The high range of cyclotorsional eye movements during a simulated PRK procedure suggests that 3D tracking could improve surface ablation results when treating high astigmatism or when wavefront guided.

Purpose: This study aims to examine the relationship between retinal arteriolar narrowing and left ventricular hypertrophy in hypertensive patients., Methods: A total of 30 patients with a recent history of hypertension (22 M, 8 F; 33 +/- 8; BMI 24,96 +/- 2.8;), consecutively referred to the Hypertension Unit by their family doctors, were studied. Generalized retinal arteriolar narrowing was measured by two ophthalmologists from computer-scanned images on retinal photographs, and summarized as arteriole-to-venule ratio (AVR). Left ventricular hypertrophy was evaluated by quantitative M-mode echocardiography., Results: All patients were stratified according to the 2003 European Society of Hypertension (ESH) guidelines: 20 subjects (66.7%) were affected by hypertension grade 1, and 10 (33.3%) were affected by hypertension grade 2. Retinal vessel diameters did not differ significantly by grade 1 vs grade 2 hypertension. Echocardiographic left ventricular hypertrophy was present in 10 (33%) patients. No significant correlation was shown between arteriole-to-venule ratio (AVR) and left ventricular mass. [Spearman r = 0.22; p = 0.23]., Conclusions: We suggest some explanations for the fact that we did not find any correlation between AVR and left ventricular mass. Further clinical studies are required for a greater understanding as to whether early microvascular changes relate with other clinical indicators of hypertensive organ damage.

Hypertension is associated with cardiovascular risk and systemic target organ damage. Retinopathy is considered one of the indicators of target organ damage. This review focuses on recent studies on hypertensive retinopathy and their implications for clinical care. Early recognition of hypertensive retinopathy signs remains an important step in the risk stratification of hypertensive patients.

Purpose: To evaluate the effectiveness of low power transpupillary thermotherapy (TTT) in treating juxtafoveal recurrent choroidal neovascularization (CNV) after laser photocoagulation in patients with age-related macular degeneration (ARMD)., Methods: Eight eyes of eight patients with ARMD and juxtafoveal recurrent CNV were treated with low power TTT, delivered using an 810-nm diode laser with 350 mW, 2.0 mm spot, and 1-minute duration. Visual acuity (VA) ranged from 20/100 to 20/50. Treatment effect was evaluated by fluorescein angiography, indocyanine green angiography, and VA measurements (Early Treatment Diabetic Retinopathy Study) at 1-week, 2-week, and monthly follow-up visits., Results: No retinal damage was visible ophthalmoscopically during treatment. At the first follow-up visit, seven eyes had obliteration of CNV and one eye required a second TTT application. VA was unchanged in six eyes, improved in one eye, and worsened in one eye. Recurrences occurred in all eyes between 1 and 7 months after TTT and were treated with photodynamic therapy (PDT). More than two PDT treatments were performed in each eye in the year after recurrence., Conclusions: Low power TTT is as able to close juxtafoveal recurrent CNV as is high power conventional laser photocoagulation but does not prevent recurrences. Further intervention with TTT in order to treat recurrences is under investigation.

Background: Primary open-angle glaucoma encompasses a complex of potentially blinding ocular diseases characterized by a normal-appearing angle of the anterior chamber, a characteristic degeneration of the optic nerve with resultant typical visual field defects, and usually, an elevated intraocular pressure. It can be subdivided into 2 groups according to the age at onset: the more prevalent chronic open-angle glaucoma diagnosed after 40 years of age, and the less common juvenile form, which occurs between 3 years of age and early adulthood. A locus for primary open-angle glaucoma (GLC1A) has been mapped to a 3-centimorgan region of the long arm of chromosome 1 (1q23-25). Recently, the myocilin (MYOC) gene, located in this chromosomal interval, has been found mutated in several patients affected by primary open-angle glaucoma., Objective: To describe the clinical and molecular genetic features of 4 pedigrees affected by autosomal dominant juvenile open-angle glaucoma, all from the Italian region of Puglia., Methods: Clinical study, gonioscopy, automated perimetry, and DNA analysis were performed on several members of the 4 families., Results: We identified a new molecular defect (1177GACA-->T) in the third exon of the GLC1A gene. This mutation is present in all affected persons and in 2 still phenotypically normal persons., Conclusion: Our results are important for diagnostic purposes because it is now possible to identify asymptomatic carriers, for whom clinical surveillance for the early detection and treatment of glaucoma may be suggested.

Purpose: This study assessed the phoric and refractive changes possibly caused by visual display unit (VDU) activity., Methods: In a longitudinal trial nearly 6000 VDU operators received two ophthalmological examinations at intervals ranging from 34 to 43 months. The findings from the two examinations were correlated to VDU work (hours daily and years of VDU work), age and sex., Results: Changes in the refractive state seemed to be mainly age-related. There was a slight tendency toward hyperopia (imbalance of latent hyperopia)., Conclusions: In the analysis of ocular motility, the results show no worsening capable of causing a definitive change from heterophoria to heterotropia. Heterophoric subjects, however, tend to improve both with regular office work and with additional VDU activity.

Purpose: Serotonin is biochemically present in the iris and ciliary body of animals and humans. Controversial findings are reported about the concentrations of serotonin in aqueous humor with respect to plasma in humans. The aim of this study was to evaluate the levels of serotonin both in aqueous humor and plasma in human subjects., Methods: In 50 patients with glaucoma or cataract, plasma and aqueous humor serotonin levels were measured by HPLC with electrochemical detection. Serotonin plasma levels were also measured in 25 healthy subjects as controls., Results: In all patients with cataract or glaucoma, the aqueous humor serotonin concentration is significantly lower than that in plasma [1.14+/-0.29 (SEM) vs. 5.33+/-1.03 ng/ml, p<0.01]. Furthermore, in the same patients and in 25 healthy controls, serotonin plasma levels were similar., Conclusion: Our study shows that serotonin is present in human aqueous humor and its concentration is 4 times lower than in plasma.

Glaucoma is a group of ocular diseases characterized by an optic neuropathy in which degeneration of retinal ganglion cells leads to a characteristic excavation of the optic nerve head. Primary open-angle glaucoma (POAG) can be subdivided into two groups according to age of onset:- 1. the more common middle- to late-age onset, chronic open-angle glaucoma (COAG) diagnosed after the age of 40 years; 2. the rarer juvenile open-angle glaucoma (JOAG), which is diagnosed between the age of 3 years and early adulthood. Recently, the gene coding for the trabecular meshwork-induced glucocorticoid response protein (TIGR), located in chromosome 1 (1q23-25), was found mutated in patients affected by POAG. In this work we describe the clinical and molecular genetic features of several Italian families affected by autosomal dominant POAG, collected in various regions of Italy.

Background: Aging causes loss of neurons and adrenergic nerve termination in various human organism systems and apparatus. The aim of this work is the observation of qualitative and quantitative differences in the orientation and density of the human choroid adrenergic innervation in relation to age., Methods: The choroid specimens were taken from the corresponding sectors of the eyeballs of four patients aged between 70 and 75 years and patients aged between 40 and 45 years. The glyoxilic method of Furness and Costa (1975) was used., Results: The location and orientation of the adrenergic fibres was similar in the adult and aged patients. However, the fibres are clearly fewer in number, less rich in varicosity and have reduced fluorescence. In the suprachoroid lamina thickness and in the vascular layer, the adrenergic synaptic contacts with the melanocytes are fewer in number, as are also the SIF-cells (small intensely fluorescent cells)., Conclusions: With age there is a significant reduction of the orthosympathetic innervation of the human choroid. This fact could explain some physiopathological aspects of the choroid circulation and blood flow and, therefore, play a part in ocular pression variations.

With the existing literature on the aspects of anatomic and physiological ocular choroid membrane variables in mind, the authors verify the possibility of applying the methods of Axelsson et al and of Lindvall and Bjorklund, as simplified by Furness and Costa for fluorescent microscopy, to the study of human choroid nerve topographic distribution. The material for the study was obtained from three human eyeballs, two enucleated because of malignant melanoma of the choroid and one because of neoplasia of the ciliary body. A binocular dissecting microscope was used. A fluorescent microscope was used to observe the histological specimens and photographs were taken. The following results are presented and discussed: 1) the fluorescent paravascular nervous fibres and periarterial nervous plexuses divided into preterminal and terminal fibres; 2) in the suprachoroidal layer, there were small groups of polygonal nervous branches with or without this connection; 3) the most intervasal plexus development was in the posterior part of the vascular layer with preterminal and terminal fibres, 4) in the intervascular space, melanocytes and free adrenergic nervous terminations were observed; 5) adrenergic fibres were not observed in the choriocapillaris of the choroid membrane; 6) there were adrenergic neurons in the vascular layer.

Experimental work from our laboratory has confirmed the protective power of vanadium compounds on hyperglycemia and glycosuria in streptozotocin (STZ) diabetes. Furthermore, the diabetic cataract too has been partially prevented. The protection slightly increased, when vanadium was administered in combination with vitamin E. This investigation has introduced a combination of Na3VO4 plus the lazaroid U-83836E, a liposoluble antioxidant much more efficacious than tocopherol, in order to improve the insufficient protection when vitamin E was used. Male Wistar rats, rendered diabetic with STZ, were treated for 12 weeks with Na3VO4 in drinking water, U-83836E carried by the food, or both. The most significant metabolic parameters (food and fluid intake, diuresis and excreted feces) were studied monthly by means of metabolic cages. Body weight, glycemia, glycosuria and proteinuria were also recorded. At week 6 and 12 of the treatment, the opaqueness of the eye lenses was controlled. Circulation glycosylated hemoglobin (HbA1c), fructosamine, N-acetyl-beta-D-glucosaminidase (NAG) and fluorescent peroxides were evaluated at the end of the experiment. After the first month of treatment U-83836E improved significantly the protective effect of vanadate alone on polydipsia and polyuria, but more efficiently on hyperglycemia and glycosuria. The further ameliorating effect of the lazaroid was observed also on HbA1c, NAG and, most important, on the cataract. In conclusion, these findings demonstrate that the lazaroid U-83836E succeeds in further protecting the most important symptoms of diabetes treated with vanadate, and that this antioxidant acts effectively even when it is administered per os, in a non invasive manner.

Experimental work in our laboratory has confirmed the protective activity of vanadium compounds on hyperglycemia and glycosuria in streptozotocin (STZ) diabetes. Furthermore, diabetic cataract has also been partially prevented. Nevertheless, the combination of a natural antioxidant, vitamin E, with Na3 VO4 has not further enhanced this ameliorating effect. Our experimental approach has been an attempt to block the prooxidant activity of both STZ and vanadate, with the purpose of eliciting the best possible antidiabetic protection. More recently, a lipid soluble synthetic antioxidant U-78517F, a 2-methylaminochroman, has been reported to have a significant protective effect against brain injury and ischemia. This compound inhibits the iron-dependent lipid peroxidation 100 times more effectively than vitamin E. This investigation has introduced a combination of the vanadium compound plus the aforesaid lazaroid, as its (-) enantiomer, U-83836E, in order to improve the insufficient protection when vitamin E was used. For twelve weeks, male Wistar rats, rendered diabetic with STZ, were administered Na3VO4 in drinking water along with the lazaroid carried by the food. Four, eight and twelve weeks after the beginning of the protective treatment, fluid and food intake, diuresis and excreted feces, glycosuria and proteinuria were determined on biological samples obtained in metabolic cages; body weight and glycemia were also recorded. At weeks 6 and 12 of the treatment, the opaqueness of the eye lenses was controlled and registered. At the end of the experiment, circulating glycosylated hemoglobin (HbA1c), fructosamine, N-acetyl-beta-D-glucosaminidase (NAG), and fluorescent peroxides were evaluated. Within the first month of treatment, protection by the combination paralleled that elicited by vanadate alone. At subsequent steps, U-83836E significantly improved the protective effect of vanadate alone on polydipsia and polyuria, but especially on hyperglycemia and glycosuria. The further ameliorating effect of the lazaroid was also observed on HbA1c and NAG, and, most important, on the cataract. In conclusion, these findings demonstrate that the lazaroid U-83836E succeeds in further protecting the most important symptoms of diabetes treated with vanadate, and that this antioxidant acts effectively even when it is administered orally in food, in a non invasive manner.

The authors, after having mentioned several methods to detect malingering, have attempted to demonstrate the reliability of Lotmar's visometer test in assessing the real visual acuity of ten malingerers (five of whom denied bilateral vision). The authors confirmed their data with several other subjective and objective methods that demonstrated the reliability of the visometer test.

Peculiar psychic reactivity of glaucomatous patients detected clinically and widely treated in the literature, has led us to study the behaviour of intraocular pressure in normal and glaucomatous subjects when submitted to various stresses. The data obtained show that prolonged stress increases intraocular pressure in normal subjects, unlike shorter stress which only causes an increase of intraocular pressure in glaucomatous patients. The possible genesis of the phenomenon is discussed.

Because of phosphorus involvement in metabolic processes, 32P is a suitable radioisotope for the investigation of the function of normal and malignant cells. The basic principles of the 32P test are analysed. This paper presents the results on a series of patients who underwent the 32P uptake test at the Ospedale Oftalmico of Turin. An evaluation of the dose to the patient is also presented.

Thyrotoxicity of Ethylenthiourea (2-imidazolidinethione) (ETU) is well known: this paper examines the extent to which ETU alone may damage certain non-thyroid tissues, and the possible enhancement of its effects through synergism when it is taken with substances employed for medical or alimentary reasons. It was found that the lethality of ETU is augmented by accumulation of fractionated doses, particularly in male as opposed to female rats. When accompanied by ethanol, its harmfulness is increased, whereas phenobarbital provides a certain degree of protection. Liver secretion of triglycerides is greatly impaired (delta % = -31) by acute administration, which results in steatosis. This is not observed during subacute administration. Liver microsomal cytochrome P450 is significantly reduced (delta % = -32) after a long term administration. The 30 week treatment leads to a form of "selection". Some animals die (28.6%), whereas others survive despite: i) prolonged failure to put on weight, ii) alopecia (80% loss of hair), iii) severe conjuntivitis, iv) blepharitis, v) peripheral nervous system distress. These findings underscore the importance of investigating the relation between hazardous compounds and possible potentiating factors, on the one hand, and inclusion of organs not yet recognized as targets, on the other hand, when setting tolerance limits for ambient pollution.

The authors attempted to predict postoperative visual acuity in patients undergoing cataract extraction by comparing the results obtained using two subjective methods: Lotmar's visometer test and the blue-field entoptic (BFE) test. Both tests allow assessment of retinal visual acuity in the presence of opacities of the ocular media. Measurements were made on 60 patients before cataract extraction. These subjects were followed for three months in order to assess their postoperative visual acuity and to ascertain the reliability of the tests. Analysis of the data demonstrates the high level of reliability of both methods. Lotmar's visometer test gives a more exact assessment of macular function. However, in the presence of total lens opacity, the BFE test becomes necessary since Lotmar's test loses reliability in such cases.

Three cases of abortive Bourneville's disease, without detected involvement of the CNS, are reported. Two were in the same family and had a 20-year follow up. The importance of fluoroangiography in studying the retinal manifestations of this disease is stressed.

The authors employed fluorescence iridography and to evaluate the changes induced by a 1-year treatment with calcium dobesilate.