Efficacy of a gas permeable contact lens to induce peripheral myopic defocus

Purpose. The purpose of this work was to evaluate the potential of a novel custom-designed rigid gas permeable (RGP) contact lens to modify the relative peripheral refractive error in a sample of myopic patients. Methods. Fifty-two right eyes of 52 myopic patients (mean [TSD] age, 21 [T2] years) with spherical refractive errors ranging from j0.75 to j8.00 diopters (D) and refractive astigmatism of 1.00 D or less were fitted with a novel experimental RGP (ExpRGP) lens designed to create myopic defocus in the peripheral retina. A standard RGP (StdRGP) lens was used as a control in the same eye. The relative peripheral refractive error was measured without the lens and with each of two lenses (StdRGP and ExpRGP) using an open-field autorefractometer from 30 degrees nasal to 30 degrees temporal, in 5-degree steps. The effectiveness of the lens design was evaluated as the amount of relative peripheral refractive error difference induced by the ExpRGP compared with no lens and with StdRGP conditions at 30 degrees in the nasal and temporal (averaged) peripheral visual fields. Results. Experimental RGP lens induced a significant change in relative peripheral refractive error compared with the nolens condition (baseline), beyond the 10 degrees of eccentricity to the nasal and temporal side of the visual field (p G 0.05). The maximum effect was achieved at 30 degrees. Wearing the ExpRGP lens, 60% of the eyes had peripheral myopia exceeding j1.00 D, whereas none of the eyes presented with this feature at baseline. There was no significant correlation (r = 0.04; p = 0.756) between the degree of myopia induced at 30 degrees of eccentricity of the visual field with the ExpRGP lens and the baseline refractive error. Conclusions. Custom-designed RGP contact lenses can generate a significant degree of relative peripheral myopia in myopic patients regardless of their baselin spherical equivalent refractive error.

Changes in peripheral refractive profile after orthokeratology for different degrees of myopia

Purpose: The purpose of this study was to evaluate the effect of orthokeratology for different degrees of myopia correction in the relative location of tangential (FT) and sagittal (FS) power errors across the central 70 of the visual field in the horizontal meridian. Methods: Thirty-four right eyes of 34 patients with a mean age of 25.2 ± 6.4 years were fitted with Paragon CRT (Mesa, AZ) rigid gas permeable contact lenses to treat myopia (2.15 ± 1.26D, range: 0.88 to 5.25D). Axial and peripheral refraction were measured along the central 70 of the horizontal visual field with the Grand Seiko WAM5500 open-field auto-refractor. Spherical equivalent (M), as well as tangential (FT) and sagittal power errors (FS) were obtained. Analysis was stratified in three groups according to baseline spherical equivalent: Group 1 [MBaseline = 0.88 to 1.50D; n = 11], Group 2 [MBaseline = 1.51 to 2.49D; n = 11], and Group 3 [MBaseline = 2.50 to 5.25D; n = 12]. Results: Spherical equivalent was significantly more myopic after treatment beyond the central 40 of the visual field (p50.001). FT became significantly more myopic for all groups in the nasal and temporal retina with 25 (p 0.017), 30 (p 0.007) and 35 (p 0.004) of eye rotation. Myopic change in FS was less consistent, achieving only statistical significance for all groups at 35 in the nasal and temporal retina (p 0.045). Conclusions: Orthokeratology changes significantly FT in the myopic direction beyond the central 40 of the visual field for all degrees of myopia. Changes induced by orthokeratology in relative peripheral M, FT and FS with 35 of eye rotation were significantly correlated with axial myopia at baseline. Keywords: Field

Alterações na biometria e na refração durante o ano letivo II

Dissertação de mestrado em Optometria Avançada

Encontros e desencontros da educação de adultos numa associação de teatro amador

Dissertação de mestrado em Ciências da Educação (área de especialização em Educação de Adultos)

Effect of hormonal changes on corneal biomechanical properties and anterior segment ocular perameters

Dissertação de mestrado em Optometria Avançada

Retinal Detachment in Preeclampsia

Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. The majority of patients have complete recovery of vision with clinical management, and surgery is unnecessary. This is a case report of a 27 year old patient who developed the severe form of preeclampsia on her first pregnancy. She had progressive blurred vision, until she could see only shadows. Ophthalmic examination diagnosed spread and bilateral retinal detachment. With blood pressure control at postpartum, the patient had her retina reattached, and recovery of vision.

Vitamina D y homeostasis del calcio extra e intracelular

La vitamina D es uno de los principales reguladores de la homeostasis del calcio extracelular. El intestino es un importante "blanco" de acción de la vitamina desencadenándose allí un aumento de la absorción del catión que permite mantener la calcemia en los valores adecuados. El presente proyecto esta dirigido a conocer el papel del glutatión intestinal y de las oxidorreductasas del ciclo de Krebs durante ese proceso de incremento del transporte de calcio estimulado por la vitamina D. Para ello se estudiarán la absorción intestinal de Ca, la captación de Ca en vesículas de membrana basolateral del enterocito y actividades de enzimas relacionadas a la homeostasis del Ca (Ca-ATPasa, fostotasa alcalina) en animales raquíticos y tratados con vitamina D. Se usará DL-butionina-S, R-sulfoximina para disminuir el contenido intestinal de glutatión. Se emplearán metabolitos derivados de la vitamina D "in vivo" e "in vitro" e inhibidores de mecanismos de señales hormonales para dilucidar las vías usadas por la vitamina D para incrementar las actividades de la oxidoreductasas ligadas a NAD del ciclo de Krebs. La relación de la vitamina D con la homeostasis intracelular de CA se estudiará en el sistema visual del pollo desde retina (target de vitamina D) a corteza visual. Para ello se determinará la distribución de proteínas involucradas en el manejo del Ca intracelular (Ca-ATPasa de membrana plasmática, calbindina D28k y receptor de vitamina D o VDR) como los niveles de ARNm de las mismas en los diferentes niveles de organización del sistema visual.

Análisis de la aplicabilidad de la técnica de disco-menisco rotante en el estudio de reacciones de transferencia de carga con reacciones químicas acopladas

El electrodo de disco rotante es una de las técnicas más útiles y más ampliamente empleada en el estudio de la cinética de reacciones de electrodo. Sin embargo, la construcción de electrodos de disco rotante convencionales, que involucra la inclusión del material de electrodo de una vaina de material aislante, no siempre es posible o conveniente. Por ejemplo, cuando es necesario utilizar materiales monocristalinos, se presentan numerosas dificultades debidas principalmente a su extrema fragilidad. (...) Objetivos generales * Se intenta establecer la aplicabilidad de la técnica del electrodo de disco-menisco rotante en el estudio de la cinética de reacciones de transferencia de carga con reacciones químicas acopladas. En particular, se estudiarán los mecanismos de reacción que involucran procesos catalíticos y ECE (electroquímico-químico-electroquímico). Objetivos específicos * Determinar las desviaciones que produce la presencia del menisco de electrolito en las curvas experimentales de corriente límite vs. raíz cuadrada de la velocidad de rotación, para cada uno de los dos mecanismos mencionados a partir de la comparación de datos obtenidos para meniscos de diferentes alturas y sobre electrodos convencionales. * Simular la respuesta electroquímica introduciendo los términos de corrección adecuados para tener en cuenta las variaciones en las condiciones hidrodinámicas que introduce la modificación de la geometría del sistema. * Establecer la metodología apropiada para el tratamiento de los datos experimentales a fin de posibilitar la obtención de los parámetros cinéticos de las reacciones. El plan de trabajo que se propone permitirá profundizar la caracterización del comportamiento hidrodinámico del disco-menisco rotante, incrementando las posibilidades de la utilización de esta técnica que es sumamente adecuada para estudios sobre electrodos monocristalinos, siendo estos últimos la clave para dilucidar la influencia que la estructura superficial del electrodo tiene sobre la cinética y los mecanismos de reacciones de transferencia de carga de interés práctico, como el desprendimiento de hidrógeno y la reducción de oxígeno. Las ventajas asociadas a la omisión de la vaina de material aislante posibilitan, a su vez, que el uso del DMR pueda extenderse a otros tipos de sistemas en los cuales el uso de electrodos rotantes convencionales presenta dificultades.

Estudios estructurales y funcionales de la glucogenina

Glucogenina es el nombre asignado a la proteína de 38 kDa que se encuentra unida covalentemente al glucógeno y que inicia la biosíntesis de navo del polisacárido. El aporte del grupo en el tema comprende: la identificación en retina bovina de fracciones de a-1,4- glucanoproteína distinguibles por su solubilidad e insolubilidad en ácido tricloroacético; la demostración de que el glucógeno posee proteína covalentemente unida al glucano; la identificación del arninoácido involucrado en la unión proteína-polisacárido; la caracterización de la fracción de glucógeno insoluble en ácido tricloroacético corno proteoglucógeno; la descripción de proteoglucógeno asociado a membranas microsomales en retina; la demostración de que en organismos primitivos como Neuraspara crassa y Escherichia coli el glucógeno se halla covalentemente unido a una proteína de 31 kDa que llamamos M-glucogenina; que no es reconocida por anticuerpo policlonal anti-glucogenina de 38 kDa de mamífero, y cuya secuencia de diez aminoácidos del extremo N-terminal es distinta a la de la glucogenina de 38 kDa. El objetivo general está dirigido a interrogantes acerca de aspectos estructurales funcionales de la glucogenia, la proteína de 38 kDa que se encuentra unida covalentemente al glucógeno y que inicia la biosíntesis de novo del polisacárido. Dentro del aspecto funcional la pregunta fundamental es si la vía que se inicia con la glucogenina y termina con proteoglucógeno constituye la única alternativa para la biosíntesis del glucógeno celular. Con respecto al aspecto estructural, el mecanismo involucrado en su actividad autoglucosiltransferasa acapara la atención, tanto en lo referente a la identificación del sitio o sitios activos responsable(s) de la formación de uniones glucosil-a-l,4-glucosa como en lo referente a la causa determinante de la incorporación de no mas de ocho a once glucosas, formando un oligoglucano lineal unido al residuo tirosina 194 que actuará como primer de la glucógeno sintetasa.

Oftalmoscopia direta versus retinografia da detecção de retinopatia hipertensiva: estudo comparativo

FUNDAMENTO: Detecção de retinopatia hipertensiva (RH) com oftalmoscopia direta é parte da avaliação de pacientes hipertensos. Sua utilização tem sido questionada devido a sua subjetividade e alta variabilidade interobservador. OBJETIVO: Determinar a prevalência de RH em hipertensos em acompanhamento ambulatorial, a concordância do diagnóstico com a oftalmoscopia e a retinografia e correlacioná-la com outras lesões de órgão-alvo. MÉTODOS: Estudo observacional, analítico e transversal, com a avaliação de 99 pacientes. Oftalmoscopia direta e retinografia realizadas por dois examinadores de forma independente. Classificação da RH, conforme descrito por Keith, Wagener e Barker. RESULTADOS: A prevalência da RH de qualquer grau foi maior que 90,0%, por ambos os métodos. Na oftalmoscopia, observamos alterações de grau I em 51,0%, e de grau II em 43,0%, com um paciente apresentando RH de grau III. Na retinografia, observamos alterações de grau I em 42,0%, e grau II em 52,0%, sendo detectados três pacientes com RH de grau III, dois dos quais não detectados pela oftalmoscopia. A concordância entre os observadores para a presença e gravidade de RH foi fraca com oftalmoscopia direta e boa com a retinografia. Disfunção renal, alterações eletrocardiográficas (hipertrofia ventricular, onda q patológica, alteração de repolarização), e história de acidente vascular cerebral foram observadas em 70,0%, 27,0% e 10,0% dos pacientes, respectivamente. Não houve relação entre a gravidade da RH e as demais lesões de órgão-alvo. CONCLUSÃO: Foi observada uma alta prevalência de RH por ambos os métodos. A concordância entre os observadores para o diagnóstico e determinação da gravidade da RH foi melhor com a retinografia. Não houve, na amostra estudada, associação da gravidade da RH com outras lesões de órgão-alvo.

Empleo de óptica adaptativa y fluorescencia en un oftalmoscopio laser de barrido para el registro de células

Estudio elaborado a partir de una estancia en la Universidad de Rochester, Estados Unidos, de octubre del 2006 a enero del 2007. La estancia realizada en la Universidad de Rochester estuvo orientada al aprendizaje en profundidad del oftalmoscopio láser de barrido. El oftalmoscopio láser de barrido emplea una técnica confocal con la finalidad de visualizar diferentes estructuras retinianas en seres vivos. El instrumento diseñado y desarrollado en el Centro de Ciencias de la Visión incorpora un sistema de óptica adaptativa y fluorescencia. La óptica adaptativa aplicada en este oftalmoscopio tiene como objetivo corregir las aberraciones existentes en el ojo y así permitir observar detalles de la retina que de otra forma se verían emborronados. De esta forma se consigue alcanzar valores de resolución muy cercanos a los impuestos por difracción. Por otro lado el uso de fluorescencia tiene por objetivo el permitir la visualización de células y estructuras que, de no ser teñidas, son transparentes a la luz y visible. Esta técnica se ha estado utilizando principalmente en primates y ratas, aunque actualmente también se están llevando a cabo medidas de células de epitelio pigmentario en seres humanos ya que el pigmento contenido en estas células permite la aplicación de la fluorescencia sin necesidad de utilizar tinción.

Stem Cell Transplantation for Retinal Degenerations

Within the last few years, several reports have revealed that cell transplantation can be an effective way to replace lost neurons in the central nervous system (CNS) of patients affected with neurodegenerative diseases. Concerning the retina, the concept that newborn photoreceptors can integrate the retina and restore some visual functions was univocally demonstrated recently in the mouse eye (MacLaren et al. 2006) and remains to be achieved in human. These results pave the way to a standard approach in regenerative medicine aiming to replace lost photoreceptors. With the discovery of stem cells a great hope has appeared towards elaborating protocols to generate adequate cells to restore visual function in different retinal degeneration processes. Retinal stem cells (RSCs) are good candidates to repair the retina and are present throughout the retina development, including adulthood. However, neonatal mouse RSCs derived from the radial glia population have a different potential to proliferate and differentiate in comparison to adult RSCs. Moreover, we observed that adult mouse RSCs, depending on the culture conditions, have a marked tendency to transform, whereas neonatal RSCs show subtle chromosome abnormalities only after extensive expansion. These characteristics should help to identify the optimal cell source and culture conditions for cell transplantation studies. These results will be discussed in light of other studies using RSCs as well as embryonic stem cells. Another important factor to consider is the host environment, which plays a crucial role for cell integration and which was poorly studied in the normal and the diseased retina. Nonetheless, important results were recently generated to reconsider cell transplantation strategy. Perspectives to enhance cell integration by manipulating the environment will also be presented.

MFGE8 does not influence chorio-retinal homeostasis or choroidal neovascularization in vivo.

PURPOSE: Milk fat globule-epidermal growth factor-factor VIII (MFGE8) is necessary for diurnal outer segment phagocytosis and promotes VEGF-dependent neovascularization. The prevalence of two single nucleotide polymorphisms (SNP) in MFGE8 was studied in two exsudative or "wet" Age-related Macular Degeneration (AMD) groups and two corresponding control groups. We studied the effect of MFGE8 deficiency on retinal homeostasis with age and on choroidal neovascularization (CNV) in mice. METHODS: The distribution of the SNP (rs4945 and rs1878326) of MFGE8 was analyzed in two groups of patients with "wet" AMD and their age-matched controls from Germany and France. MFGE8-expressing cells were identified in Mfge8(+/-) mice expressing ß-galactosidase. Aged Mfge8(+/-) and Mfge8(-/-) mice were studied by funduscopy, histology, electron microscopy, scanning electron microscopy of vascular corrosion casts of the choroid, and after laser-induced CNV. RESULTS: rs1878326 was associated with AMD in the French and German group. The Mfge8 promoter is highly active in photoreceptors but not in retinal pigment epithelium cells. Mfge8(-/-) mice did not differ from controls in terms of fundus appearance, photoreceptor cell layers, choroidal architecture or laser-induced CNV. In contrast, the Bruch's membrane (BM) was slightly but significantly thicker in Mfge8(-/-) mice as compared to controls. CONCLUSIONS: Despite a reproducible minor increase of rs1878326 in AMD patients and a very modest increase in BM in Mfge8(-/-) mice, our data suggests that MFGE8 dysfunction does not play a critical role in the pathogenesis of AMD.

Pharmacokinetics and posterior segment biodistribution of ESBA105, an anti-TNF-alpha single-chain antibody, upon topical administration to the rabbit eye.

PURPOSE: The purpose of this study was to characterize local distribution and systemic absorption of the tumor necrosis factor (TNF)-alpha inhibitory single-chain antibody fragment (scFv) ESBA105 following topical administration to the eye in vivo. METHODS: Rabbits received ESBA105 as topical eye drops in two dosing regimens. First, pharmacokinetics after the topical route of administration was compared to the intravenous (i.v.) route by means of applying the identical cumulative daily dose of ESBA105. In a second study rabbits received five eye drops daily for six consecutive days in a lower frequency topical dosing regimen. Kinetics and biodistribution of ESBA105 in ocular tissues and fluids as well as in sera were determined in all animals. RESULTS: After topical administration to the eye, ESBA105 quickly reaches therapeutic concentrations in all ocular compartments. Systemic exposure after topical administration is 25,000-fold lower than exposure after i.v. injection of the identical cumulative daily dose. ESBA105 levels in vitreous humor and neuroretina are significantly higher on topical administration than after i.v. injection. Absolute and relative intraocular biodistribution of ESBA105 is different with topical and systemic delivery routes. Compared to its terminal half-life in circulation (7 hours), the vitreal half-life of ESBA105 is significantly enhanced (16-24 hours). CONCLUSIONS: On topical administration, ESBA105 is efficiently absorbed and distributed to all compartments of the eye, whereby systemic drug exposure is very low. Based on its unique intraocular biodistribution and pharmacokinetics and the absolute intraocular levels reached, topical ESBA105 appears highly attractive for treatment of various ophthalmological disorders.

Severe occlusive vasculitis as a complication of cat scratch disease

BACKGROUND: The purpose of this communication is to report a severe occlusive vasculitis as a complication of cat scratch. HISTORY AND SIGNS: A 34-year-old Hispanic woman presented with a sudden visual loss of the right eye associated with shivers, high fever and arthritis which developed 2 months after a cat's bite. Fundus examination showed papillitis and a palor of the paramacular zone of the retina. Fluorescein angiography revealed multiple arterial and venous vasculitic occlusions. THERAPY AND OUTCOME: Auto-immune disease and endocarditis were ruled out by an extensive medical work-up.The diagnosis of Bartonella henselae was confirmed by a positive serology. A systemic antibiotherapy with azithromycin, doxycyclin, rifampicin and steroid therapy resulted in a good clinical response, including a rapid visual recovery with a visual acuity of 20/20 and no relapse of the disease at 6 months follow-up. CONCLUSIONS: Ocular complications associated with cat scratch disease may include vasculitis with both arterial and venous occlusions causing severe visual loss.