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Diabetic retinopathy is a frequently observed complication in both type 1 and type 2 diabetes, specially in patients with long term disease and poor glicemic control. Irreversible visual loss appears at the final stages of diabetic retinopathy and it is considered one of the most tragic of diabetic complications. It is also considered an important factor of morbidity and has a high economical impact once it is the leading cause of blindness. The pathophysiology of the retinal microvascular alterations is related to the chronic hyperglycemia that leads to the following circulatory disturbances: loss of vascular tonus, increase in vascular permeability, edema and exudation, with vascular obstruction and ischemia that stimulates neovascularization, which may lead to fibrous retraction and vitreous hemorrhages with retinal detachment. Recent studies have indicated that the strict glicemic and blood pressure controls are effective in reducing or blocking the progression of retinopathy. Up to now no pharmacological agents have shown to be effective in preventing or reducing neovascularization and visual loss. Presently, the most effective available treatment for proliferative retinopathy is laser photocoagulation. Further studies are needed to obtain new products and technologies that could effectively prevent or block retinopathy progression.

Objective: To examine the effect of indomethacin, a cyclooxygenase (CO) inhibitor, on laser-induced subretinal neovascularization (SRN)

Because fibronectin (FN) is known to be present in membranes in proliferative vitreoretinopathy, we sought to identify cytokines that regulate the release of FN by retinal pigment epithelial cells (RPE). Levels of FN in the supernatant of cultured human RPE cells were quantified with an ELISA, after which the cells were stimulated with human recombinant cytokines, interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF alpha), interleukin-6 (IL-6), interferon gamma (IFN-gamma), transforming growth factor beta 1 and 2 (TGF-beta), and phorbol myristate acetate (PMA). Protein kinase C (PKC) was blocked by 2 nM calphostin C or 1 mM staurosporine. RPE cells released FN into the supernatant constitutively. TGF-beta 1 and TGF-beta 2 upregulated the FN release in a dose- and time-dependent manner. The other cytokines tested were without effect. In combination, IFN-gamma and IL-1 beta reduced the effect of TGF-beta. PMA, which is a PKC activator, also increased the release of FN in a dose-dependent manner. Blocking of PKC with specific inhibitors abolished the effects of TGF-beta and PMA. The results show that TGF-beta is a potent stimulator of FN release by RPE cells, and exerts its effects via signal transduction involving PKC. Its effect is reduced by IFN-gamma.

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In this article the authors report two cases of Charles Bonnet syndrome, defined as complex visual hallucinations in patients with low vision, and the patient is aware of the unreal nature of the phenomenon. A great number of cases is misdiagnosed due to lack of direct questioning by the physician. Since the emotional distress caused by this disease, the knowledge of its symptoms is essential in the management of these patients.

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