Effects of major ozonated autohemotherapy in the treatment of dry age related macular degeneration: a randomized controlled clinical study

AIM: To evaluate the effect of systemic ozonated major autohaemotherapy (O3-AHT) in patients affected by dry age related macular degeneration (AMD). METHODS: This study was a randomized, controlled clinical study. One hundred and forty patients with the diagnosis of AMD in both eyes, with the study eye presenting dry AMD and soft drusen, were randomly assigned in a 1:1 ratio to either receive 27 major ozonated autohemotherapy treatments during 12-month period, or a standardized multi-vitamin therapy. Primary outcome was the change in best corrected visual acuity (mean logMar change) between the baseline and 6 and 12 months, end point of the study. In addition, to investigate the safety of prolonged ozonated autohaemotherapy, we measured the routine haemato- chemical parameters and biochemical oxidative stress values at baseline and after 12 months treatment time. RESULTS: The mean baseline best corrected visual acuity in study eyes was 0.36 in the treatment group and 0.38 in the control group (difference not statistically significant). At the primary endpoint, 6 months post-baseline, the mean logMAR change in the treated group improved by 0.1 and the values of the control group at the same time impaired by 0.2 respect to the baseline. Four percent and twenty-five percent of eyes in the group treated with O3-AHT gained 1 or more lines after 6 and 12 months respectively compared to 0% in the eyes which received no treatment (P <0.05 at 12 months). None of the treated patients experienced a loss in visual acuity in their study eye at 6 and 12 months, compared to 16% and 40 % of patients in the control group who lost 2 lines or more at 6 months and 12 months respectively (P <0.05 treated vs control group)). Major ozonated autohemotherapy was shown to be safe and well- tolerated by the patients. Moreover, the haematochemical parameters showed a decrease in the Reactive Oxygen Metabolites (300±10.1 UCARR at 12 months compared to a baseline value of 380±10.4 UCARR, P <0.05) and an increase in Biological Antioxidant Potential plasma values (2100±34.8 micromoles/ C vitamin after 12 months compared to the baseline value of 1610±36.2, P <0.05) in the treated patients when compared to the control group. This data suggests that major ozonated autohaemotherapy may exert a role in reducing oxidative stress by endogenously stimulating the production of antioxidant molecules. CONCLUSION: The results of this study suggests that major ozonated autohaemotherapy could be a safe and effective therapeutic option for high-risk patients with dry AMD, and that a series of such treatments could improve the natural course of AMD.

Magnetic resonance imaging:Is there a role in clinical management for acute ischemic colitis?

AIM:To validate the utility of magnetic resonance imaging(MRI) for the clinical management of acute ischemic colitis(IC).METHODS:This is a magnetic resonance(MR) prospective evaluation of 7 patients who were proved to have acute IC on the basis of clinical,endoscopic and computed tomography(CT) findings and who were imaged in our institution between February 2011 and July 2012.The mean age of the patients was 72.28 years.Abdominal CTs were obtained using a 64-detector row configuration for all patients with un-enhanced and contrast-enhanced scans,in the late arterial phase(start delay 45-50 s) and in the portal venous phase(start delay 70-80 s).The MR examinations were performed using a 1.5T superconducting magnet,using Fast Imaging Employing Steady State Acquisition and T2-weighted fast-recovery fast-spin echo sequences in axial and coronal plane.CT and MRI examinations were analysed for the presence of colonic abnormalities and associated findings.RESULTS:Segmental involvement was seen in 6 patients(85.71%),with a mean length of involvement of 412 mm(range 145.5-1000 mm).Wall thickness varied between 6 mm and 17.5 mm(mean 10.52 mm) upon CT examinations and from 5 to 15 mm(mean 8.8 mm) upon MR examinations.The MRI appearance of the colonic wall varied over the time:TypeⅠappearance with a 3 layer sandwich sign was seen in 5 out of 12 examinations(41.66%),patients underwent MR within a mean of 36 h(ranging from 1 to 54 h) after the CT examination.Type Ⅱ and Ⅲ appearance with a 2 layer sign,was seen in 4 examinations(33.33%),patients underwent MR within a mean of 420.5 h(ranging from 121 to 720 h) after the CT examination.In the remaining three MRI examinations,performed within a mean of 410 h(ranging from 99.5 to 720 h) the colonic wall appeared normal.CONCLUSION:MRI,only using precontrast images,may be used as a substitute for invasive procedures in diagnosis and follow-up of acute IC.