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Longo R, Allegrini F, Gusson E, Morbio R, Di Gennaro G, Gozzi LA, Marchini G, Zoccante L. Visual-motor involvement in autism spectrum disorder: could the stereopsis deficit affect motor coordination? Front Psychiatry 2023; 14:1130185. [PMID: 38034932 PMCID: PMC10687461 DOI: 10.3389/fpsyt.2023.1130185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
PurposeGiven the known difficulty in sensory processing and in motor skills in patients with Autism Spectrum Disorder (ASD), and since visual impairment could interfere with children’s behaviour, early detection and management of visual-motor difficulties are crucial. This exploratory study aims to evaluate the visual-motor status in a cohort of children affected by ASD.MethodsThe records of patients affected by ASD and admitted between 2018 and 2022 to the Pediatric University Hospital of Verona were reviewed. Best Corrected Visual Acuity, cycloplegic refraction, stereopsis, convergence, complete ocular motility, strabismus examination, slit-lamp anterior segment examination and fundus ophthalmoscopy were collected and reviewed.ResultsA total of 253 patients (203 ASD and 50 healthy controls) were included in the study. A higher number of total orthoptic defects were detected in the ASD group, in comparison with the control group. Specifically, a higher percentage of stereopsis deficit and convergence insufficiency was observed.ConclusionIn our cohort of children with ASD stereopsis deficit, convergence insufficiency and refractive errors are the most observed ocular conditions. These findings are consistent with the known alterations of motor skills and sensory processing in ASD. Moreover, our study supports the hypothesis that visual acuity is not compromised in children with ASD. As a result, a complete ophthalmic evaluation is highly recommended in children with ASD, to guarantee early detection and treatment of possible visual-motor defects.
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Affiliation(s)
- Rosa Longo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Integrated University Hospital of Verona, Verona, Italy
| | - Francesca Allegrini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Integrated University Hospital of Verona, Verona, Italy
| | - Elena Gusson
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Integrated University Hospital of Verona, Verona, Italy
| | - Roberta Morbio
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Integrated University Hospital of Verona, Verona, Italy
| | - Gianfranco Di Gennaro
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, Verona, Italy
| | - Luigi Alberto Gozzi
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, Verona, Italy
| | - Giorgio Marchini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Integrated University Hospital of Verona, Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, Verona, Italy
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Franzolin E, Gusson E, Panozzo G. The effect of pars plana vitrectomy with internal limiting membrane peeling on the durability of the intravitreal dexamethasone implant in the treatment of diabetic macular edema. Am J Ophthalmol Case Rep 2022; 26:101401. [PMID: 35243151 PMCID: PMC8881408 DOI: 10.1016/j.ajoc.2022.101401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the influence of pars plana vitrectomy with internal limiting membrane peeling on recurrence time of diabetic macular edema in eyes under treatment with dexamethasone intravitreal implant injections. Material and methods Twelve pseudophakic eyes of 12 patients with non-proliferative diabetic retinopathy and non-tractional diabetic macular edema were included. All eyes had already been treated with two or more dexamethasone intravitreal implant injections evidencing a recurrence time of three months or less (early recurrence). At baseline, they underwent pars plana vitrectomy with internal limiting membrane peeling, ending with dexamethasone intravitreal implant injection. Patients were then followed-up monthly, treated with a second injection at the first recurrence, and followed up to the second recurrence. Measurements of best corrected visual acuity, intraocular pressure, and central foveal thickness by spectral-domain optical coherence tomography were performed at each follow-up examination. Results Vitrectomized eyes showed a significant extension of recurrence time of diabetic macular edema, and specifically from 3.4 (3.2–3.7) to 6.5 (5.7–8.2) months after the first injection, and to 7.0 (5.7–8.2) months (p < 0.01) after the second injection (p < 0.01). Conclusions and importance Pars plana vitrectomy with internal limiting membrane peeling seems not to influence functional and anatomical results in eyes under treatment with dexamethasone intravitreal implant injections for diabetic macular edema, but appears to significantly extend the benefit of the drug.
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Affiliation(s)
- Elia Franzolin
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Corresponding author. Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L. A. Scuro 10, 37134, Verona, Italy.
| | - Elena Gusson
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giacomo Panozzo
- Department of Ophthalmology, Bussolengo Civil Hospital, Verona, Italy
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Stillo F, Mattassi R, Diociaiuti A, Neri I, Baraldini V, Dalmonte P, Amato B, Ametrano O, Amico G, Bianchini G, Campisi C, Cattaneo E, Causin F, Cavalli R, Colletti G, Corbeddu M, Coppo P, DE Fiores A, DI Giuseppe P, El Hachem M, Esposito F, Fulcheri E, Gandolfo C, Grussu F, Guglielmo A, Leuzzi M, Manunza F, Moneghini L, Monzani N, Nicodemi E, Occella C, Orso M, Pagella F, Paolantonio G, Pasetti F, Rollo M, Ruggiero F, Santecchia L, Spaccini L, Taurino M, Vaghi M, Vercellio G, Zama M, Zocca A, Aguglia M, Castronovo EL, DE Lorenzi E, Fontana E, Gusson E, Lanza J, Lizzio R, Mancardi MM, Rosina E. Guidelines for Vascular Anomalies by the Italian Society for the study of Vascular Anomalies (SISAV). INT ANGIOL 2022; 41:1-130. [PMID: 35546136 DOI: 10.23736/s0392-9590.22.04902-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Stillo
- SISAV Past President, Service of Vascular Anomalies Surgery, Casa di Cura Guarnieri accreditata SSN, Rome, Italy
| | - Raul Mattassi
- Service of Vascular Surgery, Casa di cura Humanitas accreditata SSN, Varese, Italy
| | - Andrea Diociaiuti
- Unit of Dermatology, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
| | - Iria Neri
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vittoria Baraldini
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Bruno Amato
- Service of Vascular and General Surgery, Federico II University Hospital, Naples, Italy
| | - Orsola Ametrano
- Department of Pediatric Dermatology, Santobono Hospital, Naples, Italy
| | - Giulia Amico
- Department of Medical Genetics, IRCCS "G. Gaslini" Institute, Genoa, Italy
| | - Giuseppe Bianchini
- Department of Vascular Surgery, IRCCS - Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Corradino Campisi
- Department of Vascular and General Surgery, University of Genoa, Genoa, Italy
| | - Elisa Cattaneo
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Francesco Causin
- Unit of Neuroradiology, University Hospital of Padua, Padua, Italy
| | - Riccardo Cavalli
- Unit of Pediatric Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Colletti
- Private Practitioner in Maxillofacial Surgery, Associazione Italiana Sindrome di Sturge Weber, Milan, Italy
| | | | - Paola Coppo
- Unit of Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Antonio DE Fiores
- Service of Diagnostic Imaging Ultrasound, Casa di Cura Guarnieri Accreditata SSN, Rome, Italy
| | | | - May El Hachem
- Unit of Pediatric Dermatology, Dipartimento Pediatrico Universitario-Ospedaliero (DPUO), Associazione Italiana Sindrome di Sturge Weber, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Esposito
- Unit of Emergency Radiology, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Ezio Fulcheri
- Unit of Pathological Anatomy and Histology, University of Genoa, Genoa, Italy
| | - Carlo Gandolfo
- Unit of Radiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Grussu
- Unit of Plastic Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alba Guglielmo
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Miriam Leuzzi
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Laura Moneghini
- Unit of Anatomy, Pathology and Medical Genetics, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nicola Monzani
- Pediatric Intensive Care Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Massimiliano Orso
- Regione Umbria, Direzione regionale Salute e Welfare, Perugia, Italy
| | - Fabio Pagella
- ENT Department, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | | | | | | | | | | | - Luigina Spaccini
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea Hospital, Rome, Italy
| | | | | | - Mario Zama
- Unit of Plastic Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alfredo Zocca
- Unit of Internal Medicine, ASST Fatebenefratelli, Milan, Italy
| | - Maria Aguglia
- Unit of Clinical Pathology, PO "Vito Fazzi", Lecce, Italy
- Associazione HHT Onlus, Rome, Italy
| | - Enza L Castronovo
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena DE Lorenzi
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Fontana
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- AOUI (Azienda Ospedaliera Universitaria Integrata) di Verona, Verona, Italy
| | - Elena Gusson
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- Unit of Ophthalmology, Women and Children Hospital AOUI, Verona, Italy
| | - Jessica Lanza
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Lizzio
- ENT Department, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
- Associazione HHT Onlus, Rome, Italy
| | - Maria M Mancardi
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- Unit of Child Neuropsychiatry, Department of Neurosciences, IRCCS "G. Gaslini" Institute, Genoa, Italy
| | - Erica Rosina
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
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Franzolin E, Longo R, Gusson E, Ficial B, Marchini G. Pediatric eye emergency department activity during the first wave of Covid-19 pandemic. Ital J Pediatr 2021; 47:217. [PMID: 34736495 PMCID: PMC8567118 DOI: 10.1186/s13052-021-01167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background We investigated the volume and the characteristics of pediatric eye emergency department (PEED) consultations performed at our tertiary eye center during the early months of the COVID-19 pandemic and we compared them to those carried out in the same time interval of the previous three years. Methods Ophthalmic emergency examinations of patients aged ≤18 years old and done during the national COVID-19 lockdown (March 9th, 2020 – May 3rd, 2020) and in the corresponding date range of the previous three years (2017, 2018, and 2019) have been considered and reviewed. The following features were retrieved and analyzed: age, gender, duration and type of accused symptoms, traumatic etiology, and the discharge diagnosis. Results 136, 133, and 154 PEED visits have been performed respectively in 2017, 2018, and 2019, while 29 patients presented in 2020. Therefore, the volume of PEED activity decreased by 79.4% (p < 0.0001). Demographical and clinical characteristics were comparable to those of the pre-COVID period. Despite the absolute reduction in the number of traumas, urgent conditions increased significantly from 30.7 to 50.7% (p = 0.024). Conclusions PEED activity decreased consistently after the onset of the pandemic and it was mainly attended by those children whose conditions required prompt assistance, reducing the number of patients diagnosed with milder pathologies. At the end of the emergency, better use of PEED could avoid overcrowding and minimize waste, allowing resource optimization for the management of urgent cases.
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Affiliation(s)
- Elia Franzolin
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rosa Longo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Gusson
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Verona, Verona, Italy.
| | - Giorgio Marchini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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5
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Panozzo G, Mura GD, Franzolin E, Giannarelli D, Albano V, Alessio G, Arrigo A, Casati S, Cassottana P, Contardi C, D'Aloisio R, Fasce F, Gusson E, Marchini G, Mastropasqua L, Niccolò M, Palmisano C, Pastore MR, Saviano S, Tognetto D, Bandello F. Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study. Eye (Lond) 2021; 36:1687-1693. [PMID: 34345028 PMCID: PMC8330474 DOI: 10.1038/s41433-021-01718-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO). METHODS DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups. RESULTS The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (p < 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (p < 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, p < 0.0001) with a lower BCVA loss (-2.6 ± 3.5 letters vs -8.2 ± 6.2 letters, p < 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of >50 μm CST worsening in eyes from both groups. CONCLUSION Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.
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Affiliation(s)
- Giacomo Panozzo
- Ophthalmology Unit, Clinica San Francesco, Verona, Italy. .,ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland.
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Elia Franzolin
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Diana Giannarelli
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Valeria Albano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Gianni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Casati
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Paola Cassottana
- Department of Ophthalmology, San Martino University Hospital, IRCCS, Genova, Italy
| | - Cecilia Contardi
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Rossella D'Aloisio
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Fasce
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Gusson
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Giorgio Marchini
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Leonardo Mastropasqua
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Massimo Niccolò
- Department of Ophthalmology, University of Genova, Genova, Italy
| | - Carmela Palmisano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Marco Rocco Pastore
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Sandro Saviano
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kiani AK, Falsini B, Ziccardi L, Gusson E, Mangialavori D, Allegrini F, Colao E, Bertelli M. Flavonoid supplements increase neurotrophin activity to modulate inflammation in retinal genetic diseases. Acta Biomed 2020; 91:e2020014. [PMID: 33170164 PMCID: PMC8023125 DOI: 10.23750/abm.v91i13-s.10683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/23/2020] [Indexed: 11/23/2022]
Abstract
Retinal degenerative disorders induce loss of photoreceptors associated with inflammation, and negative remodeling and plasticity of neural retina. Retinal degenerative diseases may have genetic and/or environmental causes. Degeneration of retinal pigment epithelium cells initiates a vicious circle increasing the ongoing inflammation in both retina and choroid. Flavonoids are polyphenolic molecules with antioxidant activity and dietary intake, specifically of anthocyanins and flavanols, improves oxidative stress and neuro-inflammation. In vitro and ex vivo studies have also revealed biological effects of flavonoids on retinal protection against oxidative stress and inflammation. In this brief review, the protective role of flavonoids against retinal degeneration and inflammation will be discussed along with their therapeutic potential for the treatment of retinal degenerative diseases.
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Affiliation(s)
| | - Benedetto Falsini
- Department of Ophthalmology, Catholic University of Sacred Heart, Gemelli Policlinic, Rome, Italy.
| | | | - Elena Gusson
- Unit of Ophthalmology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Domenica Mangialavori
- Institute of Ophthalmology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - Francesca Allegrini
- Eye Clinic, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy.
| | - Emma Colao
- Medical Genetics Unit, Magna Graecia University, Catanzaro, Italy.
| | - Matteo Bertelli
- MAGI EUREGIO, Bolzano, Italy; MAGI'S LAB, Rovereto (TN), Italy; EBTNA-LAB, Rovereto (TN), Italy.
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Paolacci S, Iarossi G, Gusson E, Maltese PE, Dallavilla T, Fanelli F, Zulian A, Cerra D, Unfer V, Marchini G, Bertelli M. CRB1-Related Cystic Maculopathy in Twins Conceived Through Heterologous Fertilization With Variant-Carrying Oocytes. J Pediatr Ophthalmol Strabismus 2020; 57:e19-e24. [PMID: 32176805 DOI: 10.3928/01913913-20200204-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022]
Abstract
Cystic maculopathy has been associated with genetic disorders such as retinitis pigmentosa, X-linked retinoschisis, cone dystrophy, and foveal retinoschisis. Familial foveal retinoschisis was recently described as a rare disease caused by CRB1 variants. The authors report the phenotype-genotype pattern of a pair of dizygotic twins with early-onset cystic maculopathy due to CRB1 pathogenic variants. The twins were conceived by heterologous fertilization with variant-carrying oocytes. The probands were monitored for a period of 4 years. Next generation sequencing of a panel of genes responsible for retinal dystrophies was performed. Both children carried three pathogenic variants in CRB1: a novel heterozygous truncating variant p.(Val855*) inherited from the father and two known heterozygous missense variants, p.[(Phe144Val; Thr745Met)], inherited from the oocyte donor. The findings confirm that CRB1 variants can be responsible for foveal retinoschisis with variable clinical expressivity ranging from schitic macular alteration to early-onset forms of cystic maculopathy. The authors highlight the importance of exome analysis of gamete donors to assess the likelihood of recessively inherited disorders by means of a prediction algorithm able to combine parent and donor exome data. [J Pediatr Ophthalmol Strabismus. 2020;57:e19-e24.].
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Gusson E, Bosello F, Allegrini F, Firolli L, Tomaello I, Marchini G, Micciolo R, Pignatto S, Capone A. Long-Term Anatomic and Visual Outcome Following Vitrectomy for Stage 4B and 5 Retinopathy of Prematurity. Ophthalmic Surg Lasers Imaging Retina 2019; 50:208-214. [PMID: 30998241 DOI: 10.3928/23258160-20190401-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/05/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Surgical indications in stages 4B and 5 retinopathy of prematurity (ROP) are not universally accepted. The authors' purpose is to evaluate the long-term anatomic and visual outcomes of vitrectomy for retinal detachment (RD) associated with stages 4B and 5 ROP. PATIENTS AND METHODS Data of patients who consecutively underwent vitrectomy for stages 4B and 5 ROP from 1999 to 2013 were retrospectively reviewed and included grade of retinal attachment and visual acuity (VA) at the last follow-up. RESULTS Seventy eyes of 38 infants were included: 23 with stage 4B and 47 with stage 5 ROP. Lens-sparing vitrectomy was performed in 11 eyes, combined lensectomy / vitrectomy in 59 eyes. Mean follow-up was 8.5 years. Anatomic success was maintained in 41 eyes (58.5%), and among them, VA greater than 5/200 was achieved in 17 eyes (41.4%). CONCLUSION The long-term visual and anatomic success rates were encouraging for the surgical correction of RD associated with late stages ROP. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:208-214.].
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9
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Imperatore V, Pinto AM, Gelli E, Trevisson E, Morbidoni V, Frullanti E, Hadjistilianou T, De Francesco S, Toti P, Gusson E, Roversi G, Accogli A, Capra V, Mencarelli MA, Renieri A, Ariani F. Parent-of-origin effect of hypomorphic pathogenic variants and somatic mosaicism impact on phenotypic expression of retinoblastoma. Eur J Hum Genet 2018; 26:1026-1037. [PMID: 29662154 DOI: 10.1038/s41431-017-0054-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/27/2017] [Accepted: 11/23/2017] [Indexed: 11/09/2022] Open
Abstract
Retinoblastoma is the most common eye cancer in children. Numerous families have been described displaying reduced penetrance and expressivity. An extensive molecular characterization of seven families led us to characterize the two main mechanisms impacting on phenotypic expression, as follows: (i) mosaicism of amorphic pathogenic variants; and (ii) parent-of-origin-effect of hypomorphic pathogenic variants. Somatic mosaicism for RB1 splicing variants (c.1960+5G>C and c.2106+2T>C), leading to a complete loss of function was demonstrated by high-depth NGS in two families. In both cases, the healthy carrier parent (one with retinoma) showed a variant frequency lower than that expected for a heterozygous individual, indicating a 56-60% mosaicism level. Previous evidences of a ~3-fold excess of RB1 maternal canonical transcript led us to hypothesize that this differential allelic expression could influence phenotypic outcome in families at risk for RB onset. Accordingly, in five families, we identified a higher tumor risk associated with paternally inherited hypomorphic pathogenic variants, namely a deletion resulting in the loss of 37 amino acids at the N-terminus (c.608-16_608del), an exonic substitution with a "leaky" splicing effect (c.1331A>G), a partially deleterious substitution (c.1981C>T) and a truncating C-terminal variant (c.2663+2T>C). The identification of these mechanisms changes the genetic/prenatal counseling and the clinical management of families, indicating a higher recurrence risk when the hypomorphic pathogenic variant is inherited from the father, and suggesting the need for second tumor surveillance in unaffected carriers at risk of developing adult-onset cancer such as osteosarcoma or leiomyosarcoma.
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Affiliation(s)
| | - Anna Maria Pinto
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Elisa Gelli
- Medical Genetics, University of Siena, Siena, Italy
| | - Eva Trevisson
- Department of Woman and Child Health, University of Padova Istituto di Ricerca Pediatrica, IRP, Città della Speranza, Padova, Italy.,Istituto di Ricerca Pediatrica, IRP, Città della Speranza, Padova, Italy
| | - Valeria Morbidoni
- Department of Woman and Child Health, University of Padova Istituto di Ricerca Pediatrica, IRP, Città della Speranza, Padova, Italy.,Istituto di Ricerca Pediatrica, IRP, Città della Speranza, Padova, Italy
| | | | - Theodora Hadjistilianou
- Unit of Ophthalmology and Retinoblastoma Referral Center, Department of Surgery, University of Siena, Policlinico 'Santa Maria alle Scotte', Siena, Italy
| | - Sonia De Francesco
- Unit of Ophthalmology and Retinoblastoma Referral Center, Department of Surgery, University of Siena, Policlinico 'Santa Maria alle Scotte', Siena, Italy
| | - Paolo Toti
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Policlinico 'Santa Maria alle Scotte', Siena, Italy
| | - Elena Gusson
- Unit of Ophthalmology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gaia Roversi
- Department of Medicine and Surgery, University Milan-Bicocca; Ospedale San Gerardo, ASST Monza, Monza, Italy
| | | | | | - Maria Antonietta Mencarelli
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy. .,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - Francesca Ariani
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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10
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Miotto S, Zemella N, Gusson E, Panozzo G, Saviano S, Scarpa G, Boschi G, Piermarocchi S. Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article. J Ocul Pharmacol Ther 2017; 34:298-308. [PMID: 29148864 PMCID: PMC5899278 DOI: 10.1089/jop.2017.0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.
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Affiliation(s)
- Stefania Miotto
- 1 Department of Ophthalmology, Camposampiero Hospital, ULSS 6 Euganea , Padua, Italy
| | - Nicola Zemella
- 2 Department of Ophthalmology, Mestre Hospital, ULSS 3 Serenissima , Venice, Italy
| | - Elena Gusson
- 3 Department of Ophthalmology, University of Verona , Verona, Italy
| | - Giacomo Panozzo
- 4 Department of Ophthalmology, Bussolengo Hospital, ULSS 9 Scaligera , Verona, Italy
| | - Sandro Saviano
- 5 Department of Ophthalmology, University of Trieste , Trieste, Italy
| | - Giuseppe Scarpa
- 6 Department of Ophthalmology, Ca Foncello Hospital, ULSS 2 Marca Trevigiana , Treviso, Italy
| | - Giorgio Boschi
- 6 Department of Ophthalmology, Ca Foncello Hospital, ULSS 2 Marca Trevigiana , Treviso, Italy
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11
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Graziano C, Gusson E, Severi G, Isidori F, Wischmeijer A, Brugnara M, Seri M, Rossi C. A de novo PUF60 mutation in a child with a syndromic form of coloboma and persistent fetal vasculature. Ophthalmic Genet 2017; 38:590-592. [PMID: 28471317 DOI: 10.1080/13816810.2017.1318927] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Claudio Graziano
- a Medical Genetics Unit , Policlinico S. Orsola-Malpighi , Bologna , Italy
| | - Elena Gusson
- b University Eye Clinic, Pediatric Ophtalmology Service, Department of Neurosciences , Biomedicine and Movement, University of Verona , Verona , Italy
| | - Giulia Severi
- a Medical Genetics Unit , Policlinico S. Orsola-Malpighi , Bologna , Italy
| | - Federica Isidori
- a Medical Genetics Unit , Policlinico S. Orsola-Malpighi , Bologna , Italy
| | - Anita Wischmeijer
- c Clinical Genetics Service, Department of Pediatrics , Regional Hospital of South Tyrol , Bolzano , Italy
| | - Milena Brugnara
- d Department of Pediatrics , University of Verona , Verona , Italy
| | - Marco Seri
- a Medical Genetics Unit , Policlinico S. Orsola-Malpighi , Bologna , Italy
| | - Cesare Rossi
- a Medical Genetics Unit , Policlinico S. Orsola-Malpighi , Bologna , Italy
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12
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Masson R, Piretti E, Pellegrin S, Gusson E, Poretti A, Valente EM, Cantalupo G. Early-onset head titubation in a child with Poretti-Boltshauser syndrome. Neurology 2017; 88:1478-1479. [PMID: 28283601 DOI: 10.1212/wnl.0000000000003823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/20/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Riccardo Masson
- From the University of Verona (R.M., E.P., S.P., G.C.); Verona Hospital (E.G.), Italy; Johns Hopkins University (A.P.), Baltimore, MD; IRCCS Santa Lucia Foundation (E.M.V.), Rome; and Department of Molecular Medicine (E.M.V.), University of Pavia, Pavia, Italy
| | - Elena Piretti
- From the University of Verona (R.M., E.P., S.P., G.C.); Verona Hospital (E.G.), Italy; Johns Hopkins University (A.P.), Baltimore, MD; IRCCS Santa Lucia Foundation (E.M.V.), Rome; and Department of Molecular Medicine (E.M.V.), University of Pavia, Pavia, Italy
| | - Serena Pellegrin
- From the University of Verona (R.M., E.P., S.P., G.C.); Verona Hospital (E.G.), Italy; Johns Hopkins University (A.P.), Baltimore, MD; IRCCS Santa Lucia Foundation (E.M.V.), Rome; and Department of Molecular Medicine (E.M.V.), University of Pavia, Pavia, Italy
| | - Elena Gusson
- From the University of Verona (R.M., E.P., S.P., G.C.); Verona Hospital (E.G.), Italy; Johns Hopkins University (A.P.), Baltimore, MD; IRCCS Santa Lucia Foundation (E.M.V.), Rome; and Department of Molecular Medicine (E.M.V.), University of Pavia, Pavia, Italy
| | - Andrea Poretti
- From the University of Verona (R.M., E.P., S.P., G.C.); Verona Hospital (E.G.), Italy; Johns Hopkins University (A.P.), Baltimore, MD; IRCCS Santa Lucia Foundation (E.M.V.), Rome; and Department of Molecular Medicine (E.M.V.), University of Pavia, Pavia, Italy
| | - Enza Maria Valente
- From the University of Verona (R.M., E.P., S.P., G.C.); Verona Hospital (E.G.), Italy; Johns Hopkins University (A.P.), Baltimore, MD; IRCCS Santa Lucia Foundation (E.M.V.), Rome; and Department of Molecular Medicine (E.M.V.), University of Pavia, Pavia, Italy
| | - Gaetano Cantalupo
- From the University of Verona (R.M., E.P., S.P., G.C.); Verona Hospital (E.G.), Italy; Johns Hopkins University (A.P.), Baltimore, MD; IRCCS Santa Lucia Foundation (E.M.V.), Rome; and Department of Molecular Medicine (E.M.V.), University of Pavia, Pavia, Italy.
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13
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Piermarocchi S, Bini S, Martini F, Berton M, Lavini A, Gusson E, Marchini G, Padovani EM, Macor S, Pignatto S, Lanzetta P, Cattarossi L, Baraldi E, Lago P. Predictive algorithms for early detection of retinopathy of prematurity. Acta Ophthalmol 2017; 95:158-164. [PMID: 27320903 DOI: 10.1111/aos.13117] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/06/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate sensitivity, specificity and the safest cut-offs of three predictive algorithms (WINROP, ROPScore and CHOP ROP) for retinopathy of prematurity (ROP). METHODS A retrospective study was conducted in three centres from 2012 to 2014; 445 preterms with gestational age (GA) ≤ 30 weeks and/or birthweight (BW) ≤ 1500 g, and additional unstable cases, were included. No-ROP, mild and type 1 ROP were categorized. The algorithms were analysed for infants with all parameters (GA, BW, weight gain, oxygen therapy, blood transfusion) needed for calculation (399 babies). RESULTS Retinopathy of prematurity (ROP) was identified in both eyes in 116 patients (26.1%), and 44 (9.9%) had type 1 ROP. Gestational age and BW were significantly lower in ROP group compared with no-ROP subjects (GA: 26.7 ± 2.2 and 30.2 ± 1.9, respectively, p < 0.0001; BW: 839.8 ± 287.0 and 1288.1 ± 321.5 g, respectively, p = 0.0016). Customized alarms of ROPScore and CHOP ROP correctly identified all infants having any ROP or type 1 ROP. WINROP missed 19 cases of ROP, including three type 1 ROP. ROPScore and CHOP ROP provided the best performances with an area under the receiver operating characteristic curve for the detection of severe ROP of 0.93 (95% CI, 0.90-0.96, and 95% CI, 0.89-0.96, respectively), and WINROP obtained 0.83 (95% CI, 0.77-0.87). Median time from alarm to treatment was 11.1, 5.1 and 9.1 weeks, for WINROP, ROPScore and CHOP ROP, respectively. CONCLUSION ROPScore and CHOP ROP showed 100% sensitivity to identify sight-threatening ROP. Predictive algorithms are a reliable tool for early identification of infants requiring referral to an ophthalmologist, for reorganizing resources and reducing stressful procedures to preterm babies.
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Affiliation(s)
| | - Silvia Bini
- Department of Ophthalmology; University of Padova; Padova Italy
| | | | - Marianna Berton
- Department of Ophthalmology; University of Padova; Padova Italy
| | | | - Elena Gusson
- Ophthalmology Unit; Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - Giorgio Marchini
- Ophthalmology Unit; Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
| | - Ezio Maria Padovani
- Department of Pediatrics; Section of Newborn Intensive Care Unit; University Hospital of Verona; Verona Italy
| | - Sara Macor
- Department of Medical and Biological Sciences- Ophthalmology; University of Udine; Udine Italy
| | - Silvia Pignatto
- Department of Medical and Biological Sciences- Ophthalmology; University of Udine; Udine Italy
| | - Paolo Lanzetta
- Department of Medical and Biological Sciences- Ophthalmology; University of Udine; Udine Italy
| | - Luigi Cattarossi
- Department of Pediatrics- Neonatology; University of Udine; Udine Italy
| | - Eugenio Baraldi
- Department of Woman's and Child's Health; University of Padova; Padova Italy
| | - Paola Lago
- Department of Woman's and Child's Health; University of Padova; Padova Italy
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14
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Maltese P, Ziccardi L, Iarossi G, Gusson E, D’Agruma L, Marchini G, Buzzonetti L, Nicoletti A, Benedetti S, Bertelli M. Osteoporosis-pseudoglioma syndrome: Report of two cases and a manifesting carrier. Ophthalmic Genet 2017; 38:473-479. [DOI: 10.1080/13816810.2016.1253107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Paolo Maltese
- MAGI Non-Profit Human Medical Genetics Institute, Rovereto (TN), Italy
| | - Lucia Ziccardi
- Neuro-Ophthalmology Unit, “G.B. Bietti” Foundation – IRCCS, Rome, Italy
| | - Giancarlo Iarossi
- Department of Ophthalmology, Bambino Gesù IRCCS Children’s Hospital, Rome, Italy
| | - Elena Gusson
- Eye Clinic, Department of Neurosciences, Biomedicine and Movement, University and AOUI (Azienda Ospedaliera Universitaria Integrata) of Verona, Verona, Italy
| | - Leonardo D’Agruma
- Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giorgio Marchini
- Eye Clinic, Department of Neurosciences, Biomedicine and Movement, University and AOUI (Azienda Ospedaliera Universitaria Integrata) of Verona, Verona, Italy
| | - Luca Buzzonetti
- Department of Ophthalmology, Bambino Gesù IRCCS Children’s Hospital, Rome, Italy
| | - Annalisa Nicoletti
- MAGI Non-Profit Human Medical Genetics Institute, Rovereto (TN), Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Sabrina Benedetti
- MAGI Non-Profit Human Medical Genetics Institute, Rovereto (TN), Italy
| | - Matteo Bertelli
- MAGI Non-Profit Human Medical Genetics Institute, Rovereto (TN), Italy
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15
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Parolini B, Panozzo G, Gusson E, Pinackatt S, Bertoldo G, Rottini S, Pignatto S. Diode laser, vitrectomy and intravitreal triamcinolone. A comparative study for the treatment of diffuse non tractional diabetic macular edema. Semin Ophthalmol 2009; 19:1-12. [PMID: 15658006 DOI: 10.1080/08820530490519925] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the effectiveness and safety of diode laser, pars plana vitrectomy (PPV) with gas tamponade, and intravitreal triamcinolone (IVT) as possible treatments for diffuse diabetic macular edema (dDME). To determine whether the new macular edema Classification previously proposed by some of the authors may help as a guide in the choice of treatment. METHODS A retrospective, comparative study of 169 eyes with dDME that underwent treatment. The eyes divided into 3 groups: in the PPV Group, 59 eyes received PPV with gas tamponade; in the DIODE Group, 53 eyes received a laser grid; in the IVT Group, 57 eyes received an intravitreal injection of 4 mg of triamcinolone acetonide. The follow up ranged from 6 to 24 months. The eyes were classified according to the new DME Classification based on OCT. MAIN OUTCOMES Change in foveal thickness as determined by Optical Coherence Tomography (OCT); change in visual acuity; intra and postoperative complications. RESULTS Mean visual acuity (VA) improved at 3 months with every treatment. At one year only eyes which underwent PPV still had better VA than the pre-op value, while eyes which underwent IVT and laser treatment showed regression. PPV show the greater percentage of eyes which gain 3 or more lines of VA at one year (17%). Mean foveal thickness improved at 3 months with every treatment. Only the eyes into the PPV Group showed relatively low foveal thickness at one year. Better final VA and foveal thickness were obtained if preop VA is > or = 0.3 and if earlier stages of DME were treated according to the new DME Classification. PPV was the treatment which offered the most stable results with at one year or longer. Similar results were observed into the PPV Groups as a whole and into a subgroup of eyes with preoperative PVD. No complications were encountered with laser diode treatment. Long term complications into the IVT Group were elevated IOP (8%), retinal detachment (3.5%) and posterior cataract (15%). Long term complications into the PPV Group were retinal detachment (3.4%) and cataract (90%). CONCLUSIONS Diode laser, PPV with gas tamponade and IVT are effective alternative treatments to decrease foveal thickness and improve visual acuity in eyes with DME. However while the results of PPV are stable in the long term follow-up, diode laser and IVT do not offer stable results. Complications may be severe with PPV and IVT. It is necessary to carefully select cases which would benefit from these types of treatments. The authors think that the OCT Classification may serve as a guide for the choice of treatment.
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Affiliation(s)
- B Parolini
- Teclo Vitreo-Retinal Service, Verona, Italy
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16
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Zoppini G, Verlato G, Targher G, Casati S, Gusson E, Biasi V, Perrone F, Bonora E, Muggeo M. Is fasting glucose variability a risk factor for retinopathy in people with type 2 diabetes? Nutr Metab Cardiovasc Dis 2009; 19:334-339. [PMID: 18571393 DOI: 10.1016/j.numecd.2008.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 01/25/2008] [Accepted: 02/26/2008] [Indexed: 11/23/2022]
Abstract
AIMS Fasting plasma glucose variability strongly predicts the incidence of cardiovascular events in type 2 diabetic patients. We prospectively assessed whether fasting plasma glucose variability predicts the development/progression of retinopathy in a large cohort of type 2 diabetic outpatients. METHODS In the period 1996-1999, 1019 type 2 diabetic participants (aged 69+/-11 years) in the Verona Diabetes Study underwent at least 3 fasting plasma glucose (FPG) determinations and an eye examination by retinography. Of these, 746 underwent a 2nd eye examination in the period 2000-2004, while 273 did not (102 patients had died before undergoing the 2nd eye examination). For each patient, the mean (M-FPG) and the coefficient of variation of FPG (CV-FPG) were computed. RESULTS By the 2nd eye examination, 124 patients had either developed new retinopathy (79 patients) or progressed to a more severe degree of retinopathy (45 patients). In a multivariable logistic regression analysis, the development/progression of retinopathy was independently predicted by average glycaemia over time, expressed as glycated haemoglobin (odds ratio [OR] 1.82, 95%CI 1.40-2.38 for 1 SD increase) or M-FPG (OR 1.88, 1.47-2.41), but not by CV-FPG. Among other independent variables, HDL-cholesterol was inversely associated with the development/progression of retinopathy. CONCLUSIONS These results suggest that in elderly type 2 diabetic patients the magnitude of hyperglycaemia, but not fasting plasma glucose variability, strongly predicts the development/progression of diabetic retinopathy independently of other known risk factors.
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Affiliation(s)
- G Zoppini
- Unit of Endocrinology and Metabolic Diseases, University of Verona, Verona Italy
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Abstract
PURPOSE More than ten years after ETDRS, Optical Coherence Tomography (OCT) greatly enhanced our ability to detect macular thickening and has brought new insights on the morphology of edema and on the presence of vitreal traction. In this study we propose a new classification of macular edema based on OCT findings to better catalogue and follow this complex clinical entity. METHODS Since January 2000 we analysed with OCT 2 (Zeiss Inc.) more than one thousand and two hundred eyes with DME. RESULTS The classification takes into account five parameters: retinal thickness, diffusion, volume, morphology and presence of vitreous traction. Standard figures and numerical values for every parameter are given. CONCLUSION Although ETDRS guidelines for laser treatment of DME still remain the only proven therapy for this condition, many other strategies are now on trial, and the vast majority of authors use OCT as the best indicator of therapeutic benefit. The amount of information given by OCT demonstrates that macular edema is a complex clinical entity with various morphology and gravity, and disclaimed the limitations of a simple "clinical" definition. As in many other examples such as macular holes and choroidal neovascularization, a uniform and precise definition of macular edema would increase the possibility to compare and judge the result of different therapeutic strategies. Aim of this classification is to implement the ETDRS clinical definition of DME with the precise and useful data given by OCT to better diagnose, catalogue and follow macular edema.
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Affiliation(s)
- G Panozzo
- Teclo, Vitreoretinal Service, Verona, Italy.
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Abstract
The aim is to present, along with a brief literature review, the results of OCT scan in eyes with diabetic macular edema (DME), as well as examples of the utility of OCT for different therapeutic approaches. One-hundred and thirty-six eyes with diabetic retinopathy were analyzed with OCT to explore the different patterns of DME. Some eyes with DME were studied with OCT pre and postoperatively to determine the efficacy of photocoagulation and vitrectomy to restore a normal macular profile. Sixty-eight eyes with a central foveal thickness of 200 mu or more were considered "edematous". Three different patterns of DME were recognized and analyzed: macular thickening, cystoid macular edema and shallow retinal detachment. The change in macular profile and internal retinal structure after laser or surgical treatment are well visible with OCT. OCT contributes in understanding the anatomy of DME and the intraretinal damage and seems to be the technique of choice for the follow-up of macular edema. We think that this tool should always be used in monitoring the effect of therapies in future studies.
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