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Retinal complications in patients with inflammatory optic neuritis (ON) are generally related to post-infectious neuroretinitis and are considered uncommon in autoimmune/demyelinating ON, whether isolated or caused by multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). More recently, however, cases with retinal complications have been reported in subjects positive for myelin oligodendrocyte glycoprotein (MOG) antibodies. We report a 53-year-old woman presenting with severe bilateral ON associated with a focal area of paracentral acute middle maculopathy (PAMM) in one eye. Visual loss recovered remarkably after high-dose intravenous corticosteroid treatment and plasmapheresis, but the PAMM lesion remained visible on both optical coherence tomography and angiography as an ischaemic lesion affecting the middle layers of the retina. The report emphasises the possible occurrence of retinal vascular complications in MOG-related optic neuritis, an important addition to the diagnosis of, and possible differentiation from, MS-related or NMOSD-related ON.

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PURPOSE: To investigate the possible beneficial effects of omega-3 polyunsaturated fatty acids (ω3-PUFAs) in ischemic retinal angiogenesis and whether AMP-activated protein kinase (AMPK) is involved. METHODS: Human retinal microvascular endothelial cells (hRMECs) were exposed to dimethyloxalylglycine (DMOG), a hypoxia-inducible factor hydroxylase inhibitor, in the presence or absence of docosahexaenoic acid (DHA) and small interfering RNA (siRNA) for AMPKα for 24 h. Ischemic factors, endothelial mesenchymal transition marker, endothelial barrier integrity, cell migration, and tube formation were evaluated. Neonatal AMPKα2-/- and control wild-type (WT) mice were submitted to an oxygen-induced retinopathy (OIR) protocol; their nursing mother mice were either fed ω3-PUFAs or not. In the end, ischemic markers and endothelial cell proliferation were evaluated in neonatal mouse retinal tissue through immunohistochemical or immunofluorescent assays among all studied groups. RESULTS: Cells exposed to DMOG displayed increased expressions of hypoxic and endothelial mesenchymal transition (vimentin) markers and barrier disarrangement of Zonula Occludens-1 compared to the control, accompanied by increased cellular migration and tube formation (p < 0.05). AMPK activity was significantly decreased. Supplementation with DHA restored the mentioned alterations compared to DMOG (p<0.05). In siRNAAMPKα-treated cells, the beneficial effects observed with DHA were abolished. DHA upregulated G-protein receptor-120 (GPR120), which promptly increased intracellular levels of calcium (p ≤ 0.001), which consequently increased Calcium/calmodulin-dependent protein kinase kinase ß expression (CaMKKß) thus phosphorylating AMPKThr172. AMPKα2-/- and wild-type (WT) OIR mice exhibited similar retinal ischemic changes, and the oral supplementation with ω3-PUFA efficiently prevented the noticed ischemic alterations only in WT mice, suggesting that AMPKα2 is pivotal in the protective effects of ω3-PUFA. CONCLUSIONS: ω3-PUFAs protect the retina from the effects of ischemic conditions, and this effect occurs via the GPR120-CaMKKß-AMPK axis. A better understanding of this mechanism might improve the control of pathological angiogenesis in retinal ischemic diseases.

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Neurovespina is a synthetic peptide modified from Occidentalin-1202, a nine amino acid residue peptide isolated from the venom of the social wasp Polybia occidentalis. Previous studies showed that this peptide has a neuroprotective effect on the central nervous system, but its action on the eye has not been explored. So, the objective of this work was to investigate the neuroprotective effect of Neurovespina on the retina and its angiogenic potential in the chicken chorioallantoic membrane (CAM). Retinal ischemia was induced in rats by acute elevation of intraocular pressure (IOP). Electroretinography (ERG) measurements, histopathological and immunohistochemical analysis, and transmission electronic microscopy (TEM) records were performed to check the neuroprotection effect of Neurovespina in the retina of the animals. The angiogenic activity of the peptide was investigated by CAM assay. The results showed that Neurovespina was able to reduce the effects induced by ischemic injury, preventing the reduction of a- and b-waves in the scotopic ERG. Histopathological and immunohistochemistry assays showed that Neurovespina, mainly at 60 µg/ml, protected all layers of the retina. The CAM assay revealed that the peptide promoted the reduction of CAM vessels. So, Neurovespina was able to protect retinal cells from ischemic insult and has an antiangiogenic effect, which can be considered as a promising neuroprotective agent for intravitreal application.

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Retinal ischemia-reperfusion (rI/R) generates an oxidative condition causing the death of neuronal cells. Epigallocatechin 3-gallate (EGCG) has antioxidant and anti-inflammatory properties. Nonetheless, its correlation with the pathway of nuclear factor erythroid 2-related factor 2/heme oxygenase-1 (Nrf2/HO-1) for the protection of the retina is unknown. We aimed to evaluate the neuroprotective efficacy of single-doses of EGCG in rI/R and its association with Nrf2/Ho-1 expression. In albino rabbits, rI/R was induced and single-doses of EGCG in saline (0-30 mg/kg) were intravenously administered to select an optimal EGCG concentration that protects from retina damage. To reach this goal, retinal structural changes, gliosis by glial fibrillary acidic protein (GFAP) immunostaining, and lipid peroxidation level by TBARS (thiobarbituric acid reactive substance) assay were determined. EGCG in a dose of 15 mg/kg (E15) presented the lowest levels of histological damage, gliosis, and oxidative stress in the studied groups. To determine the neuroprotective efficacy of E15 in a timeline (6, 24, and 48 h after rI/R), and its association with the Nrf2/HO-1 pathway, the following assays were done by immunofluorescence: apoptosis (TUNEL assay), necrosis (high-mobility group box-1; HMGB1), Nrf2, and HO-1. In addition, the Ho-1 mRNA (qPCR) and lipid peroxidation levels were evaluated. E15 showed a protective effect during the first 6 h, compared to 24 and 48 h after rI/R, as revealed by a decrease in the levels of all damage markers. Nuclear translocation Nrf2 and HO-1 staining were increased, including Ho-1 mRNA levels. In conclusion, a single dose of E15 decreases the death of neuronal cells induced by oxidative stress during the first 6 h after rI/R. This protective effect is associated with the nuclear translocation of Nrf2 and with an elevation of Ho-1 expression.

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Diffusion-weighted magnetic resonance imaging (dMRI) is widely used to infer microstructural characteristics of tissue, particularly in cerebral white matter. Histological validation of the metrics derived from dMRI methods are needed to fully characterize their ability to capture biologically-relevant histological features non-invasively. The data described here were used to correlate metrics derived from dMRI and quantitative histology in an animal model of axonal degeneration ("Histological validation of per-bundle water diffusion metrics within a region of fiber crossing following axonal degeneration" [1]). Unilateral retinal ischemia/reperfusion was induced in 10 rats, by the elevation of pressure of the anterior chamber of the eye for 90 min. Five rats were used as controls. After five weeks, injured animals were intracardially perfused to analyze the optic nerves and chiasm with dMRI and histology. This resulted in 15 brain scans, each with 80 diffusion-sensitizing gradient directions with b = 2000 and 2500 s/mm2 and 20 non-diffusion-weighted images (b = 0 s/mm2), with isometric voxel resolution of 125 µm3. Histological sections were obtained after dMRI. Optical microscopy photomicrographs of the optic nerves (stained with toluidine blue) are available, as well as their corresponding automatic segmentations of axons and myelin.

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INTRODUCCIÓN: Dentro de las vasculopatías retinianas, las oclusiones venosas de la retina (OVR) representan la segunda causa más frecuente de pérdida de visión luego de la retinopatía diabética. Se han descripto dos tipos diferentes de OVR: la oclusión de vena central de la retina (OVCR), y la oclusión de rama venosa retinal (ORVR). De acuerdo al compromiso oclusivo del lecho capilar de la retina, se las clasifica en isquémicas (o no perfundidas), y no isquémicas (perfundidas), presentando una patogénesis, diagnóstico, pronóstico y tratamiento diferente. Se ha demostrado que los niveles de factor de crecimiento vascular endotelial (VEGF) aumentan significativamente en las oclusiones venosas retinianas, lo que tiene como consecuencia una disfunción de la barrera hematorretinal y el aumento de la permeabilidad vascular, con el consecuente edema macular. La inyección intravítrea de bevacizumab, un anticuerpo monoclonal recombinante que actúa en forma directa contra cualquier forma activa de VEGF, ha demostrado ser efectiva para reducir el espesor macular y mejorar la agudeza visual en el tratamiento de OVR. OBJETIVO: Evaluar los cambios en la agudeza visual y en los espesores maculares de pacientes con oclusiones venosas retinianas tratados con inyecciones intravítreas de bevacizumab. Pacientes y métodos: Se evaluaron retrospectivamente 39 pacientes con diagnóstico de oclusión venosa retiniana (OVR) complicada de edema macular y tratados mediante inyección intravítrea de 1,25 mg/0,05 ml bevacizumab (Avastin®, Roche Diagnostic GmbH, Manheim, Alemania), con un seguimiento mínimo de 18 meses. La agudeza visual se evaluó mediante tabla de Snellen y se convirtió en unidades LogMAR. El espesor macular se evaluó mediante tomografía de coherencia óptica (OCT). Según la presentación clínica se las clasificó en: 1. Oclusión de rama (ORVR), incluyendo las oclusiones hemisféricas y 2. Oclusión de vena central (OVCR), incluyendo oclusión venosa hemicentral. A su vez, mediante angiografía fluoresceínica se las clasificó en oclusiones predominántemente isquémicas, y predominántemente no isquémicas. Las variables cuantitativas se analizaron mediante medidas de tendencia central, dispersión y forma. Los cambios en la agudeza visual se calcularon utilizando la prueba de Wilcoxon. Las diferencias entre variables continuas fueron calculadas mediante la prueba T de Student para variables paramétricas, y Mann Whitney para variables no paramétricas. RESULTADOS: La edad promedio fue de 66,8 años (DE: 13,65; rango= 31-92 años). El 55% de los casos estudiados fueron OVCR y el 37,5% ORVR. La media del total de inyecciones durante los 18 meses de seguimiento fue de 4,11±1,61 (rango= 1 a 6). La terapia con láser de rescate se realizó en 10 (25%) pacientes. Todos los pacientes que debieron ser tratados con láser tuvieron una AV inferior a 1 décima al final del seguimiento. La agudeza visual promedio al inicio del tratamiento fue de 1,092 con una desviación estándar (DE) de 0,36, con un rango de 0,10 y 1,60. Tras el inicio del tratamiento, todos los grupos de pacientes logran un incremento significativo en la AV (P= <0,0001). A los 18 meses de tratamiento la agudeza visual promedio fue de 0,739 con una DE de 0,45 con un rango de entre 0,00 y 1,50. La agudeza visual media de los pacientes con OVCR antes del tratamiento fue de 1,09 (DE: 0,35; rango= máxima 0,50 y mínima 1,60), y a los 18 meses de tratamiento de 0,87 (DE: 0,73; rango= 0,20 a 1,50). En cambio, los pacientes con ORVR antes del tratamiento presentaron una media de 1,10 (DE: 0,31; rango= máxima de 0,40 y mínima de 1,6), y luego del tratamiento una media de 0,53 (DE: 0,38; rango= máxima 0,1 y mínima 1,2). El 54,5% de los casos fue de predominio isquémico o mixtos, y el 43,5% fue a predominio edematosos al inicio del tratamiento. La agudeza visual media de los pacientes con tipo edematoso fue de 0,93 (DE: 0,34; rango= máxima 0,10 y mínima 1,40), mientras que los pacientes con patología isquémica presentaron una media de 1,25 (DE: 0,32; rango= máxima de 0,40 y mínima de 1,6). Ambos grupos respondieron en forma significativa al tratamiento (p< 0.05). Sin embargo, los pacientes con predominio edematoso lograron una mejoría mayor que aquellos con predominio isquémico. (P=0.0054) La agudeza visual media de los pacientes con predominio edematoso a los 18 meses del tratamiento fue de 0,50 (DE: 0,44; rango= máxima 0,0 y mínima 1,40), mientras que los pacientes con predominio isquémico presentaron una media de 0,97 (DE: 0,35; rango= máxima 0,20 y mínima 1,4). La media de los espesores maculares previo al inicio del tratamiento fue de 654.19 ± 272.05 micras (rango= 215 a 1497 micras), mientras que la media luego del tratamiento fue de 449 ± 247,62 micras (rango= 140 a 1005 micras) (p=0,0009). No hubo efectos colaterales ni complicaciones locales ni sistémicas atribuibles a la inyección de bevacizumab durante el seguimiento. CONCLUSIÓN: El bevacizumab fue eficaz en el tratamiento del edema macular secundario a OVR. La respuesta terapéutica fue mayor en las ORVR. En nuestra serie no hubo complicaciones oculares ni sistémicas vinculadas al tratamiento. (AU)

INTRODUCTION: Within the retinal vascular disease,retinal venous occlusion (RVO) represents the second most common cause of vision loss after diabetic retinopathy. In turn, it is estimated that the RVO affects approximately 1.6% of people worldwide. It has been described two different types of RVO: the central retinal vein occlusion (CRVO), which includes the hemicentral retinal vein occlusion (HCRVO), and the branch retinal vein occlusion (BRVO), which includes Major BRVO (occlusion of a retinal vein that drains one of the quadrants or more), Minor BRVO (occlusion of a retinal vein that drains less than a quadrant) and Hemispheric retinal vein occlusions (half or more of the retina). According to the occlusive pattern of the retinal capillary bed, this disease is classified as ischemic (or non perfused); when the areas of noncapillary perfusion, seen under fluorescein angiography, have an extension of more than 10 disc diameters; and non-ischemic (o perfused), presenting a pathogenesis, diagnosis, prognosis and different treatment. Non-ischemic form is generally more benign, with a less dramatic visual impairment, a greater chance of spontaneous recovery, a better treatment response, and generally has no risk of neovascularization. Instead; ischemic form is much more severe, causing a more dramatic visual acuity decline, with little chance of clinical improvement, an increased risk of blindness and an increased risk of neovascularization. Although the physiopathogenesis of OVR is not accurately known, it is suggested that the thickening and stiffness of arteries and arterioles caused by arteriosclerosis leads to compression of the retinal veins at the sites where adventitia is shared with arteries (in its intraneural route to the optic nerve and the arteriovenous crossings), leading eventually to a turbulent blood flow, damage to endothelial cells, thrombus formation and eventual vein occlusion. This theory is supported by studies showing pathological structural changes in veins and arteries of patients with VO. Moreover, other factors related to venous deregulation, such as inadequate vasoconstriction and increased vascular permeability, could also play an important role in the retinal venous occlusive phenomena. In some patients, especially young people and adults under 50 years old, inflammatory disorders and hypercoagulable states may contribute to the hysiopathogenesis of the RVO. It has been shown that the presence of vascular endothelial growth factor (VEGF) increased significantly the chances to develop retinal vein occlusions. The result is a blood­retinal barrier dysfunction and an increased vascular permeability, with consequent macular edema. It has also been reported that VEGF plays an important role in the pathogenesis of macular edema in both ORV and CRVO.10 While there is insufficient level 1 evidence to support OVR treatment, multiple therapeutic possibilities have been described, such as anticoagulation, intravitreal fibrinolysis, hemodilution, laser photocoagulation, laser-induced anastomosis, radial optical neurotomy, adventiciotomía, intravitreal injection of triamcinolone acetonide, intravitreal injection of dexamethasone, and injection intravitreal antiangiogenic monoclonal antibodies, such as ranibizumab, bevacizumab, and aflibercept, alone or associated with photocoagulation, have shown efficacy and variables complications rates. Intravitreal injection of bevacizumab, a recombinant monoclonal antibody that acts directly against any active form of VEGF, has been shown to be effective in reducing macular thickness and improving visual acuity in the treatment of OVR. However, the need for multiple injections has been reported since the effects of intravitreal bevacizumab (as well as the other antiangiogenics) are short-lived. On one hand, Bevacizumab has the disadvantage that it is administered off-label; in addition each dose must be extracted from a vial for oncological use, which represents a risk of contamination if strictly rules of asepsis are not taken. On the other hand, the cost of each dose is lower than that of other products (ranibizumab, aflibercept) already approved for intraocular use. This allows that more patients have access to a prolonged treatment in underdeveloped or developing countries, such as Argentina. PURPOSE: To evaluate changes in visual acuity and macular thickness after intravitreal bevacizumab for the treatment of macular edema in patients with retinal vein occlusions (RVO). PATIENS AND METHODS: 39 consecutive patients with macular edema complicating RVO and treated with intravitreal injections of bevacizumab 1.25 mg/0.05 ml alone or associated with scattered peripheral laser photocoagulation, with a minimun follow-up of 18 months, were evaluated. Snellen visual acuity in LogMar units and macular thinckness measured by optical coherence tomography (OCT) were the end points. According to clinical and fluorescein angiographic presentation RVO were classified in branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO), and in non ischemic and ischemic. Wilcoxon test for paired variables, Mann Whitney for independant variables, and Student test for continuous variables, were used for statistical analysis. RESULTS: With a mean age of 66.8 years (SD: 13.65; range= 31-92 years), 62.5% of cases were CRVO and 37.5% BRVO. Mean number of injections was 4.11±161 (range= 1-6). Laser was performed in 25% of patients that did not respond to bevacizumab. At 18 months of follow-up, improvement of visual acuity and macular thickness was statistically significant (p=0.0001 and p=0.0009 respectively). BRVO showed better response to treatment than CRVO. Best visual results were obtained at first month (median= 1.00 P25= 0.5 P75= 1.30) and at 9 month (median= 0.8 P25= 0.5 P75= 1.20) after first injection, but no further improvement was observed beyond 9 months of treatment (p=0.84). No significant visual and macular thickness differences were obtained between patients treated with bevacizumab alone (p=0.116) and bevacizumab and laser (p=0.846). No ocular or systemic attributable-to-treatment side effects were observed. CONCLUSIONS: Bevacizumab was effective in improving visual acuity and reducing macular thinckness in patients with macular edema complicating RVO, especially in BRVO. No ocular or systemic complications were observed during follow-up. (AU)

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Anamnesis: a three years-old female Colombian Paso Fino equine presented visual impairment related to an anesthetic intervention with two alpha-2-adrenergic agents (xylazine 0.8 mg/kg + detomidine 10 ug/kg). Clinical and laboratory findings: ophthalmologic exam resulted in positive threat test with evidence of impaired obstacle circumvention due to failure in perception of distances and details of objects, resulting in unsteady gait and mount inability. The eye fundus presented horizontal bands on the nontapetal area and mild peripapillary edema. Scotopic electroretinogram (ERG) was performed under white light evidencing a decrease in amplitude and increase in A and B wave latencies for both eyes, compared with the reference. Hyperreflective tapetal zones and retinal folds are also observed. Leptospira tests were negative (Patoc: 1.25, Icterohaemorrhagiae: 1.25, Grippotyphosa: negative, Pomona: negative, Canicola: 1.50, Hardjo: 1.25, Ballum: negative, Bratislava: 1.25). Therapeutic approach: dexamethasone (0.2 mg/kg IM, for three days) and a vitamin supplement were prescribed. Conclusion: administration of two alpha2- adrenergic agonists may cause retinal ischemia with later development of retinal degeneration in horses.

Anamnesis: Equino hembra paso fino 36 meses de edad que presenta déficit visual relacionado a un evento anestésico con 2 agentes alfa-2-adrenérgicos (xilacina 0,8 mg/kg + detomidina 10 ug/kg). Hallazgos clínicos y de laboratorio: Al examen oftalmológico presenta prueba de amenaza positiva, al sorteo de obstáculos evidencia alteración en la percepción de distancias y detalle de objetos, resultando en una marcha insegura e imposibilidad de monta. El fondo de ojo se observan bandas horizontales en la zona no tapetal y leve edema peripapilar. Se realiza ERG bajo ambiente escotopico con luz blanca y se observa una disminución en la amplitud y aumento de latencias en ondas A y B de ambos ojos, comparado con la referencia. Posteriormente se visualizan zonas de hiperreflectividad tapetal y pliegues retínales. Se realizó prueba de Leptospira con resultado negativo: Patoc: 1.25, Icterohaemorrhagiae: 1.25, Grippotyphosa: negativo, Pomona: negativo, Canícola: 1.50, Hardjo: 1.25, Ballum: negativo, Bratislava: 1,25. Aproximación terapéutica: se formula dexametasona a razón de 0,2mg/kg IM durante 3 días y luego un suplemento vitamínico. Conclusión: La mezcla de dos agonistas alfa2-adrenérgicos puede causar un evento isquémico retinal con el posterior desarrollo de degeneración retiniana en caballos.

Anamnesis: Equino fêmea passo fino 36 meses de idade que apresenta déficit visual relacionado a um evento anestésico com 2 agentes alfa-2-adrenérgicos (xilacina 0.8 mg/kg detomidina 10 ug/kg). Achados clínicos e de laboratório: Ao exame oftalmológico apresenta prova de ameaça positiva, ao sorteio de obstáculos evidência alteração na percepção de distâncias e detalhe de objectos, resultando numa marcha insegura e impossibilidade de monta. As faixas horizontais de fundo de olho são observadas no nontapetal área e edema peripapilar suave. Escotópica ERG foram realizados sob luz branca ambiente e uma redução na amplitude e aumento latências ondas A e B de ambos os olhos, em comparação com a referência é observado. Posteriormente áreas do tapete hyperreflectivity e dobras de retina são exibidos. Teste de Leptospira foi realizada com resultado negativo: 1,25 Patoc Icterohaemorrhagiae 1,25 Grippotyphosa: negativo, Pomona: negativo, canicola: 1.50, Hardjo: 1,25, Nes: negativo, Bratislava 1,25. Therapeutic abordagem: dexametasona é formulado a 0,2 mg / kg IM por 3 dias e, em seguida, um suplemento vitamínico. Conclusão: A mistura de dois agonistas alfa-2-adrenérgicos pode causar evento isquêmico da retina com o posterior desenvolvimento da degeneração da retina em cavalos.