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AimTo describe the vascular features of choroidal tumors using enhanced depth imaging (EDI), optical coherence tomography (OCT), and OCT-angiography.MethodsIn this prospective study, we evaluated 116 Caucasian patients with choroidal tumors (60 eyes with choroidal nevi, 40 with choroidal melanoma, 6 with choroidal hemangioma, 2 with optic disc melanocytoma, 6 with choroidal osteoma, and 2 with retinal metastases). Patients underwent a complete ophthalmic examination including bulbar echography, EDI-OCT, OCT-angiography, and multicolor imaging. Sixteen patients also underwent fluorescein and indocyanine angiography.ResultsThe left eye was more involved than the right eye. The mean tumor thickness was 1.23±0.17 mm in the 60 eyes with choroidal nevi; 2.75±0.83 mm in the 40 eyes with choroidal melanoma; 3.28±0.78 mm in the 6 eyes with retinal angioma; 2.02±0.001 mm in the 2 eyes with optic disc melanocytoma; 2.40±0.31 mm in the 6 eyes with choroidal osteoma; and last, 3.49±0.001 mm in the 2 eyes with retinal metastases. OCT-angiography showed: (i) a lack of blood flow in the outer retinal layer (ORL) and a normal choroid capillary layer in choroidal nevi and optic disc melanocytomas; (ii) a lack of blood flow in the ORL of choroidal metastases; and (iii) a dense irregular vascular network in the ORL and choroid capillary layers of choroidal melanomas, choroidal hemangiomas, and choroidal osteomas.ConclusionsOCT-angiography is a noninvasive reliable method with which to evaluate the vascularization of small choroidal tumors and may improve the diagnosis of these tumors.

AimsThe aims of this study was to report anatomical changes of the ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) thickness, and macular volume in patients with multiple sclerosis (MS). We also investigated the correlation between anatomical and functional changes in terms of visual acuity and macular sensitivity investigated and visual fields.MethodsProspective comparative study included 105 eyes of 53 consecutive patients. The patients were divided into two groups: group A included 56 eyes of 28 patients with diagnosis of MS; group B involved 49 eyes of 25 healthy patients. The examination included Goldmann tonometry, biomicroscopic and fundus oculi examination, retinography, GCC examination, circumpapillary RNFL (cpRNFL), and macular volume. The functional test included measurement of best-corrected visual acuity (BCVA), visual field, and MP.ResultsMS group showed a significant reduced GCC, cpRNFL, macular volume, BCVA, visual field, and macular sensitivity compared with the control group (P

Si tratta di una descrizione dell'anatomia e della microanatomia retinica alla luce delle più moderne ricerche, con ampio spazio alle recenti possibilità in diagnostica morfofunzionale

Transpupillary thermotherapy of choroidal melanomas Purpose: R. Forte, G. Cennamo To evaluate the effectiveness of transpupillary thermotherapy (TTT) as a single treatment of choroidal melanomas. Methods: We studied a series of 50 cases of choroidal melanoma treated with TTT and evaluated them with standardized A-scan and B-scan echography before and after treatment (1 week, 1, 3, and 6 months after treatment, then every 6 months). Results: There were 22 males and 28 females with a mean age of 57 years (range, 22-78). The mean thickness of the lesion was 2.7 ± 0.6 mm (range, 1.63-3.72). The mean follow-up was 38 months (range, 21-41). In almost all the eyes treated with TTT, substantial regression of tumoral microcirculation was observed after 1 week associated with a 70%-80% reduction in tumor thickness after 6 months (stabilized during follow-up). In one case of juxtapapillary melanoma with a thickness of 3.72 mm, another TTT application was necessary for local relapse. Visual acuity (VA) decreased to 20/30 in two cases (4%) and to 20/200 in four cases (8%) after the development of a cystoid macular edema. These latter patients were treated with two intravitreal injections (range, 1-3) of triamcinolone acetonide, and after a follow-up of 25 months (range, 21-29) VA improved to 20/20 in the first two cases, while two of the four other cases improved to 20/40 and two to 20/30. Conclusion: Transpupillary thermotherapy has visual results similar to those obtained with irradiation for the treatment of choroidal melanomas. Nevertheless, considering the high rate of recurrence at 5 and 10 years after transpupillary thermotherapy alone, most authors think that transpupillary thermotherapy is useful when associated irradiation for the treatment of choroidal melanomas, but its precise indications need to be defined.

PurposeTo evaluate circumpapillary retinal nerve fiber layer (cpRNFL) and ganglion cell complex (GCC) after ocular blunt trauma.MethodsBest-corrected visual acuity (BCVA), cpRNFL and GCC were evaluated by RTVue-100 OCT in all consecutive patients with previous monocular blunt trauma seen between January 2012 and December 2012.ResultsTwenty-two patients (11 females, 11 males, mean age 43.9±14.2 years) were included in the study. Patients were seen after a mean of 8.42±13.3 (range, 0.08-55.3) years from ocular blunt trauma. BCVA was normal in 11 cases and was less than 0.4 LogMAR in all cases. In 9/22 patients (40.9%), cpRNFL and GCC were reduced, whereas in one case an isolated reduction of GCC with normal cpRNFL was present. In patients with reduction of cpRNFL and GCC, mean BCVA was 0.17±0.17 LogMAR. In 6/9 patients (66.6%) with cpRNFL and GCC reduction, BCVA was ≤0.1 LogMAR.ConclusioncpRNFL and GCC reduction may be present after ocular blunt trauma and may be associated with preserved visual acuity

Sir, We thank Dr Chhablani1 for his interest in our article2; we evaluated diffuse diabetic macular oedema and obtained good functional and anatomic results during a follow-up of 12 months after treatment with intravitreal bevacizumab, when compared with the combination of intravitreal triamcinolone and laser photocoagulation. We agree that intravitreal bevacizumab lacks in large randomized controlled trials and could be used in case of gross macular oedema in order to reduce macular thickening, followed by laser photocoagulation. The latter remains indeed the gold standard for diabetic macular oedema.

To evaluate the effectiveness of transpupillary thermotherapy (TTT) as a single treatment of choroidal melanomas.We studied a series of 50 cases of choroidal melanoma treated with TTT and evaluated them with standardized A-scan and B-scan echography before and after treatment (1 week, 1, 3, and 6 months after treatment, then every 6 months).There were 22 males and 28 females with a mean age of 57 years (range, 22-78). The mean thickness of the lesion was 2.7 +/- 0.6 mm (range, 1.63-3.72). The mean follow-up was 38 months (range, 21-41). In almost all the eyes treated with TTT, substantial regression of tumoral microcirculation was observed after 1 week associated with a 70%-80% reduction in tumor thickness after 6 months (stabilized during follow-up). In one case of juxtapapillary melanoma with a thickness of 3.72 mm, another TTT application was necessary for local relapse. Visual acuity (VA) decreased to 20/30 in two cases (4%) and to 20/200 in four cases (8%) after the development of a cystoid macular edema. These latter patients were treated with two intravitreal injections (range, 1-3) of triamcinolone acetonide, and after a follow-up of 25 months (range, 21-29) VA improved to 20/20 in the first two cases, while two of the four other cases improved to 20/40 and two to 20/30.Transpupillary thermotherapy has visual results similar to those obtained with irradiation for the treatment of choroidal melanomas. Nevertheless, considering the high rate of recurrence at 5 and 10 years after transpupillary thermotherapy alone, most authors think that transpupillary thermotherapy is useful when associated irradiation for the treatment of choroidal melanomas, but its precise indications need to be defined.

In a study of ten young and seven elderly healthy men we have performed an oral glucose tolerance test (75 g) and employed a euglycemic hyperinsulinemic (0.25 mU× kg/min) glucose clamp technique in order to determine insulin sensitivity. This latter experimental protocol consisted of 120 min of euglycemic clamp followed by 60 min in which the clamp and a mild muscular exercise (35% VO 2 max ) were combined. d -[ 3 H]glucose infusion allowed a determination of the glucose turnover parameters. Our results show that in elderly subjects glucose disappearance rate and glucose metabolic clearance rate are significantly lower during both clamp, and clamp + muscular exercise studies. On the contrary, hepatic glucose production was similar under both conditions and was independent of age.

The authors report a case of a slow reduction of vision in the left eye of a 69-year-old woman. The slit-lamp examination of the eye showed a vascularized achromic subconjunctival mass close to the nasal limbus, invading the inferonasal corneal quadrant. At B-scan and standardized A-scan echography, the mass was shown to be localized to the ciliary body, with characteristics of a malignant melanoma. The patient did not want to undergo conservative treatment. Therefore, enucleation was performed and light microscopy revealed a pigmented malignant melanoma of the ciliary body with extrascleral growth and infiltration of the anterior third of the corneal stroma. No alteration of Bowman's membrane was present. The corneal infiltration, limited to the anterior third of the stroma, could be due to the fact that at this level the collagen fibers are disposed less regularly than those of the posterior two-thirds, with this different disposition responsible for the weak resistance opposed to the tumoral invasion.

To determine the efficacy of echography with new generation contrast agents in visualizing vascularization of choroidal malignant melanomas.An echographic contrast medium consisting of phospholipidic microbubbles filled with sulphur hexafluoride (Sonovue) was used to visualize microcirculation in 25 cases of choroidal lesions already diagnosed with standardized echography (21 choroidal malignant melanomas, four disciform lesions).In untreated malignant melanomas contrast agent echography revealed the presence of a dense microcirculation inside the mass. In one case vitreal seeding of the contrast agent was detectable before enucleation and histological examination revealed the presence of tumoral cells. In 12 cases treated with transpupillary thermotherapy, contrast agent echographic evaluation showed heavy regression of microcirculation after 1 week, confirmed in one case by histology, and a reduction of 70-80\% in dimensions after 6 months (which appeared to have stabilized at subsequent examinations). In four cases treated with proton beam brachytherapy 2 years prior to our examination, contrast agent echography showed the absence of a microvascular network and the presence of large vessels and blood lakes. In four cases of disciform lesion, deep and superficial retina-associated vascularization was observed, with a weak spread of contrast agent inside the lesion.Live representation with good resolution of choroidal malignant melanoma microcirculation was obtained.

The tumors of the skull base that develop in the suprasellar region are associated with eyesymptoms and signs that make the consultation of an ophthalmologist absolutely necessary, both in the diagnostic stage than during follow-up. The role of the ophthalmologist includes the recognition of the characteristic symptomatology of an intracranial tumor, the request for appropriate diagnostic examinations and for further specialist consultancies, but above all the prognostic evaluation of the ocular complications of the tumor and of its therapy.

Laccase isoenzymes from Pleurotus ostreatus, a white rot basidiomycete fungus, have been extensively studied by our research group. More recently we have reported that the addition of CuSO4 to culture broth results in a large increase of the total laccase activity and in the production of a new isoenzyme: POXA1b. POXA1b secreted in the culture broth exhibits interesting properties with regard to pH stability. In fact the enzyme shows an increase of t1/2 from pH 3.0 to 10.0 and, surprisingly, displays a t1/2 value at pH 10.0 of about 100 days. Furthermore POXA1b is partly secreted, in fact analysis of proteins from cellular extract showed the presence of a larger amount of POXA1b in this extract than in the culture broth. The enzyme purified from cellular extract (POXA1b-I) shows some differences respect to the secreted enzyme (higher molecular mass, slightly different catalytic constants and lower pH stability). Extra-cellular POXA1b, named POXA1b-P, has been also purified from fungal culture in the presence of a serine protease inhibitor PMSF, in order to prevent protease action that may affect this isoenzyme. Comparison of properties of the three forms make evident significant similarity between POXA1b-P and POXA1b-I respect to POXA1b. A marked difference can be observed with regard to pH stability, as a fact POXA1b is the most stable form at alkaline pHs.

The conformation changes in solution of three fungal laccases in different environmental conditions were examined by circular dichroism (CD) and electron paramagnetic resonance (EPR) spectroscopy. CD measurements indicate that the secondary structure of proteins depends slightly on the pH or ionic strength, though the presence of salt could interfere in the molecular recognition process between substrates and enzymes. The enzymes, however, are highly destabilized by prolonged exposure to low pH or high temperature. The observed unfolding of the proteins coincides with their inactivation and, in some cases, with precipitation. On the other hand, these conditions do not determine the disruption of the geometric arrangement of their metal centres, and this fact suggests that these centres represent the more stable core of the proteins.

A new laccase isoenzyme (POXA1b, where POX is phenol oxidase), produced by Pleurotus ostreatus in cultures supplemented with copper sulphate, has been purified and fully characterized. The main characteristics of this protein (molecular mass in native and denaturing conditions, pI and catalytic properties) are almost identical to the previously studied laccase POXA1w. However, POXA1b contains four copper atoms per molecule instead of one copper, two zinc and one iron atom per molecule of POXA1w. Furthermore, POXA1b shows an unusually high stability at alkaline pH. The gene and cDNA coding for POXA1b have been cloned and sequenced. The gene coding sequence contains 1599 bp, interrupted by 15 introns. Comparison of the structure of the poxa1b gene with the two previously studied P. ostreatus laccase genes (pox1 and poxc) suggests that these genes belong to two different subfamilies. The amino acid sequence of POXA1b deduced from the cDNA sequence has been almost completely verified by means of matrix-assisted laser desorption ionization MS. It has been demonstrated that three out of six putative glycosylation sites are post-translationally modified and the structure of the bound glycosidic moieties has been determined, whereas two other putative glycosylation sites are unmodified.

To determine the accuracy of applanation tonometry in patients with corneas thinned by photorefractive keratectomy, and to correlate corneal changes with tonometric readings.The intraocular pressure was measured with Goldmann applanation tonometry in 87 patients who underwent photorefractive keratectomy before and 1, 6 and 12 months after treatment. The treatments ranged from -1.5 to -14 diopters (mean=-7.6+/-4.1 diopters) and the fellow eyes were used as controls.In the treated eyes the intraocular pressure before surgery ranged from 11 to 26 mmHg (mean=17.7+/-2.8 mmHg). One month after surgery it ranged from 5 to 22 mmHg (mean=11.9+/-2.7 mmHg) with a significant underestimation (P=1x10(-33)). Six months after surgery it ranged from 6 to 22 mmHg (mean=12+/-3 mmHg) with a significant underestimation (P=5x10(-30)). Twelve months after surgery it ranged from 8 to 22 mmHg (mean=12.7+/-2.7 mmHg) with a significant underestimation (P=5x10(-31)).A correcting factor should be applied when using applanation tonometry to measure intraocular pressure in patients who have undergone PRK.

Merkel cell neuroendocrine carcinoma is a cutaneous neoplasm rarely affecting the eyelids and periocular tissue. Merkel cells, which are probably of epithelial origin, are clear oval cells in the epidermis and outer root sheaths of hair follicles. They share ultrastructural features with neuroendocrine cells and have been reported to be associated with touch receptors.

The evaluation of the so-called ‘prescleral layer’ has been introduced by K.C. Ossoinig to provide valuable information in making differential diagnoses between dense vitreous membranes and retinal detachment when the detached membranous surface gives borderline delta dB values. The authors have tried to establish whether this kind of examination can be helpful in making differential diagnoses in cases of retinoschisis.

A patient with a juxtapapillary hamartoma is described, in consideration not only for the scarcity of such cases described in the literature, but also for the clinical and echographic characteristics that were observed for the involvement of the right eye, and because the patient was female. Echography and especially standardized A-scan echography, showing a lesion at high reflectivity without acoustic shadowing, allowed us to exclude the presence of a malignant melanoma and retinoblastoma, and directing us to the diagnosis of a malformation of angiomatous type.

At present an exact measurement of intraorbital optic nerve diameter is possible by using standardized A-scan echography. Measurements are made with an accuracy of 0.4 µsec for the anterior orbit and ± 0.6 µsec for the posterior orbit. In addition, it is known that some types of anesthetic cause modifications in the intracranial pressure. The authors evaluated the effect of a number of anesthesiological techniques on the intracranial pressure by measuring the optic nerve diameter within the orbit. The results demonstrate a significant increase in the optic nerve diameter in patients subjected to anesthesia with premedication of atropine and diazepam in combination with intravenously administered ketamine. The type of anesthetic should be specified in case of biometry of the optic nerve if these measurements are performed under general anesthesia.

Long-standing diabetic subjects have an impaired sympathetic nervous system activity as a consequence of autonomic neuropathy. Moreover, in this latter group of subjects the parasympathetic rather than the sympathetic nervous system seems firstly impaired by glucose metabolism derangements. In the present study we show that, in aged diabetic subjects with a short duration of the disease (less than 5 years), and who are free from diabetic complications, it is possible to evidence a primary compromise of sympathetic rather than parasympathetic nervous system activity since a greater rate of orthostatic hypotension occurred. In the light of the well-known age-related changes in the physiopathology of cardiovascular activity, we hypothesize that in aged diabetic patients, even after a short duration of disease, sympathetic compromise precedes the derangement of parasympathetic nervous system activity.

The study of subretinal fluid (S.R.F.) composition may provide useful information about the pathogenesis and behavior of idiopathic retinal detachment. It is generally believed that S.R.F. initially consists of degenerated fluidified vitreous passing through a retinal break into to the space between the neurosensorial and neuroepithelial layers. Later S.R.F. becomes richer in proteins, probably because of leakage from choroidal vessels (Akhmeteli, et al. 1977, Chignell, et al. 1977). S.R.F. has been the object of much research, but its study presents a great deal of difficulty for various reasons: (a) the easy contamination of the sample with blood on extraction; (b) the small quantity of extractable material; (c) the variety of separation techniques employed by different authors, which hinders comparison of the results. Moreover, the study of S.R.F. alone provides us with data relative to its composition, but not with data comparable to the structure of the vitreous, from which the S.R.F. is originally derived. A-scan echography, on the other hand, allows us to study the S.R.F. and the vitreous as a whole at the same time thus enabling us to discover any meshwork changes in the vitreous or reflectivity modifications in the S.R.F. (Gallenga 1973, Ossoinig 1966).

Ophthalmodynamometric data based on 5 patients with low-tension glaucoma and two other groups with either chronic simple glaucoma, or carotid stenosis insufficiency, respectively, are reported. The re

The diagnosis of endobulbar tumour and the identification of their nature being made (Bellone & Gallenga 1970–1971, Gallenga & Mazzeo 1974–1975, Ossoinig, et al. 1975, Mazzeo, et al. 1979) echography plays a fundamental role even in the subsequent strategy (Table 1).

A case of bilateral multiple pigment epithelium detachments in a 36 year old man is reported. The value of E.R.G., E.O.G. and fluorescein angiography in the differential diagnosis between multiple serous detachments of the pigment epithelium and multiple vitelliform degeneration is stressed.

Measurements of optic nerve diameter with standardized A-scan echography were made in a group of patients with cerebral diseases. Intracranial pressure was monitored at the time of the optic nerve diameter measurements. This study indicates that optic nerve sheath distension completely disappears as soon as intracranial pressure is normalized.

Pseudophakodonesis is considered the major cause of late corneal and retinal complications in IOL surgery. Three groups of IOL patients were studied with B-scan and M-mode echography – those with anterior chamber lenses, iris fixation lenses and posterior chamber lenses. Only patients with IOLs in the proper position were included in the study. B-scan was used to control the correct position of the IOL, while M-mode echography was used to determine inertial movements of the IOL.

At present, A- and B-scan echography enables differential diagnosis between vitreo-retinal diseases, secondary retinal detachment and neoplasia.