Adolfo Sebastiani - Academia.edu (original) (raw)
Papers by Adolfo Sebastiani
Age-related macular degeneration (AMD) represents the leading cause of central blindness in devel... more Age-related macular degeneration (AMD) represents the leading cause of central blindness in developed countries. The majority of severe vision loss occurs in the neovascular form of AMD, generally characterized by the presence of choroidal neovascularization (CNV) beneath the fovea. Photodynamic therapy with verteporfin (PDT-V) and drugs acting against vascular endothelial growth factor are the most commonly employed treatments for AMD-related subfoveal CNV. The combined use of both these strategies is the most promising therapeutic approach towards this harmful disease. The therapeutic action of PDT-V depends to a photochemical perturbation of thrombo-coagulative processes within CNV. Predictive correlations between peculiar coagulation-balance gene polymorphisms and different levels of post-PDT-V benefit have been recently documented in Caucasian patients with neovascular AMD. Particularly, heterozygous A-allele carriers of factor V Leiden 1691 or prothrombin 20210 gene are characterized by a greater possibility to exhibit clinical benefit after PDT-V. Both mutations induce thrombophilia increasing the thrombin generation in plasma and, thus, they can consistently intensify the photothrombotic phase of the therapeutic CNV occlusion. In prospect, considering the different individual susceptibility to PDT-V, a preoperative assessment of the genotypic thrombophilic background could optimize the eligibility criteria of this intriguing treatment. This review summarizes some of the recent published patents on treatment of neovascular AMD, with a particular attention to PDT-V application in combined therapeutic modalities.
Oncology, 2004
Background/Objective: Clear cell renal cell carcinoma (CCRCC) is a malignant neoplasm frequently ... more Background/Objective: Clear cell renal cell carcinoma (CCRCC) is a malignant neoplasm frequently associated with an increase in circulating immune complexes (CIC). Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a disease involving the chorioretinal structures of the eye, and it is commonly observed in association with several immunogenic disorders. We report here the clinical association between humoral immunologic modifications during tumoral diseases (long-standing CIC increase) and chorioretinal changes resembling atypical APMPPE. Case Report: A 52-year-old white male affected by metastatic CCRCC is described. Histopathologic review of his surgically removed organs (kidney and lung), periodical laboratory immunologic tests and ophthalmologic examinations, including fluorescein and indocyanine green angiographies, were performed. Results: The patient underwent total left nephrectomy (May 1997) and total left pneumonectomy (March 2001) for the presence of sta...
Background: The etiology of primary cutaneous anaplastic large-cell CD30+ lymphoma is largely unk... more Background: The etiology of primary cutaneous anaplastic large-cell CD30+ lymphoma is largely unknown, and although an infectious involvement has been suspected, the implication of infectious agents in its pathogenesis is still unclear. Findings: We report the case of a HIV-negative patient referred to our hospital with a rapidly enlarging skin tumor on her upper eyelid. Surgical excision was performed and histological analysis evidenced a primary cutaneous anaplastic large-cell lymphoma. Due to the ocular localization and to the prominent angiogenic component of the lesion, molecular analyses for the detection of Chlamydophila pneumoniae and HHV8 were performed, revealing the presence of an infection by both pathogens in surgical biopsy and in peripheral blood mononuclear cells. Conclusions: These findings suggest for the first time a possible association of C. pneumoniae and/or HHV8 infection, or both together, with primary cutaneous anaplastic large-cell lymphoma in non-immunocompromised and HIV-negative subjects. This potential pathogenic association, if confirmed, could provide potential indications for future therapy.
Санкт-Петербург на всех этапах развития российской науки был и остается ведущим лихенологическим ... more Санкт-Петербург на всех этапах развития российской науки был и остается ведущим лихенологическим центром страны. Именно здесь работали основоположники российской и советской лихенологии Александр Александрович Еленкин (1873-1942) (рис. 1) и его ученик Всеволод Павлович Савич (1885-1972), оставившие после себя целую научную школу. Сегодня в Санкт-Петербурге сосредоточена самая многочисленная группа лихенологов и расположен крупнейший лихенологический гербарий в России, находящийся в Ботаническом институте им. В. Л. Комарова РАН. В. П. Савич был одним из первых студентов и выпускников Санкт-Петербургского университета (учился с 1904 по 1912 г.), в дальнейшем специализировавшихся в области лихенологии. Жизнь В. П. Савича в студенческие годы явно была насыщенной, а интересы-разносторонними (рис. 2, 3). По приглашению профессора Христофора Яковлевича Гоби (1847-1919) он непродолжительное время (в 1906 г.) работал препаратором Ботанического кабинета и куратором университетского гербария (рис. 4). Однако осенью того же года он поступил практикантом и внештатным хранителем Спорового гербария на работу в Императорский Ботанический сад, с которым и была связана в дальнейшем вся его научная жизнь. В годы обучения в университете В. П. Савич активно участвовал в работе Студенческого ботанического кружка и Межкружковой организации студенческих научных кружков (рис. 5), и даже был секретарем этих организаций [1, 2]. Первые его публикации, подготовленные под руководством А. А. Еленкина, также появились еще во времена студенчества (начиная с 1909 г.), причем большинство из них вышло в Трудах Студенческого научного кружка физико-математического факультета Санкт-Петербургского университета и в Трудах Императорского Санкт-Петербургского
PloS one, 2017
To study the effect of torsional phacoemulsification energy on corneal endothelium evaluating the... more To study the effect of torsional phacoemulsification energy on corneal endothelium evaluating the relationship between changes of endothelial cells and postoperative visual acuity. This prospective clinical observational cohort study included 50 patients with cataract who underwent torsional phacoemulsification. Sequential quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed four weeks preoperatively and six weeks postoperatively using noncontact specular microscopy. This work confirmed the strong relationship, described by a linear model (one-way ANOVA, R2 = 77.9%, P < 0.0001), between the percentage of endothelial cell loss (ECL%) and the 5-score harm scale. According to the Tukey post-hoc pairwise comparison test, distinct values of ECL% are grouped in 3 subsets. The value of ECL = 10% has been identified as cut-off to discriminate patients with excellent postoperative best-corrected visual acuity (BCVA > 85 letters) from those wi...
Eye (London, England), Jul 9, 2018
In the face of the global epidemic of diabetes, it is critical that we update our knowledge about... more In the face of the global epidemic of diabetes, it is critical that we update our knowledge about the pathogenesis of diabetes and the related micro alterations on the vascular network in the body. This may ultimately lead to early diagnosis and novel treatment options for delaying the progression of diabetic complications. Research has recently revealed the pivotal role of endothelin in the pathogenesis of diabetic complications, particularly in the regulation of the capillary flow, which is affected in the course of retinopathy. Although there are several reviews on various approaches to the treatment of diabetes, including normalization of glucose and fat metabolism, no reviews in literature have focused on the endothelin system as a therapeutic target or early indicator of diabetic microangiopathy. In this review, we summarize some of the experimental and clinical evidence suggesting that current therapeutic approaches to diabetes may include the modulation of the blood concentr...
Journal of refractive surgery (Thorofare, N.J. : 1995)
To the Editor: We read with interest the article by P.S. Hersh attempting to standardize the clas... more To the Editor: We read with interest the article by P.S. Hersh attempting to standardize the classification of topographic patterns after laser refractive surgery (Hersh PS. A standardized classification of corneal topography after laser refractive surgery. J Refract Surg 1997;13:571-575). To standardize a technique is always a very important and difficult task, but it is the best way to facilitate improvement in technology as people can compare their experiences, and with the “same language,” faster improvement can occur. To standardize a technique has already been realized in other areas of ophthalmology, such as ophthalmic echography, by Karl Ossoinig in the early 1970s (Ossoinig KC. Standardized Ophthalmic Echography of the Eye, Orbit and Periorbital Region, 3rd edition. Iowa City, IA: Goodfellow Company; 1985). For this reason, we suggest an improvement to Hersh’s classification. Hersh suggested using a differential map (derived from subtraction of the preoperative from postoperative values at corresponding points on the actual power maps) to follow-up patients, utilizing a 0.5 step. Since then, we have used his classification, but had some discrepancies (see figures). In Figure 1, the differential map automatically generated by the computer (EyeSys Vista) has a 0.5 step and according to Hersh’s classification, would be classified as a regular homogeneous pattern. In Figure 2, the same patient shows a toric with axis pattern. The difference between the two images are the scales. Figure 1 has 0 difference as a mean point, and goes from a difference of +3.50 to -3.50 D. In Figure 2, it goes from 0 to -7.00 D. Figure 2 was generated using a different scale. This is important because if we perform a treatment below 3.50 D, we will fit in the correct classification, but if we perform a high dioptric treatment, utilizing the first scale, it is quite obvious that we will get a uniform image, as most of the area will have a dioptric difference superior to the highest level of the scale. Moreover, this will allow better detection of small irregular areas. We suggest the following criterion: to assign the last step to the highest difference value obtained from the map. Hersh’s classification referred to topographic findings after treatment for myopia and myopic astigmatism. We suggest that this classification be extended to findings after hyperopic PRK; the differential map should derive from subtraction of the postoperative from preoperative values at corresponding points on the actual power maps. The result would be patterns similar to those found for myopia and myopic astigmatism, the only difference being that a toric with axis treatment will increase the patient’s corneal toricity (Fig 3).
Investigative Ophthalmology & Visual Science, 2006
Journal of Medical Virology, 1990
The efficacy of different therapies and vaccine preparations was assessed for treating or prevent... more The efficacy of different therapies and vaccine preparations was assessed for treating or preventing herpetic ocular keratitis induced by experimental inoculation in rabbits with two HSV-1 variants that display different pathogenetic potential. Early administration of acyclovir (ACV) promoted fast healing and prevented neurologic involvements: a-Interferon (a-IFN) was less efficient than ACV; combined therapy with both drugs increased the antiviral effects. In an attempt to prevent the disease, rabbits were vaccinated with a slightly pathogenic HSV-1 variant or with a secreted form of an engineered HSV-1 glycoprotein gB (gB-Is) and were subsequently challenged with a highly pathogenic HSV-1 variant. Immunization of rabbits with gB-1s was much more efficient than immunization with live virus in reducing the severity of herpetic keratitis and in preventing CNS disease.
Ophthalmology, Oct 1, 2001
To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topogra... more To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism. Noncomparative, interventional case series. A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant. A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography. At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications. Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.
Cns Drugs, 2004
SSRIs are the most commonly prescribed antidepressant drugs, in part because of their favourable ... more SSRIs are the most commonly prescribed antidepressant drugs, in part because of their favourable safety profile compared with older antidepressants. However, the widespread use of SSRIs leads to an increased occurrence of rare adverse effects. This review, based on data from published experimental research, clinical studies and case reports, describes the role of serotonin in the control of intraocular pressure (IOP) and the evidence for IOP modifications in patients receiving SSRIs. In a small percentage of patients with depression, the cause of SSRI withdrawal has been the occurrence of ill-defined visual disturbances. It can be speculated that in some of these patients, the iatrogenic ocular alterations could have been due to changes in IOP. There have also been a limited number of case reports of acute attacks of glaucoma occurring during treatment with SSRIs. Although causality is not exactly specified, the relationship between SSRIs and this ocular adverse event is strongly implied. Nevertheless, in a small clinical study assessing the effect of a single dose of fluoxetine on IOP, the drug was shown to increase this parameter, although the effect was asymptomatic. The clinical signs of unexpected adverse drug effects are often disregarded, with the exception of those characterised by serious symptoms (such as acute angle-closure glaucoma in the case of IOP modifications). Also, the distribution of iridocorneal angle configurations in the general population implies that an adverse effect on IOP will be pauci- or asymptomatic in most patients (intermittent, sub-acute or progressive angle-closure glaucoma). As a result, it is likely that the incidence of SSRI-related IOP modifications is underestimated. Until the involvement of SSRIs in IOP modifications is better understood, ophthalmological consultations should be considered before starting and during treatment with any SSRI in patients with glaucomatous risk factors, especially those who are elderly.
Ophthalmologica, 2003
The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop adm... more The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop administration on visual field parameters and ocular perfusion pressure (OPP) in patients affected by primary open-angle glaucoma. A prospective, randomized double-blind study was carried out. Sixty-four glaucomatous subjects were enrolled in the clinical trial and subsequently separated into four study groups, of 16 patients each, to compare the systemic and ocular effects of placebo, clonidine 0.125%, apraclonidine 1.0% and brimonidine 0.2%. No significant variations in the ocular or systemic parameters were observed after placebo administration. All the alpha-adrenoreceptor agonist compounds induced a significant reduction of the intraocular pressure. Clonidine induced significant modifications of mean blood pressure, OPP and visual field indices. The acute administration of apraclonidine did not affect both mean blood pressure and OPP, but a worsening of the visual field was nevertheless recorded. The analyzed parameters did not significantly vary after brimonidine instillation. The present findings demonstrate that the lack of effects on the blood flow and the absence of vasomotor activity at the level of the posterior pole exhibited by brimonidine is related to its alpha-2 selectivity, as appears by comparing this compound with the other alpha-agonists available for the management of glaucoma.
Ophthalmology, 2000
To test the feasibility of a new surgical technique aimed at replacing diseased corneal endotheli... more To test the feasibility of a new surgical technique aimed at replacing diseased corneal endothelium while minimizing visual recovery time. Noncomparative, prospective, clinic-based, interventional case series. A total of seven patients with aphakic bullous keratopathy (n = 2), pseudophakic bullous keratopathy (n = 4), or Fuchs' corneal dystrophy (n = 1) participated. All patients underwent a surgical procedure including removal of the epithelium, creation of a 9.5-mm corneal flap, substitution of an underlying 6.5-mm button of deep stroma and endothelium with a 7.0-mm donor button, and suturing of the flap back into position using a 10-0 running nylon suture. In the two most recently operated patients, anterior lamella, 160 microm in thickness, was removed from the donor button before transplantation. Visual acuity, refraction, keratometry, corneal topography. All corneas were clear, and the surface reepithelialized within 4 weeks after surgery. Regular astigmatism of less than 4 diopters was recorded in all cases as early as 4 weeks after surgery. Epithelial interface ingrowth with extensive melting of the corneal flap was observed in one patient 3 months after surgery and was managed by removal of the flap and resuturing of the donor button. Endokeratoplasty represents a promising alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium.
Eye, 2003
Aims Retinal venous tortuosity (RVT) is a common finding in patients affected by different forms ... more Aims Retinal venous tortuosity (RVT) is a common finding in patients affected by different forms of chronic anaemia. The aims of this study were to quantify RVT in anaemic patients with ß-thalassaemia major and to verify whether it is related to some of the following parameters: patient's age, ferritin plasma level, and Desferrioxamine (DFX) daily dosage. Methods A retrospective study was carried out. In total, 36 consecutive thalassaemic patients, treated with polytransfusion regimen and DFX, were age-and sex-matched with a control group of 36 normal subjects. All subjects bilaterally underwent red-free fundus photography, centred on the optic disc. The four main retinal veins were measured with a computer-assisted method. Results Mean venous length in the thalassaemic group was significantly greater than that observed in the control group (Po0.001). In thalassaemic patients, no significant correlations between retinal venous length and, respectively, plasma ferritin level and DFX daily dosage were documented. Statistical analysis demonstrated a very significant association between patient's age and increased RVT only in thalassaemic patients (Po0.001). Conclusions Our findings demonstrate that patients with b-thalassaemia major have increased RVT, as compared to normal subjects. In this selected anaemic population, patient's age, closely related to anaemia duration, is the only variable responsible for the RVT increment. This clinical sign indicates a long-standing duration of anaemia.
British Journal of Ophthalmology, 2002
European Journal of Ophthalmology, 2002
To investigate the cause of recurrent central retinal vein occlusion in a 26-year-old white woman... more To investigate the cause of recurrent central retinal vein occlusion in a 26-year-old white woman. Case report. Complete blood analyses were done, including HLA tissue typing, immunoserologic and coagulation tests, with cardiovascular and capillaroscopy investigations. Factor V:R506Q and prothrombin 20210 GIA mutations were checked by polymerase chain reaction and restriction enzyme analysis. DNA analysis showed the patient to be heterozygous for factor V:R506Q mutation. During a follow-up of 18-months, after starting anticoagulant therapy, the patient had not suffered from any other ocular or systemic occlusive vascular accident. The R506Q factor V gene mutation may be associated with recurrent central retinal vein occlusions. Genetic investigation should be promptly recommended in thrombotic patients to establish a specific preventive treatment.
Ophthalmologica, 2003
The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop adm... more The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop administration on visual field parameters and ocular perfusion pressure (OPP) in patients affected by primary open-angle glaucoma. A prospective, randomized double-blind study was carried out. Sixty-four glaucomatous subjects were enrolled in the clinical trial and subsequently separated into four study groups, of 16 patients each, to compare the systemic and ocular effects of placebo, clonidine 0.125%, apraclonidine 1.0% and brimonidine 0.2%. No significant variations in the ocular or systemic parameters were observed after placebo administration. All the alpha-adrenoreceptor agonist compounds induced a significant reduction of the intraocular pressure. Clonidine induced significant modifications of mean blood pressure, OPP and visual field indices. The acute administration of apraclonidine did not affect both mean blood pressure and OPP, but a worsening of the visual field was nevertheless recorded. The analyzed parameters did not significantly vary after brimonidine instillation. The present findings demonstrate that the lack of effects on the blood flow and the absence of vasomotor activity at the level of the posterior pole exhibited by brimonidine is related to its alpha-2 selectivity, as appears by comparing this compound with the other alpha-agonists available for the management of glaucoma.
Age-related macular degeneration (AMD) represents the leading cause of central blindness in devel... more Age-related macular degeneration (AMD) represents the leading cause of central blindness in developed countries. The majority of severe vision loss occurs in the neovascular form of AMD, generally characterized by the presence of choroidal neovascularization (CNV) beneath the fovea. Photodynamic therapy with verteporfin (PDT-V) and drugs acting against vascular endothelial growth factor are the most commonly employed treatments for AMD-related subfoveal CNV. The combined use of both these strategies is the most promising therapeutic approach towards this harmful disease. The therapeutic action of PDT-V depends to a photochemical perturbation of thrombo-coagulative processes within CNV. Predictive correlations between peculiar coagulation-balance gene polymorphisms and different levels of post-PDT-V benefit have been recently documented in Caucasian patients with neovascular AMD. Particularly, heterozygous A-allele carriers of factor V Leiden 1691 or prothrombin 20210 gene are characterized by a greater possibility to exhibit clinical benefit after PDT-V. Both mutations induce thrombophilia increasing the thrombin generation in plasma and, thus, they can consistently intensify the photothrombotic phase of the therapeutic CNV occlusion. In prospect, considering the different individual susceptibility to PDT-V, a preoperative assessment of the genotypic thrombophilic background could optimize the eligibility criteria of this intriguing treatment. This review summarizes some of the recent published patents on treatment of neovascular AMD, with a particular attention to PDT-V application in combined therapeutic modalities.
Oncology, 2004
Background/Objective: Clear cell renal cell carcinoma (CCRCC) is a malignant neoplasm frequently ... more Background/Objective: Clear cell renal cell carcinoma (CCRCC) is a malignant neoplasm frequently associated with an increase in circulating immune complexes (CIC). Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a disease involving the chorioretinal structures of the eye, and it is commonly observed in association with several immunogenic disorders. We report here the clinical association between humoral immunologic modifications during tumoral diseases (long-standing CIC increase) and chorioretinal changes resembling atypical APMPPE. Case Report: A 52-year-old white male affected by metastatic CCRCC is described. Histopathologic review of his surgically removed organs (kidney and lung), periodical laboratory immunologic tests and ophthalmologic examinations, including fluorescein and indocyanine green angiographies, were performed. Results: The patient underwent total left nephrectomy (May 1997) and total left pneumonectomy (March 2001) for the presence of sta...
Background: The etiology of primary cutaneous anaplastic large-cell CD30+ lymphoma is largely unk... more Background: The etiology of primary cutaneous anaplastic large-cell CD30+ lymphoma is largely unknown, and although an infectious involvement has been suspected, the implication of infectious agents in its pathogenesis is still unclear. Findings: We report the case of a HIV-negative patient referred to our hospital with a rapidly enlarging skin tumor on her upper eyelid. Surgical excision was performed and histological analysis evidenced a primary cutaneous anaplastic large-cell lymphoma. Due to the ocular localization and to the prominent angiogenic component of the lesion, molecular analyses for the detection of Chlamydophila pneumoniae and HHV8 were performed, revealing the presence of an infection by both pathogens in surgical biopsy and in peripheral blood mononuclear cells. Conclusions: These findings suggest for the first time a possible association of C. pneumoniae and/or HHV8 infection, or both together, with primary cutaneous anaplastic large-cell lymphoma in non-immunocompromised and HIV-negative subjects. This potential pathogenic association, if confirmed, could provide potential indications for future therapy.
Санкт-Петербург на всех этапах развития российской науки был и остается ведущим лихенологическим ... more Санкт-Петербург на всех этапах развития российской науки был и остается ведущим лихенологическим центром страны. Именно здесь работали основоположники российской и советской лихенологии Александр Александрович Еленкин (1873-1942) (рис. 1) и его ученик Всеволод Павлович Савич (1885-1972), оставившие после себя целую научную школу. Сегодня в Санкт-Петербурге сосредоточена самая многочисленная группа лихенологов и расположен крупнейший лихенологический гербарий в России, находящийся в Ботаническом институте им. В. Л. Комарова РАН. В. П. Савич был одним из первых студентов и выпускников Санкт-Петербургского университета (учился с 1904 по 1912 г.), в дальнейшем специализировавшихся в области лихенологии. Жизнь В. П. Савича в студенческие годы явно была насыщенной, а интересы-разносторонними (рис. 2, 3). По приглашению профессора Христофора Яковлевича Гоби (1847-1919) он непродолжительное время (в 1906 г.) работал препаратором Ботанического кабинета и куратором университетского гербария (рис. 4). Однако осенью того же года он поступил практикантом и внештатным хранителем Спорового гербария на работу в Императорский Ботанический сад, с которым и была связана в дальнейшем вся его научная жизнь. В годы обучения в университете В. П. Савич активно участвовал в работе Студенческого ботанического кружка и Межкружковой организации студенческих научных кружков (рис. 5), и даже был секретарем этих организаций [1, 2]. Первые его публикации, подготовленные под руководством А. А. Еленкина, также появились еще во времена студенчества (начиная с 1909 г.), причем большинство из них вышло в Трудах Студенческого научного кружка физико-математического факультета Санкт-Петербургского университета и в Трудах Императорского Санкт-Петербургского
PloS one, 2017
To study the effect of torsional phacoemulsification energy on corneal endothelium evaluating the... more To study the effect of torsional phacoemulsification energy on corneal endothelium evaluating the relationship between changes of endothelial cells and postoperative visual acuity. This prospective clinical observational cohort study included 50 patients with cataract who underwent torsional phacoemulsification. Sequential quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed four weeks preoperatively and six weeks postoperatively using noncontact specular microscopy. This work confirmed the strong relationship, described by a linear model (one-way ANOVA, R2 = 77.9%, P < 0.0001), between the percentage of endothelial cell loss (ECL%) and the 5-score harm scale. According to the Tukey post-hoc pairwise comparison test, distinct values of ECL% are grouped in 3 subsets. The value of ECL = 10% has been identified as cut-off to discriminate patients with excellent postoperative best-corrected visual acuity (BCVA > 85 letters) from those wi...
Eye (London, England), Jul 9, 2018
In the face of the global epidemic of diabetes, it is critical that we update our knowledge about... more In the face of the global epidemic of diabetes, it is critical that we update our knowledge about the pathogenesis of diabetes and the related micro alterations on the vascular network in the body. This may ultimately lead to early diagnosis and novel treatment options for delaying the progression of diabetic complications. Research has recently revealed the pivotal role of endothelin in the pathogenesis of diabetic complications, particularly in the regulation of the capillary flow, which is affected in the course of retinopathy. Although there are several reviews on various approaches to the treatment of diabetes, including normalization of glucose and fat metabolism, no reviews in literature have focused on the endothelin system as a therapeutic target or early indicator of diabetic microangiopathy. In this review, we summarize some of the experimental and clinical evidence suggesting that current therapeutic approaches to diabetes may include the modulation of the blood concentr...
Journal of refractive surgery (Thorofare, N.J. : 1995)
To the Editor: We read with interest the article by P.S. Hersh attempting to standardize the clas... more To the Editor: We read with interest the article by P.S. Hersh attempting to standardize the classification of topographic patterns after laser refractive surgery (Hersh PS. A standardized classification of corneal topography after laser refractive surgery. J Refract Surg 1997;13:571-575). To standardize a technique is always a very important and difficult task, but it is the best way to facilitate improvement in technology as people can compare their experiences, and with the “same language,” faster improvement can occur. To standardize a technique has already been realized in other areas of ophthalmology, such as ophthalmic echography, by Karl Ossoinig in the early 1970s (Ossoinig KC. Standardized Ophthalmic Echography of the Eye, Orbit and Periorbital Region, 3rd edition. Iowa City, IA: Goodfellow Company; 1985). For this reason, we suggest an improvement to Hersh’s classification. Hersh suggested using a differential map (derived from subtraction of the preoperative from postoperative values at corresponding points on the actual power maps) to follow-up patients, utilizing a 0.5 step. Since then, we have used his classification, but had some discrepancies (see figures). In Figure 1, the differential map automatically generated by the computer (EyeSys Vista) has a 0.5 step and according to Hersh’s classification, would be classified as a regular homogeneous pattern. In Figure 2, the same patient shows a toric with axis pattern. The difference between the two images are the scales. Figure 1 has 0 difference as a mean point, and goes from a difference of +3.50 to -3.50 D. In Figure 2, it goes from 0 to -7.00 D. Figure 2 was generated using a different scale. This is important because if we perform a treatment below 3.50 D, we will fit in the correct classification, but if we perform a high dioptric treatment, utilizing the first scale, it is quite obvious that we will get a uniform image, as most of the area will have a dioptric difference superior to the highest level of the scale. Moreover, this will allow better detection of small irregular areas. We suggest the following criterion: to assign the last step to the highest difference value obtained from the map. Hersh’s classification referred to topographic findings after treatment for myopia and myopic astigmatism. We suggest that this classification be extended to findings after hyperopic PRK; the differential map should derive from subtraction of the postoperative from preoperative values at corresponding points on the actual power maps. The result would be patterns similar to those found for myopia and myopic astigmatism, the only difference being that a toric with axis treatment will increase the patient’s corneal toricity (Fig 3).
Investigative Ophthalmology & Visual Science, 2006
Journal of Medical Virology, 1990
The efficacy of different therapies and vaccine preparations was assessed for treating or prevent... more The efficacy of different therapies and vaccine preparations was assessed for treating or preventing herpetic ocular keratitis induced by experimental inoculation in rabbits with two HSV-1 variants that display different pathogenetic potential. Early administration of acyclovir (ACV) promoted fast healing and prevented neurologic involvements: a-Interferon (a-IFN) was less efficient than ACV; combined therapy with both drugs increased the antiviral effects. In an attempt to prevent the disease, rabbits were vaccinated with a slightly pathogenic HSV-1 variant or with a secreted form of an engineered HSV-1 glycoprotein gB (gB-Is) and were subsequently challenged with a highly pathogenic HSV-1 variant. Immunization of rabbits with gB-1s was much more efficient than immunization with live virus in reducing the severity of herpetic keratitis and in preventing CNS disease.
Ophthalmology, Oct 1, 2001
To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topogra... more To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism. Noncomparative, interventional case series. A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant. A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography. At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications. Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.
Cns Drugs, 2004
SSRIs are the most commonly prescribed antidepressant drugs, in part because of their favourable ... more SSRIs are the most commonly prescribed antidepressant drugs, in part because of their favourable safety profile compared with older antidepressants. However, the widespread use of SSRIs leads to an increased occurrence of rare adverse effects. This review, based on data from published experimental research, clinical studies and case reports, describes the role of serotonin in the control of intraocular pressure (IOP) and the evidence for IOP modifications in patients receiving SSRIs. In a small percentage of patients with depression, the cause of SSRI withdrawal has been the occurrence of ill-defined visual disturbances. It can be speculated that in some of these patients, the iatrogenic ocular alterations could have been due to changes in IOP. There have also been a limited number of case reports of acute attacks of glaucoma occurring during treatment with SSRIs. Although causality is not exactly specified, the relationship between SSRIs and this ocular adverse event is strongly implied. Nevertheless, in a small clinical study assessing the effect of a single dose of fluoxetine on IOP, the drug was shown to increase this parameter, although the effect was asymptomatic. The clinical signs of unexpected adverse drug effects are often disregarded, with the exception of those characterised by serious symptoms (such as acute angle-closure glaucoma in the case of IOP modifications). Also, the distribution of iridocorneal angle configurations in the general population implies that an adverse effect on IOP will be pauci- or asymptomatic in most patients (intermittent, sub-acute or progressive angle-closure glaucoma). As a result, it is likely that the incidence of SSRI-related IOP modifications is underestimated. Until the involvement of SSRIs in IOP modifications is better understood, ophthalmological consultations should be considered before starting and during treatment with any SSRI in patients with glaucomatous risk factors, especially those who are elderly.
Ophthalmologica, 2003
The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop adm... more The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop administration on visual field parameters and ocular perfusion pressure (OPP) in patients affected by primary open-angle glaucoma. A prospective, randomized double-blind study was carried out. Sixty-four glaucomatous subjects were enrolled in the clinical trial and subsequently separated into four study groups, of 16 patients each, to compare the systemic and ocular effects of placebo, clonidine 0.125%, apraclonidine 1.0% and brimonidine 0.2%. No significant variations in the ocular or systemic parameters were observed after placebo administration. All the alpha-adrenoreceptor agonist compounds induced a significant reduction of the intraocular pressure. Clonidine induced significant modifications of mean blood pressure, OPP and visual field indices. The acute administration of apraclonidine did not affect both mean blood pressure and OPP, but a worsening of the visual field was nevertheless recorded. The analyzed parameters did not significantly vary after brimonidine instillation. The present findings demonstrate that the lack of effects on the blood flow and the absence of vasomotor activity at the level of the posterior pole exhibited by brimonidine is related to its alpha-2 selectivity, as appears by comparing this compound with the other alpha-agonists available for the management of glaucoma.
Ophthalmology, 2000
To test the feasibility of a new surgical technique aimed at replacing diseased corneal endotheli... more To test the feasibility of a new surgical technique aimed at replacing diseased corneal endothelium while minimizing visual recovery time. Noncomparative, prospective, clinic-based, interventional case series. A total of seven patients with aphakic bullous keratopathy (n = 2), pseudophakic bullous keratopathy (n = 4), or Fuchs' corneal dystrophy (n = 1) participated. All patients underwent a surgical procedure including removal of the epithelium, creation of a 9.5-mm corneal flap, substitution of an underlying 6.5-mm button of deep stroma and endothelium with a 7.0-mm donor button, and suturing of the flap back into position using a 10-0 running nylon suture. In the two most recently operated patients, anterior lamella, 160 microm in thickness, was removed from the donor button before transplantation. Visual acuity, refraction, keratometry, corneal topography. All corneas were clear, and the surface reepithelialized within 4 weeks after surgery. Regular astigmatism of less than 4 diopters was recorded in all cases as early as 4 weeks after surgery. Epithelial interface ingrowth with extensive melting of the corneal flap was observed in one patient 3 months after surgery and was managed by removal of the flap and resuturing of the donor button. Endokeratoplasty represents a promising alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium.
Eye, 2003
Aims Retinal venous tortuosity (RVT) is a common finding in patients affected by different forms ... more Aims Retinal venous tortuosity (RVT) is a common finding in patients affected by different forms of chronic anaemia. The aims of this study were to quantify RVT in anaemic patients with ß-thalassaemia major and to verify whether it is related to some of the following parameters: patient's age, ferritin plasma level, and Desferrioxamine (DFX) daily dosage. Methods A retrospective study was carried out. In total, 36 consecutive thalassaemic patients, treated with polytransfusion regimen and DFX, were age-and sex-matched with a control group of 36 normal subjects. All subjects bilaterally underwent red-free fundus photography, centred on the optic disc. The four main retinal veins were measured with a computer-assisted method. Results Mean venous length in the thalassaemic group was significantly greater than that observed in the control group (Po0.001). In thalassaemic patients, no significant correlations between retinal venous length and, respectively, plasma ferritin level and DFX daily dosage were documented. Statistical analysis demonstrated a very significant association between patient's age and increased RVT only in thalassaemic patients (Po0.001). Conclusions Our findings demonstrate that patients with b-thalassaemia major have increased RVT, as compared to normal subjects. In this selected anaemic population, patient's age, closely related to anaemia duration, is the only variable responsible for the RVT increment. This clinical sign indicates a long-standing duration of anaemia.
British Journal of Ophthalmology, 2002
European Journal of Ophthalmology, 2002
To investigate the cause of recurrent central retinal vein occlusion in a 26-year-old white woman... more To investigate the cause of recurrent central retinal vein occlusion in a 26-year-old white woman. Case report. Complete blood analyses were done, including HLA tissue typing, immunoserologic and coagulation tests, with cardiovascular and capillaroscopy investigations. Factor V:R506Q and prothrombin 20210 GIA mutations were checked by polymerase chain reaction and restriction enzyme analysis. DNA analysis showed the patient to be heterozygous for factor V:R506Q mutation. During a follow-up of 18-months, after starting anticoagulant therapy, the patient had not suffered from any other ocular or systemic occlusive vascular accident. The R506Q factor V gene mutation may be associated with recurrent central retinal vein occlusions. Genetic investigation should be promptly recommended in thrombotic patients to establish a specific preventive treatment.
Ophthalmologica, 2003
The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop adm... more The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop administration on visual field parameters and ocular perfusion pressure (OPP) in patients affected by primary open-angle glaucoma. A prospective, randomized double-blind study was carried out. Sixty-four glaucomatous subjects were enrolled in the clinical trial and subsequently separated into four study groups, of 16 patients each, to compare the systemic and ocular effects of placebo, clonidine 0.125%, apraclonidine 1.0% and brimonidine 0.2%. No significant variations in the ocular or systemic parameters were observed after placebo administration. All the alpha-adrenoreceptor agonist compounds induced a significant reduction of the intraocular pressure. Clonidine induced significant modifications of mean blood pressure, OPP and visual field indices. The acute administration of apraclonidine did not affect both mean blood pressure and OPP, but a worsening of the visual field was nevertheless recorded. The analyzed parameters did not significantly vary after brimonidine instillation. The present findings demonstrate that the lack of effects on the blood flow and the absence of vasomotor activity at the level of the posterior pole exhibited by brimonidine is related to its alpha-2 selectivity, as appears by comparing this compound with the other alpha-agonists available for the management of glaucoma.