Visual hallucinations are a common and often distressing consequence of vision loss, particularly in age-related macular degeneration. Charles Bonnet Syndrome (CBS) is defined by the triad of complex visual hallucinations, ocular pathology causing visual deterioration and preserved cognitive status. So far, although this condition is frequent, no established treatment for CBS has been stated. We report here the case of a 78-year-old woman, who came in our hospital because of a 4-week long mild depressive symptomatology. For 1 year she experienced daily sudden, unexpected, vivid and elaborate hallucinations. Insight was completely present, so the patient stated that the hallucinations were unreal and that the faces, geometrical figures and animals she saw every day were possibly due to her vision loss. The Mini Mental State Examination, digit span and verbal fluency were administered and no cognitive impairment was reported. The visual acuity was hand motion. After 4 days of treatment with venlafaxine the hallucinations completely disappeared. This is the first case to show that selective serotonin (and noradrenalin) reuptake inhibitors may be an effective and well-tolerated treatment for visual hallucinations associated with vision loss, and it adds to evidence implicating serotonergic pathways in the pathogenesis of visual hallucinations.
Aim: To investigate the effect of timolol and latanoprost on the extracellular matrix organisation, inflammatory infiltration, and expression of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in the human conjunctiva. Methods: Conjunctival biopsies were obtained from the inferior fornix during routine cataract surgery from 20 patients with primary open-angle glaucoma, who had received a monotherapy either with timolol or latanoprost, and from 10 non-glaucomatous patients. Specimens were investigated by light microscopy, immunohistochemistry using antibodies against MMP-1,-3, TIMP-2,-3 and CD 68 antibodies and by quantitative transmission electron microscopy.Results: The number of collagen fibres was significantly decreased in latanoprost-treated conjunctival specimens compared with timolol-treated eyes (p,0.01) but showed no difference to controls. Amorphous material was increased in both treated groups compared with controls (p,0.001) but was less in latanoprost-treated specimens compared with timolol-treated eyes (p,0.001). Optically clear spaces, probably containing glycosaminoglycans, were significantly reduced in both treated groups-with less of a reduction in latanoprostcompared with timolol-treated eyes (p,0.001). A marked upregulation of MMP-1 and MMP-3 and moderately increased staining for TIMP-2 and TIMP-3 was found in epithelial cells and subepithelial stromal cells of latanoprost-treated eyes. A moderate infiltration with macrophages and inflammatory cells was observed in timololtreated eyes. Conclusions: Latanoprost-treated conjunctival specimens showed a decreased stromal collagen density and a less pronounced inflammatory infiltration. The upregulation of MMP-1 and MMP-3 in latanoprost-treated eyes might explain the reduced extracellular matrix accumulation in the conjunctival stroma. Therefore, latanoprost therapy might have a more favourable effect on the outcome of glaucoma filtering surgery.Antiglaucoma drug medication is the major treatment modality for glaucoma. There is increasing evidence that the long-term use of topically administered medication affects the structure and integrity of the conjunctival tissue and the ocular surface.
. Purpose: To investigate the relationship between central corneal thickness (CCT) and optic disc size in patients with primary open‐angle glaucoma (POAG) in a hospital‐based population. Methods: Data for the right eyes of 1435 White patients with POAG were included in a retrospective hospital‐based study. All eyes underwent optic nerve head imaging using Heidelberg Retina Tomograph II (HRT II; Heidelberg Engineering, Heidelberg, Germany) and CCT measurement by ultrasound corneal pachymetry. Eyes with prior intraocular or corneal surgery were excluded. Low‐quality HRT II images were also excluded. The impact of age, gender, CCT, intraocular pressure, cylindrical and spherical refractive error as independent factors on optic disc size was investigated in a multiple linear regression analysis. Results: The data for 1104 right eyes qualified for participation in the study. The median age of these patients was 65 years. The median CCT was 547 μm (25th–75th percentile 522–575 μm). The median optic disc size was 2.21 mm2 (25th–75th percentile 1.89–2.60 mm2). Multiple linear regression analysis revealed that age (p = 0.001), CCT (p = 0.001) and spherical equivalent (p = 0.049) were correlated to disc size according to the following formula: disc area = −0.004 × age − 0.001 × CCT − 0.014 × spherical equivalent +3.290. R2 of the whole model was 0.021. Univariate regression analysis between age and disc area provided R2 = 0.008 with p = 0.002. Univariate regression analysis between disc area and CCT provided R2 = 0.005 with p = 0.02. Conclusion: In this retrospective hospital‐based study we could not detect a clinically relevant correlation between optic disc size and CCT. The correlation between CCT and disc size and between age and disc size were statistically significant, but the R2 values were very low. The results of the study are biased because of its hospital‐based design, so the results of the study need to be confirmed in a large population‐based study.
Measuring the disc size by indirect ophthalmoscopy is possible. The 90D lens showed the smallest and the 78D lens the largest deviation.
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