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A comparison was done between force development in the medial and lateral rectus muscles during saccadic movements in 8 adult patients, 2 with esotropia and 6 with exotropia who underwent surgery under topical anesthesia. Five medial rectus muscles and 8 lateral rectus muscles were studied. Isometric muscle tension was recorded with a strain gauge system from the detached muscle. Patients made saccadic eye movements with the non recorded eye. In the tension signals produced by saccades, peak tension (Fp) and steady tension (Fs) were measured. The values of Fp and Fs at different amplitudes of the saccadic eye movements were compared in the lateral and the medial rectus muscles of patients with esotropia and exotropia. There were no consistent statistical differences between values of Fp and Fs obtained in the two strabismus conditions. The force development was the same in both horizontal eye muscles of patients with esotropia and exotropia.

Piera Versura, Giuseppe Giannaccare, Marco Pellegrini, Stefano Sebastiani, Emilio C Campos Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant’Orsola-Malpighi Teaching Hospital, Bologna, Italy Abstract: Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described. Keywords: neurotrophic keratitis, neurotrophic corneal ulcer, corneal nerves

Tear film is a thin layer of non-newtonian fluid covering and protecting cornea and conjunctiva epithelia. The multifaced functions of tears are reflected by their complex structure and advances in proteomics/metabolomics/lipidomics technologies have greatly deepened the knowledge of the chemical composition of tears. The purpose of this article is to survey recent advances in proteomic analysis of human tears and to summarise the most relevant proteins proposed as biomarkers in dry eye. Besides, the potential clinical application of these biomarkers is discussed.

OBJECTIVE: Progressive restrictive eso-hypotropia may occur in highly myopic eyes due to elongation of the eyeball and dislocation of the globe out of the muscle cone in the supero-temporal quadrant. Conventional recession/resection surgical procedures are not effective in this type of strabismus. We present our results with the surgical procedure described by Yokoyama in 2001 based on the principle of replacing the globe into the muscle cone by joining the lateral and superior rectus muscles combined with medial rectus recession in selected cases. MATERIALS AND METHODS: The charts of 33 consecutive patients undergone the muscle binding procedure at our institution between 2002 and 2010 were reviewed. Pre-operative coronal MR images demonstrated downward shift of the lateral rectus and inward shift of the superior rectus in the affected eyes. Fourteen patients underwent muscle binding procedure in both eyes combined with medial rectus recession in 18 eyes. The other 19 patients underwent the Yokoyama procedure in one eye. In this latter group, medial rectus recession was performed in all the eyes undergone muscle binding procedure and in 12 patients also in the other eye. The follow-up ranged from 4 months to 8 years (mean: 40 months). RESULTS: All patients resulted improved in their deviation following single surgery. Mean horizontal deviation in primary position decreased from +60 PD before surgery (range: +45/+140 PD) to +15 PD after surgery (range: -18/+ 30 PD). Mean vertical deviation in primary position improved from 15 PD (range: 5/50 PD) to 3 PD (range: 0/15 PD). CONCLUSIONS: The surgical procedure to restore the dislocated eye-ball back into the muscle cone by joining muscle bellies of the lateral rectus and superior rectus muscles is effective for high myopic eso-hypotropia, provided that shift of the lateral and superior rectus is pre-operatively demonstrated by MR or CT images.

Purpose: Simultaneous recordings of pattern electroretinograms (PERG) and visual evoked potentials (VEP) allow us to separate a macular dysfunction from a delay in neural conduction along post-retinal visual pathaways1. Our work aims to evaluate the macular function and the neural conduction along the visual pathways in amblyopic patients. Methods: 25 anisometropic amblyopic patients [mean age 7± 1.9 years; Visual Acuity (VA): 0.44± 0.27 LogMAR in amblyopic eyes (AE), 0.023± 0.067 LogMAR in sound eyes (SE)] and 25 age-similar controls (AS eyes, VA of 0.0± 0.0 LogMAR in both eyes) were enrolled. In AE, SE and AS eyes, simultaneous PERG and VEP were recorded in response to checks reversed at the rate of 2 reversals/s stimulating macular or extramacular areas (the checks edge subtended 15’ and 60’of visual arc respectively) 2. Results: Non significant differences (ANOVA, p>0.01) in PERG and 60’ VEP responses and in 60’ Retinocortical Time (RCT; difference between VEP P100 and PERG P50 implicit times) between AE, SE and AS eyes were observed. AE eyes showed a significant (p

Purpose. Systane® Lubricating Eye Drops (Alcon Forth Worth, Inc.) contains PEG 400/PG and the gelling agent hydroxypropyl-Guar (HP-Guar). Systane is designed to provide dry eye relief by means of longer retention time on the ocular surface that may promote epithelial repair. We evaluated Systane in an open trial in patients complaining of moderate dry eye symptoms. Methods. A total of 50 subjects were enrolled (age 57.6 + 15.4; 40 women, 10 men) ; inclusion criteria were based on a tear break-up time (TBUT) < 10 sec without corneal epithelial staining. Six symptoms of ocular irritation were rated on a four-point scale. Conjunctival injection was graded. Schirmer test, conjunctival imprint cytology, inflammation score given by scraping cytology, tear protein content (serum albumin exudated in tears, lysozyme, lactoferrin, lipophillin, lipocalins) were also evaluated in both eyes. Patients were instructed to instill Systane four times a day for four weeks. Satisfaction with the product was rated at the end of the study. Media of results in both eyes was considered for statistical evaluation; the Wilcoxon test for paired data was applied, p< 0,05 was considered as statistically significant. Results All patients regularly instilled Systane and completed the study; results are expressed baseline vs endpoint. Significant reduction was demonstrated for ocular irritation symptom scores (1.44 vs 0.94, p 0.0001) and exudated serum albumin in tears (0.268 + 0.035 vs 0.198 + 0.075 mg/ml, p 0,03), while improvement was shown for patient’s satisfaction score (3.41 vs 3.94, p 0.0001), TBUT (6.9 + 0.9 vs 8.5 + 1.5 sec, p 0.0001), tear lipocalins (9.4 + 2 vs 11.3 + 2.3, results in %, p 0.03). A significantly increased proportion of patients with normal conjunctival injection (10 vs 22, results in %, p 0.01) was observed after one month follow up. Tear production, conjunctival cytology dryness, conjunctival inflammation score, tear protein content showed no significant change. Conclusions. Systane proved effective in reducing the symptoms of dry eye and it was overall well accepted. This finding is likely to be related with improved stability of tear film associated to tear lipocalin increase.

Purpose: The cataract surgery consist in phacoemulsification of the lens and implant of an intraocular lens (IOL). In some cases when the capsular support is absent we must use an anterior-chamber IOL (ACIOL’s) or a posterior-chamber IOL (PCIOL’s) transclerally sutured. We studied the intraocular inflammation after secondary implant of iris-fixated ACIOL, angle-supported anterior-chamber (AC)IOL and transcleral-fixated PCIOL. Materials: We enrolled 60 patients with post-surgery aphakia, for a total of 60 eyes. Twenty patients received an ACIOL (Artisan), in twenty patients was implanted PCIOL (PC 279Y) and in the last twenty patients was implanted an (AC)IOL. Twenty patients with PCIOL in the bag were used as control group. We performed an evaluation of anterior chamber cellularity with a laser flare-cell meter (Kowa 500) 30 and 90 days after secondary implants. Results: The anterior chamber flare-cell, after 30 days, was 15,442 ± 10,435 photon/ms in ACIOL group, 22,716 ± 6,634 photon/ms in PCIOL group and 14,11 ± 7,087 photon/ms in the (AC)IOL group. (ACIOL vs PCIOL p

BACKGROUND: Human eye muscle tension has been measured directly only in detached condition. The purpose of this study is to compare force development in single, horizontal human eye muscle during saccadic eye movements, first when the muscle was still attached and later when it was detached from the globe. METHODS: Eleven horizontal muscles of eight patients were examined during surgery under topical anesthesia for concomitant strabismus. None of the muscles examined had been operated before. Isometric muscle tension was recorded with a strain gauge system, to which the muscle tendon was attached by a silk suture. The subjects made saccadic eye movements with the non-recorded eye by fixating light-emitting diodes in the center and at 10, 20, and 30 degrees horizontally to each side. Continuous and stepwise saccades were produced. In the tension signals, peak tension (Fp), steady tension (Fs), and the ratio Fp/Fs were measured. Statistical analysis was done with multivariate analysis of variance. RESULTS: The values of Fp, Fs, and Fp/Fs at different amplitudes of the saccadic eye movements were compared in the attached and the detached muscle. There were no consistent statistical differences between the values obtained in the two conditions. CONCLUSIONS: The muscle force development, measured at the tendon, was the same in muscles attached to the globe and in muscles free from the globe. Thus isometric muscle tension can be adequately recorded in muscles still attached to the globe, which increases the possibilities for studying contractile properties of various eye muscles during ophthalmic surgery procedures performed under topical anesthesia.

Purpose The pseudoexfoliation glaucoma (PEXG) is characterized by the accumulation of abnormal fibrillar materials and pigmented cells in trabecular meshwork. We evaluated if SLT is an effective method to decrease the intraocular pressure (IOP) in patient with PEXG and if it can change the MMP-3/TIMP-1 ratio. Methods We enrolled 20 patients with PEXG, for a total of 40 eyes. The patients had a bad intraocular tensional compensation under maximal medical therapy. The eyes with worst visual field were treated with trabeculectomy while the other eyes with SLT. The aqueous humor was aspirated during surgery and the concentration of MMP-3 and its inhibitor TIMP-1 was assessed. SLT was performed using 50 spots with a size of 400 µm, pulse duration of 3 ns with mean power of 0.572±0.115 mJ. One month after SLT, because the reduction of IOP wasn’t low enough (at least 20% lower than the starting IOP) the patients were treated with trabeculectomy and the MMP-3/TIMP-1 ratio was evaluated. Results At the baseline and after 15 days from SLT, the IOP resulted to be 25,8 ± 1,9 vs. 23,0 ± 1,9 mmHg (p

Valutazione dell'apporto dell'analisi della superficie oculare nella diagnosi differenziale tra patologie autoimmuni.

Objective of the present study was to evaluate the possibility of surgically eliminating of any function of the lateral rectus muscle of the affected eye in patients with Duane syndrome with globe retraction in adduction and in patients with complete 3rd cranial nerve paralysis. Surgery was based upon a technique introduced by Alan Scott zhich consists in anchoring the lateral rectus detached from the globe onto the periosteum of the lateral wall of the orbit wigh a non-absorbable 6-0 prolene suture. Two patients with complete 3rd cranial nerve paralysis and one patient with Duane syndrome type I underwent surgery with this technique. Eye position improved in the two patients with complete 3rd cranial nerve paralysis. The patient with Duane syndrome shozed disappearance of globe retraction in adduction. Additional surgery was required to correct esotropia in the patient with Duane syndrome and to improve hypotropia in one patient with 3rd cranial nerve palsy.

Trabecular meshwork (TM) cells are now considered to play an active role in the aqueous outflow mechanism, since they exihibit smooth muscle-like contractile properties. Endothelin-1 (ET-1), a potent vasoconstrictor peptide, has been proposed to play a role in the local regulation of aqueous outflow and intra-ocular pressure control. We propose an in vitro culture model as a method in the study of ET-1-induced human trabecular meshwork (HTM) cell contractility. Experiments were performed on semi-confluent HTM cells (primary cultures established from normotensive human donor eyes) at the 2nd passage with PBS as control, ET-1, sarafotoxin 6c (a selective endothelin B receptor agonist) and Y-27632 (a selective inhibitor of rho-associated kinase). The contractile status of the cells was evaluated by a morphometric analysis of the cell area, assuming that HTM cells in culture are able to reduce their area as a consequence of cytoskeletal contraction rather than regulatory volume decrease. Our data indicate that image analysis of the HTM cell area can be a reliable method in the study of TM cell contractility, since it utilizes human cells and offers versatile opportunities for the pharmacological evaluation of drugs controling HTM cell status.

Purpose: In the field of ophthalmology, vision researchers use eye tracking to study oculomotor behavior, cognitive visual function and vision deficiencies. Fusional vergence is a disjunctive movement of the eyes that is made in order to obtain single vision with two eyes. Fusional vergence disorders are often associated with the most common forms of strabismus. The aim of the study was to characterize fusional convergence response in subjects with normal binocular viewing by using an eye tracking system. Methods: Base-out horizontal prisms of 4 and 6 diopters were used to elicit fusional convergence of the right eye in 11 subjects with normal binocular vision. Eye movements were continuously recorded using the Viewpoint infrared video eye tracker (Arrington Research, Scottsdale, AZ, USA) and custom software was developed to automatically analyze off-line the saccadic response (gaze angle and angular velocity). The Fusional Convergence Amplitude (FCA) was calculated by subtracting the baseline position of the right eye (i.e. before the introduction of the prism) from the maximum saccadic excursion of the right eye during the disconjugate eye movements in the vergence phase (Figure 1.a). Results: The typical eye-movement response in subjects achieving the fusional convergence was a preliminary saccadic movement of both eyes (version phase) followed by a convergence movement with the eyes moving towards each other to achieve single vision (vergence phase) (Figure 1). Eye tracking recordings showed that 2 patients were not able to achieve fusion with neither 4 nor 6 diopters prisms. Fusion was achieved in 8 subjects when using the 4 diopters prism and only in 6 subjects when using 6 diopters prism. One patient was excluded from the analysis because the saccadic movements were highly affected by blink artifacts. The FCA varied from 2.2°±0.2 to 3.0°±0.2 when increasing prism diopters from 4 to 6 (Figure 2). Conclusions: The fusional convergence can be accurately studied and evaluated using an eye tracking system. Preliminary results on subjects with normal vision showed that when increasing the prism diopters the fusional convergence ability decreases.

Purpose: To evaluate choroidal structural changes occurring over time in geographic atrophy (GA) secondary to age-related macular degeneration using choroidal vascularity index (CVI). Methods: Enhanced-depth imaging optical coherence tomography scans of 34 patients with GA and 32 control subjects were retrospectively analyzed. Data were collected at baseline and after a mean follow-up of 18.3 ± 8.3 months. Choroidal images were binarized using the ImageJ software, and the luminal area and stromal area were segmented. Cho- roidal vascularity index was defined as the ratio of luminal area to total choroid area. Results: Patients with GA showed significantly lower values of CVI, total choroid area, luminal area, and subfoveal choroidal thickness compared to control subjects (65.83 ± 3.95 vs. 69.33 ± 3.11, P , 0.001; 0.400 ± 0.239 mm2 vs. 0.491 ± 0.132, P = 0.006; 0.263 ± 0.152 mm2 vs. 0.340 ± 0.094, P = 0.002; 185.2 ± 79.8 mm vs. 216.8 ± 58.8 mm, P = 0.036, respectively). Best-corrected visual acuity was significantly correlated only with choroidal thickness (R = 20.509; P = 0.002). During the follow-up period in patients with GA, sub- foveal choroidal thickness decreased from 185.2 ± 79.8 to 152.2 ± 73.1 (P = 0.001), stromal area increased from 0.138 ± 0.090 mm2 to 0.156 ± 0.068 (P = 0.028), and CVI decreased from 65.83 ± 3.95 to 62.24 ± 3.63 (P , 0.001). Conclusion: This study showed for the first time that CVI is reduced in patients with GA, and that this metric further worsened during the follow-up period.

Purpose: To assess eyelid metrics in the setting of chronic ocular graft versus-host disease (oGVHD), and to further correlate them with hematological and ocular characteristics. Methods: Prospective case-control study conducted at a single tertiary-referred Center. The following eyelid tests were performed in oGVHD patients and control subjects: vertical lid pull; anterior/lower distraction; lateral/medial distraction; distance between lateral canthal angle and orbital rim; margin reflex distances (MRD) 1 and 2; duration of tarsus exposure; snap back. Correlations of eyelid metrics with hematological and ocular parameters in the oGVHD group were performed. Results: Twenty-seven patients with oGVHD and 27 healthy matched subjects were finally included. Significantly higher values of vertical lid pull, anterior/lower distraction, lateral/medial distraction, and distance between lateral canthal angle and orbital rim were found in the oGVHD group compared to controls (always p < 0.02). Conversely, MRD1 was lower in oGVHD patients compared to controls (p < 0.001). Duration of tarsus exposure and snap back test were pathological in a higher percentage in oGVHD group compared to controls (respectively 66.7 and 59.3% vs 33.3 and 25.9%; p < 0.005). Vertical lid pull test was significantly higher in oGVHD patients with superior limbic keratoconjunctivitis (13.8 ± 2.4 vs 10.9 ± 2.4, p = 0.010). Ocular GVHD patients with subtarsal fibrosis had a higher percentage of pathological values for duration of tarsus exposure test (77.3 vs 20.0%; p = 0.014). Conclusions: The present study highlighted for the first time higher eyelid laxity in oGVHD patients. This intriguing association may add a further piece to the puzzle of clinical features occurring in the setting of oGVHD.

Introduction Dry eye disease is a multifactorial disease which affects the ocular surface system, and determines ocular discomfort symptoms and visual disturbance. Various types of ocular surgery, including strabismus one, represents a recognized cause for iatrogenic dry eye. However, it is not uncommon that strabismus patients, even not undergone to surgery, report symptoms of ocular discomfort and dryness. Hypothesis We hypothesize that two possible mechanisms may determine dry eye in strabismus patients by setting up a specific vicious circle: firstly, the increased exposure of the area of the bulbar conjunctiva located on the opposite side compared to the deviation may cause the thinning of the tear film lipid layer, with increased tear film instability; secondly, the dysfunctional lubricity secondary to the altered relationship between the eyelids and the deviated globe may cause blinking-related microtrauma, and thus inflammation and tear hyperosmolarity. These two entry points into the vicious circle of dry eye may determine a cascade of detrimental mechanisms, leading to further damage of the tear film, thus closing the disease circle. Discussion Strabismus patients may be affected by signs and symptoms of dry eye syndrome. The increased exposure of the bulbar conjunctival area along with the dysfunctional lubricity between the eyelids and the deviated eye could be the main underlying pathophysiological mechanisms acting as entry points into the vicious circle of dry eye disease. If our hypothesis was to be confirmed, ocular surface parameters should be routinely investigated in strabismus patients, while the use of tear substitutes with the aim of moistening and nourishing the ocular surface could help in reducing dry eye signs and symptoms.

Purpose: To measure the corneal temperature in patients with dry eye (DE) and to correlate the values with subjective discomfort symptoms. Methods: Twenty-four patients with DE (scored as DEWS severity grade 2 to 3) and 15 age-matched normal control subjects were enrolled. Subjective symptoms of discomfort were scored with an Ocular Surface Disease Index questionnaire, and a 100-mm horizontal visual analog scale (VAS) technique was used to measure symptom intensity. Schirmer I test, tear film breakup time (TFBUT), and Oxford grade scoring were performed in all subjects. Dynamic infrared noncontact thermal imaging (Tomey TG 1000) was used to measure the central corneal temperature (CCT). After training, subjects were asked to maintain their eyes forcedly open and to signal the discomfort onset time (DOT). The temperature was measured at eye opening (T 0) and every second during 10 seconds of sustained eye opening (T 10). The first discomfort sensation onset time (DOT) was also recorded. Temperature values were correlated with the clinical tests, Ocular Surface Disease Index, VAS, and DOT, and data were statistically evaluated (significance P < 0.05). Results: The corneal temperature immediately after eye opening was significantly lower in patients with DE than in controls, in correlation to the subject age, VAS, and TFBUT. A 3-phase cooling profile in patients with DE and a point of highest decrease (HD) in both groups were identified. DOT occurred earlier in patients with DE than in controls (5.9 vs. 15.9 seconds) and was strongly correlated to the VAS, TFBUT, and CCT-HD. Conclusions: Subjective sensation of discomfort occurred earlier in patients with DE than in controls, in correlation to low corneal temperatures and enhanced tear evaporation. ©

Dry eye (DE) is a multifactorial disorder of the ocular surface unit that results in eye discomfort, visual disturbance and ocular surface damage. It is one of the most common complaints in daily ophthalmic practice. The risk of DE increases with age in both sexes, while its incidence is higher among females. In addition, the condition of menopause in aging women may also contribute to DE onset or worsening as a consequence of an overall hormonal imbalance. Sex hormones play a key role in ocular surface physiology and they impact differently on ocular surface tissues. Reduced estrogen levels were historically thought to be responsible in age-related DE onset but more recent investigations have reconsidered the role of androgens that are present and exert a protective function on the ocular surface. Hormone levels themselves, withdrawal changes in hormone levels, and the changes in hormone-receptor responsiveness are all important factors but it remains to be fully elucidated how estrogen or androgen insufficiency act alone or together in a combined imbalance or interplay to raise the risk of disease. The purpose of this review is to briefly outline current scientific evidence on the influence of androgens and estrogens, on the Lachrymal and Meibomian glands and on ocular surface epithelia including conjunctival goblet cells during reproductive and menopausal periods. The role of sex steroids is also discussed in relation to the pathogenesis of different forms of DE and Sjogren's syndrome (SS). The impact of systemic hormone therapy (HT) in DE post-menopausal women still appears as a controversial issue, despite the many clinical studies. Finally, the outcomes of topical applications of steroid-based products are summarized, underlying the need for potential (tear) biomarker(s) in the rationale of DE-targeted therapy.

To date, no treatment has proven to be effective for severe ocular graft-vs-host disease (GVHD) after allogenic hematopoietic stem cell transplantation that leads to conjunctivalization and keratinization of the cornea through damage of conjunctival goblet cells and limbal epithelial stem cells (LESCs). We report the outcomes of chimerism induced by transplantation from the same living-related bone marrow donor of conjunctiva and LESCs in 4 eyes of 2 patients with severe ocular GVHD.

Stefano Sebastiani, Michela Fresina, Mauro Cellini, Emilio C Campos Department of Experimental, Diagnostic, and Specialty Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy Purpose: To evaluate early changes in multifocal electroretinogram (mfERG) and subclinical aqueous humor flare and cellularity in patients receiving hydroxychloroquine (HCQ) as treatment for rheumatoid arthritis.Methods: Ten patients receiving treatment with HCQ and no ophthalmic symptoms were enrolled. After complete ocular examination, mfERG and laser flare-cell photometry were performed. Patients were also divided into two subgroups with HCQ cumulative dose (CD) higher or lower than 500 g. Results obtained were compared with a control group of ten healthy subjects and statistical analysis was performed.Results: In patients receiving HCQ treatment, mfERG P1-wave in ring 2 showed a significant reduction in amplitude and a significant increase in latency compared to healthy control subjects, respectively resulting in 1.143 µV vs 1.316 µV (P=0.040) and 38.611 ms vs 36.334 ms (P=0.024). These changes are highly related to CD. Furthermore, when using the laser flare-cell photometry, a significant increase in aqueous humor flare and cellularity was shown in patients with CD higher than 500 g, resulting in a mean value of 14.4 ph/ms compared to 8.1 ph/ms in patients with CD lower than 500 g (P=0.0029). These reports appear highly related to CD (P=0.001). Receiver operating characteristic curve analysis showed mfERG P1-wave amplitude in ring 2 as the most sensitive value in detecting early HCQ-related retinopathy.Conclusion: MfERG was shown to be a very sensitive test in detecting early retinal toxicity and should be used for the screening of patients receiving HCQ treatment. Although less sensitive, laser flare-cell photometry can provide further information to evaluate early toxic retinal cell damage. Keywords: hydroxychloroquine, multifocal electroretinography, laser flare-cell photometry, rheumatoid arthritis

The use of blood derived eye drops for the treatment of ocular surface disorders has become increasingly popular in recent years. The mechanism of action is the stimulation of cellular proliferation and migration by supplying an active mixture of growth factors and cytokines at the ocular surface, thus mimicking the function of the lacking natural tears. Blood derived eye drops have been used in the last decades for the treatment of a variety of ocular surface diseases, including mainly dry eye disease, persistent corneal epithelial defect, corneal ulcer, ocular surface burn, recurrent corneal erosion and limbal stem-cell deficiency. Among overall blood derived eye drops, both autologous (from the patients themselves) and homologous (from donors) products exist, with different advantages and disadvantages. Autologous serum, obtained from the patient's own peripheral blood, is the first introduced and most commonly used product. Despite several randomized clinical trials showed its safety and efficacy, a recent Cochraine meta-analysis failed to show significant results due to low evidence. Homologous sources including allogeneic serum obtained from healthy donors, and umbilical cord blood serum collected at the time of delivery, are efficient alternatives, especially when autologous serum therapy is contraindicated or not appropriate. Platelet-derived eye drops are prepared and used in various but poor standardized preparations, namely platelet-rich plasma, plasma rich in growth factors, and platelet lysate. Future perspectives of blood-derived products include the introduction of tailored eye drops, screened for the proper content of growth factors and cytokines according to each patient and ocular surface disease.

PURPOSE: To assess subfoveal choroidal blood flow (ChBF) in patients with early manifest glaucoma (EMG) and to compare blood flow with functional measures of central retinal integrity, standard automated perimetry (SAP) and pattern electroretinogram (PERG). METHODS: Subfoveal ChBF was determined by confocal, real-time laser Doppler flowmetry in 24 patients with EMG [>-6 dB mean deviation (MD), age range: 29-77 years, visual acuity: 20/25-20/20] and 23 age-matched control subjects. All patients had a therapeutically (topical beta-blockers with or without prostaglandin analogues) controlled intraocular pressure (IOP < 20 mmHg). Subfoveal choroidal blood volume (ChBVol), velocity (ChBVel) and ChBF were determined as the average of three 60 second recordings. In all patients and controls, the PERG and SAP (Humphrey 30-2), following standardized protocols, were also recorded. RESULTS: In patients with EMG, reductions in average ChBVel and ChBF were roughly equal, respectively, by 30% and 33.4% (p < 0.01), when compared to control subjects, so that there was no significant difference in ChBVol between the two groups. Pattern electroretinogram amplitudes were reduced by 46% (p < 0.01) in patients compared to controls. No correlation was found between any of the ChBF parameters and PERG amplitude, or Humphrey 30-2 MD and pattern standard deviation. CONCLUSION: The results suggest a significant alteration of both ChBVel and ChBF in EMG, which does not appear to be associated with the severity of central retinal dysfunction. These findings may contribute to a better understanding of the pathophysiology of early glaucomatous damage in EMG and have implications for the treatment of this pathologic condition.