Choroidal Thickness in Multiple Sclerosis: An Optical Coherence Tomography Study

Background@#and Purpose To identify changes in the choroidal thickness (CT) in multiple sclerosis (MS) patients with and without optic neuritis (ON) using enhanced-depth-imaging optical coherence tomography (EDI-OCT). @*Methods@#This cross-sectional study included 96 eyes with MS and 28 eyes of healthy controls.All participants underwent an ophthalmologic examination and EDI-OCT scanning (Spectralis, Heidelberg Engineering, Germany) to assess the CT and the retinal nerve fiber layer (RNFL) thickness. MS patients were divided into two groups: 1) with and 2) without a history of ON. The CT was evaluated in the fovea and at six horizontal and six vertical points at 500, 1,000, and 1,500 µm from the fovea. Paired t-tests were used to compare the groups, and p-value<0.05 was considered as significant. @*Results@#At all 13 measurements points, the CT was thicker in MS patients than in the healthy controls and was thinner in eyes with ON than in the contralateral eyes, but these differences were not statistically significant. However, the CT was always larger in all points in eyes with a history of ON than in the control eyes. The RNFL was significantly thinner (p<0.05) in both MS and ON eyes than in the control eyes. @*Conclusions@#The CT did not differ between MS and control eyes, but it was significantly larger in patients with a history of ON, in whom the RNFL was thinner. Further studies are necessary to establish the possible role of the choroid in MS.

Antiglaucoma drugs: the role of preservative-free formulations

Hypersensitive reactions to eyedrops are a common finding in clinical practice and represent a frequent cause of discontinuation of the therapy. Moreover, experimental and clinical studies show that long term use of topical drugs may induce ocular surface changes causing discomfort and potentially negatively affecting the compliance to the treatment as well as the success rate of filtering procedures. The exact mechanism involved and the roles of the active compound and the preservatives in inducing such detrimental effects of ophthalmic solutions are unclear. During the last years several antiglaucoma agents have been marketed as either preservative-free or benzalkonium chloride-free formulations in an attempt to reduce the adverse effects related to preservatives. This paper summarizes the body of evidence from existing studies about preservatives in antiglaucoma eyedrops, focusing on the latest compounds commercially available. A systematic review of the literature was performed. Current research is focusing not only on the efficacy of the drugs but also on their tolerability. Based on the existing data, there is a rationale to support the use of benzalkonium-free solutions whenever possible, especially in patients suffering from concomitant ocular surface diseases, experiencing local side effects and in those expected to need multiple and prolonged topical treatments

molteno implant in the treatment of refractory glaucomas

We have employed a single-plate Molteno implant in 62 eyes affected by secondary angle closure glaucoma [non-neovascular: n, 23; neovascular: n, 13] and congenital glaucoma [n, 26]. The median number of previously failed antiglaucoma surgical procedures was two non - neovascular secondary glaucomas [range, o-3] and three for congenital glaucomas [range, 1-6]. In 80% of the neovascular glaucoma cases filtration surgery was not attempted before implantation. The one-stage technique of implantation was used in all cases. To decrease early postoperative complications associated with prolonged hypotony, we used a tourniquet suture to occlude temporarily the tube of the implant. Results were analyzed in 46 cases with a minimum follow-up of four months [maximum 22 mo, median 12 mo]. Success was defined as an intraocular pressure of less than 20 mm Hg +/- medication. Mean intraocular pressure was 37 mm Hg [ +/- 10] preoperatively and 17 [ +/- 7] postoperatively. In three patients a revision of the implant was necessary because the tip of the tube was touching the corneal endothelium. One implant had to be exchanged because the tube was severed at the site of the tourniquet suture. Choroidal detachment was diagnosed in 15 cases [24%], requiring suprachoroidal drainage in two cases [13%]. Our study shows that the Molteno implant is a valid alternative for the treatment of complicated cases of glaucoma refractory to filtration surgery. Results on congenital glaucomas have so far been particularly rewarding, but a conservative approach is recommended