2 g oliva assessment of intraocular pressure (iop) in subjects exposed to ultrafine particles atmosp

Assessment of intraocular pressure (IOP) in subjects exposed to ultrafine particles atmospheric pollution (overall evaluation).

G. Oliva1, D. Di Clemente 2, , F. Perri4, M. Manigrasso 5,, C. Vernale 5, F. Bailardi1,, P. Avino 5, C. Giannico 4, EM Vingolo 3 ASL TA 1/1, Taranto 2 .....................................................................

3 University “Sapienza� of Rome Polo Pontino 4 NAIL - Sector Research, Certification and Verification - Territorial Department of Taranto 5 Chemical Laboratory, DIPIA, THE NAIL, Rome

Corresponding Author: Daniele Di Clemente M.D.,

Abstract - In this research the authors intend to verify possible alterations of the intraocular pressure (IOP) in subjects long term exposed to atmospheric ultrafine particles pollution. purpose of the research is to identify if the ultrafine particles air pollution, in addition to the already known airway disease, is able to impact on the mechanisms of IOP regulation of IOP, altering the delicate balance of the functions and structures nutritive, refractive and circulatory human eye.

Key words:

intraocular pressure, tonometry, ultrafine particles, urban air pollution

Introduction: effects of air pollution on

groups and d work, expanding the sample

human health are well known and for long

previously

time discussed in literature, particularly

residents for a total of 312 patients in the city

regarding the effects on morbidity and

of Taranto. For each of them has been

mortality.

examined clinically, eye and a general

Epidemiological

studies

have

investigated,

measurement

to ultrafine particles and effects involving

applanation tonometry. Statistical analysis of

human health.

data was performed using chi- framework

acquisitions

also

indicate

that

IOP

with

examining

shown a linear relationship between exposure

Recent

of

and

Goldmann

completed with Yates correction.

exposure to particles in suspension containing metals (such as particles from fossil fuels

Results - In this phase of the research was no

used for cars), may cause a wide spectrum of

statistically significant in differences of

inflammatory responses in the respiratory

intraocular pressure values in the two groups

tract and in the cardiovascular system

(Taranto Tamburi and City).

(cellular

cell

Were no statistically significant differences

permeability), possibly in relation to their

particularly in males, in women of post-

metal components and carbon dioxide high

menopausal osteoporosis, as well as in

concentrations.

workers in heavy industry.

Objectives - In this study, the Authors check

Conclusions - It can be said to have found in

and evaluate deeply potential impact of

this investigation significant variations de

pollution agents derived from the ultrasmall

alteration of IOP in the exposed and control

particles in relationship to possible variations

groups (Tamburi Taranto and Taranto City),

of the intraocular tension in particularly

in relation to a greater or lesser density of air

exposed subjects.

pollutants, in particular ultrafine particles

The analysis was conducte in the city of

present in the atmosphere. It would be

Taranto on residents in the neighborhood

appropriate to continue the investigation and

Taranto Tamburi (area closely near the steel

examinate, in addition to the modifications

factory industrial zone), compared with those

hydrodynamic of intraocular fluids, the

residents in the remaining areas of the city.

possible alterations in the posterior segment

damage

and

increased

of the eye, due to pollution damage and Materials and methods - In the period

insults, by blood, could endanger the retinal

January '11 December '12 has focused

structures and vitreous body.

attention on groups most at risk by sex, age

Another

aspect

not

to

be

overlooked,

Introduction

connected to the physical characteristics of

The current experimental and epidemiological

ultrafine powders, is related to the fact that

evidence locates in airborne finer particles the

while the powders of larger settle to the

responsibility of a variety of diseases, not

ground, the effect of gravity, in the immediate

only in respect of the respiratory trait, but also

vicinity and within short times, compared to

of other organs, which would be affected in

the point and at the moment issue, the finer

particular by the particles belonging to the

ones can travel long distances and remain

ultrafine size class, as already shown in

suspended in the air for hours or days after

previously made investigations [1, 2].

issuance, however, difficult to maintain the

The particulate matter in urban environments

original size, because of the high tendency to

is commonly divided into two main groups:

coagulate / accumulate.

coarse

border

Low and ultrafine particles (PUF) penetrate

"dimensional" between these two groups

through the nasal mucosa and conjunctiva,

generally ranges between 1 and 2.5 microns.

which explains why it was investigated

In fact, the boundary between the coarse and

whether this insult can somehow determine

the fine is usually conventionally established

significant changes in intraocular pressure

in aerodynamic diameter of 2.5 microns. The

regulation.

term ultrafine (PUF), recently introduced,

The IOP is that delicate mechanism that keeps

refers to particles with an aerodynamic

in balance the structures nutrients, refractive

diameter less than 0.1 microns (100 nm)

and circulation of the eyeball.

(Figure 1) [3,4].

The production of the circulating fluid inside

Focusing on the component relative to the

the eye (aqueous humor), on which the IOP,

PUF, becomes relevant to observe different

is driven by the ciliary body. We can

parameters from the aerodynamic diameter,

distinguish a intraocular phase for production

such as the numerical concentration of the

and a phase of resorption.

particles and the surface area. Indeed, ultra-

Reabsorption occurs through the complex

fine contribute only minimally to determine

structure

the mass of PM 10 or PM 2.5, quantified by the

meshwork). [5]

gravimetric method, but constitute the most

The IOP is considered normal Between 14

important component in terms of the number

and 18 mmHg. Circadian variations are

of mini particles and, albeit to a lesser degree,

present

of the total surface area.

modifications of Âą 2 mmHg. For example, the

and

fine

dust.

The

of

in

the

all

chamber

subjects

with

(trabecular

possible

IOP is higher than it fits the early morning

hours and then stabilized in the course of the

−

urea

day. [6,7,8]

−

amino acids

The compensatory mechanisms triggered by

−

Na (greater than in the serum), K,

these physiological changes prevent the

Ca, bicarbonates, chlorides, ascorbic

occurrence of any damage to the structures of

acid, CO

the anterior segment and posterior segment of

blood)

the eye (optic nerve) (fig ure. 2).

−

2

(values greater than in the

pH (7.1 to 7.3)

The aqueous humor, liquid stream undergoes

The IOP is determined by the balance

continual renewal, plays a key role in

between production and outflow of aqueous

ensuring a certain consistency to the eyeball

humor.

(intraocular pressure), which is higher than

Increases in IOP may be related to:

atmospheric pressure.

−

It is essential to maintain the proper

from

arrangement of the structures necessary for refractive vision. E 'linked to the activity of

blockage,

block

intrascleral,

increased

episcleral venous pressure [9].

−

fluid and amniotic fluid) tensional

(Production

canalicular structures; −

increases episcleral venous pressure (obstruction of the veins or ciliary mediastinal

syndrome,

The glaucoma, disease characters by an increase in IOP (even if there are so-called low-pressure glaucoma), determines where

and

resorption) −

inflammation

pericarditis, pulmonary emphysema).

nutrients (poverty of protein, rich in salts, values similar to cerebrospinal

−

ciliary

mechanical lock of trabecolo-

swirling,

The aqueous humor has features: −

the

(thickening of acqueous humor);

secretory ciliary processes and can be changed where overproduction, or trabecular

increase to the volume of secretion

compensatory mechanisms are not sufficient, a progressive degeneration of the fibers of the

dioptric (refractive index of 1.33 similar to that of the crystalline lens)

optical ner vo, with consequent damage of the vision periferic to initially (detected by visual

Constituent elements of the aqueous humor

field examination), and severe deficit of

are:

central vision in the final stages [10]. − −

protein enzymes

(5.16 mg/100cc) (Hyaluronidase,

carbonic anhydrase, proteases) −

glucose

−

lactic acid

Etiopathogenesis of chronic glaucoma, there would be a progressive obliteration of the arterio-capillary networks in uveal tissuetyping load of sheets and nervous.

The

most

widespread

and

precise

Survey results for these subgroups are shown

methodology for the determination of the IOP

in Tables III รท IV.

is tonometr ia applanation that exploits the

Each sub-group was divided further by

law of Imbert - Fick for which the pressure of

considering two age groups: 23 รท 46 years

a sphere can be derived by evaluating the

and> 46 years getting res ultati presented in

force necessary to flatten a small portion of its

tables V to VI II.

surface. In clinical use the Goldmann

A

tonometer,

of

extrapolating from the two groups starting

applanation has a diameter of 3.5 mm, for

only individuals (male) employees in large

which the theoretical volume of liquid

industrial towns. The last indagin and

displaced to obtain the flattening of this

conclusive data are shown in Table IX.

segment is 0,004 mmc, quantity irrelevant in

Of each patient was performed a clinical

the context of bulbar content.

examination and a general ophthalmological

You run instilling an anesthetic eye drops,

measurement of IOP, repeated for three times

and is colored with sodium fluorescein

a distance za of twenty days, with the

corneal surface, and finally shall be measured

Goldmann

with

anesthesia surface with benoxinato chloride

in

Goldmann

which

the

applanation

surface

tonometer

(Figure 3) [11].

final

comparison

was

applanation

made

tonometer

by

after

and staining of the corneal surface with sodium fluorescein. We excluded all those who had previous illnesses borne by the

Materials and methods

anterior segment of the eye, or already

Were investigated in the period from January

suffering from glaucoma, or contact lens

2011 to December 2012, 312 patients resident

wearers, or individuals who were subjected to

in the city of Taranto (Figure 4), 148 male

surgery or excimer laser.

and 164 female, between the ages of 23 and

Statistical analysis - The experimental results

71 years (Table I), which have undergone

were subjected to a test of statistical

specialist ophthalmology.

significance. How statistical test was used to

As regards their origin, 166 individuals are

test the significance of the ฯ 2.

residents of the district of Taranto Tamburi,

The niz ialmente assumed l 'the hypothesis

while the remaining 146 workers are coming

zero (or null hypothesis), according to which

from other areas of the city. (Table II).

there should be no difference between the

Were selected, then four distinct subgroups by

groups

sex, by division of the two original groups.

considered. According to the null hypothesis,

with

regard

to

the

parameter

the groups were equal between the gold and

the observed differences were attributable to chance.

Obviously, the null hypothesis can be true or false.

To check the veracity of zero it was necessary to analyze the data with an appropriate statistical test. If the test should accept the hypothesis zero, then the difference is not statistically significant. If the test instead recommended to reject the hypothesis zero, then the observed difference is declared statistically significant.

The chi-square test is a non-parametric statistical test aimed at verifying whether the frequency values obtained by detection, are significantly different from the frequencies obtained with the theoretical distribution. The statistical analysis was completed by applying Yates correction that is used for a number of observations of less than 500 and RECITAL statistically significant P values <0.05 [1 2].

Results

It would be appropriate to continue the

The statistical analysis of experimental data

investigation and found, in addition to

obtained from observation, having compared

changes in hydrodynamic buoyancy eyepiece

the two areas under investigation, leads,

end, the possible alterations in the posterior

respectively, for the male patients, for women

segment of the eye, due to insults, even by

aged> 46 years (menopausal age) and for

blood, could endanger the fund vitreous-

workers male, to reject the null hypothesis

retinal and uveal .

with the consequent result that the differences are statistically significant and therefore can not be attributed to chance (Tables III, VIII and IX).

Conclusions Enquiries were made, there was a possible effect of air pollutants, specifically particulate air pollution ultrafine on the values of IOP. This effect is pronounced in male adults (especially in large-scale industry workers) and in women of menopausal age.

Bibliography

1.

G. Oliva, M. Salducci, F. Perri, C. Vernal, V. Annoscia, M. Mariani, M. Manigrasso, C. Fanizza, F. Bailardi, P. Avino, C. Giannico. Study of the incidence of alterations of changes in the tear film and corneal sensitivity in individuals exposed to air pollution by fine particles. G. Mil Med. 2009; 159 (2) :179-184.

2.

M. Salducci, G. Oliva, F. Perri, V. Galasso, M. Manigrasso, C. Vernal, F. Bailardi, P. Avino, C. Giannico. Preliminary investigation on possible alterations of intraocular pressure in subjects exposed to ultrafine particles from air pollution. Prevention & Research - Year 2 - Quarter 4

3.

M. Manigrasso, P. Avino and C. Fanizza. Ultrafine Particles in the Urban Area of Rome.

Fresenius Environmental Bulletin, 18 (2009) 1341-1347.

4.

P. Avino, S. Casciardi, C. Fanizza, M. Manigrasso. Deep Investigation of Ultrafine Particles in Urban Air. , 2011, in press Aerosol on Air Quality Research.

5.

Duane: Duane's Ophthalmology 1998 Edition CD-ROM.

6.

JaĂŠn Ji-Diaz., Cordero-Garcia B., Lopez-De-Castro F.: Diurnal Variability of Intraocular Pressure. Arch Soc Esp Oftalmol 2007; 82: 675-680

7.

8.

Liu JH. Circadian rhythm of intraocular pressure. Glaucoma 1998; 7: 141-147 Sacca SC, Rolando M, Marletta A, Macri A, P Cerqueti, Ciurlo G. Fluctuations of intraocular pressure during the day in open-angle glaucoma, normal-tension glaucoma and normal subjects. Ophthalmologica 1998; 212: 115-119

9.

C. Toselli, M. Best. Ophthalmology Clinic 2006

10. G. Cristini , RA Meduri . Pathophysiological basis of clinical ophthalmology 1983 11. DJ Spalton , R. Hitchings , P. Hunter . Atlas of clinical ophthalmology 2006 2nd edition 12. T. Colton. Medical Statistics 1979

Demographic characteristics of the patients analyzed.

Table I

Males

Age ± SD

Female

Age ± SD

Total

148

42.2 ± 10.7

164

43.7 ± 12.8

Taranto Drums

81

39.5 ± 9.5

85

46.1 ± 13.9

Taranto City

67

46.2 ± 13.4

79

41.1 ± 13.7

Table II

Overview on the statistical analysis of data related to individuals total Pathological values

Normal values

Total

Taranto Drums

17

1 49

1.66

Taranto City

6

140

146

Total

23

290

312

χ = 4.28 2

P = 0.0 386

χ = 3.43 2

P = 0.0 642

Table I II

Statistically s ignificativa (P <0.05) Correction according to Yates Statistically not significant

Overview on the statistical analysis of data related to male individuals Pathological values

Normal values

Total

Taranto Drums

11

70

81

Taranto City

2

65

67

Total

13

135

148

χ = 5.14 2

Difference statistically significant (p <0.05) P = 0.023

χ = 3.90 2

P = 0.0483

Table IV

Correction according to Yates Difference statistically significant (P <0.05)

Overview on the statistical analysis of data related to female individuals Pathological

Normal values

Total

values Taranto Drums

6

79

85

Taranto City

4

75

79

Total

10

1 54

164

χ = 0, 28 2

Statistically not significant

P = 0.5936

χ = 0.0 4 2

P = 0, 8359

Table V

Correction according to Yates Statistically not significant

Overview on the statistical analysis of data related to male individuals (Age range 23 ÷ 46 years old) Pathological values

Normal values

Total

Taranto Drums

5

35

40

Taranto City

1

45

46

Total

6

80

86

χ = 3.52 2

Statistically not significant

P = 0, 0608

χ = 2.10 2

P = 0, 1469

Table VI

Overview on the statistical analysis of data related to male individuals (Age> 46 years old) Pathological values

Normal values

Total

Taranto Drums

6

35

41

Taranto City

1

20

21

Total

7

55

62

χ = 1.35 2

P = 0, 2450

χ = 0, 55 2

P = 0, 4602

Table VII

Correction according to Yates Statistically not significant

Statistically not significant Correction according to Yates Statistically not significant

Overview on the statistical analysis of data related to female individuals (Age range 23 ÷ 46 years old) Pathological

Normal values

Total

values Taranto Drums

1

47

48

Taranto City

1

52

53

Total

2

99

101

χ = 0.01 2

Statistically not significant

P = 0, 9436

χ = 0.42 2

P = 0, 5194

Correction according to Yates Statistically not significant

Overview on the statistical analysis of data related to female individuals (Age> 46 years

Table VIII old)

Pathological values

Normal values

Total

Taranto Drums

7

23

30

Taranto City

1

32

33

Total

8

55

63

χ = 5.84 2

Difference statistically significant (P <0.05) P = 0, 0156

χ = 4.16 2

P = 0, 0415

Table IX

Correction according to Yates Difference statistically significant (P <0.05)

Overview on the statistical analysis of data related to individuals male workers Pathological values

Normal values

Total

Taranto Drums

9

33

24

Taranto City

2

41

43

11

74

85

Total

χ = 5, 31 2

Difference statistically significant (p <0.05) P = 0, 0 212

χ = 3.92 2

P = 0, 0476

Correction according to Yates Difference statistically significant (p <0.05)

1