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PurposeTo investigate the effect of cyclosporine on corneal ultrastructure and on major signs and symptoms of patients with dry eye disease.Patients and methodsIn this prospective cohort study, patients with dry eye disease were treated with a drop of cyclosporine 0.05% twice daily. Clinical evaluation was carried out at baseline and at months 1, 3, and 6. All patients completed the Ocular Surface Disease Index (OSDI) questionnaire, and tear film break-up time (BUT), fluorescein and lissamine green staining, and Schirmer test were carried out. In vivo confocal microscopy was also performed and epithelial cellular density, keratocyte activation, and subbasal plexus morphology were assessed.ResultsA total of 40 patients completed the study. After 6 months, OSDI, BUT, and fluorescein and lissamine green staining showed a clinically significant improvement. During the 6-month follow-up, density of intermediate epithelial cells increased from 1969.5±85.4 cell/mm2to 4881.2±175.7 cell/mm2(P<0.01); average grade of keratocyte activation decreased from 3.6±0.1 to 1.8±0.1 (P<0.001); average grade of number of subbasal nerves decreased from 5.3±0.2 to 2.6±0.2 (P<0.001); average grade of nerve reflectivity decreased from 3.8±0.1 to 2.1±0.2 (P<0.001); and average grade of nerve tortuosity decreased from 3.8± 0.1 to 2.2±0.2 (P<0.001).ConclusionCyclosporine was effective in controlling symptoms and signs of dry eye disease. In vivo confocal microscopy showed an increase in cell density of intermediate epithelium cells, a decrease in hyperreflective keratocytes, and a decrease in density, tortuosity, and reflectivity of nerve fibers.

.Purpose:
The aim of this research was to study the relevance of long-term follow-up of electroretinographic oscillatory potentials (OPs) in predicting the onset of minimal non-proliferative diabetic retinopathy in insulin-dependent diabetes patients.
Methods:
A total of 80 insulin-dependent diabetics, with normal fundi and normal OPs at first examination, were followed prospectively for 10 years. Oscillatory potentials were measured and fundus examinations performed once or twice per year.
Results:
During follow-up, 35% of patients developed diabetic retinopathy after a mean disease duration of 12 ± 2 years. A decrease in OP amplitudes was seen in 46% of this group, but reductions were also seen in the 25% of patients whose fundi remained normal. Statistical analysis of best-fit survival curves shows a significant difference (p &lt; 0.001) in the point of Kaplan-Meiers' curve maximal linearity (TmaxS).
Conclusions:
It appears that eyes with reduced OP amplitude have a greater probability of developing diabetic retinopathy. Subnormal OP amplitudes are not proof of real concomitant visible vascular damage, but may reflect a predisposition to functional neurosensorial disorder.

Abnormal VECP latencies can be found in type 1 diabetic patients without retinopathy or neuropathy. The pathogenesis of this finding is still unclear. The authors report the clinical history of a diabetic patient showing normal fundus, normal oscillatory potentials, and pathological VECP latency on first examination. The clinical follow-up of this patient showed rapid evolution toward proliferative retinopathy. This finding is suggestive of a peripheral (optic nerve or retina) origin of the VECP impairment.

At present it is difficult to distinguish those human chorioretinal diseases in which the retinal pigment epithelium (RPE) is the primary site of dysfunction. This difficulty is caused by several factors such as scarcity of biochemical and histological information and a lack of correlation of basic science information available with the clinical body of knowledge.