The role of ozonized oil and a combination of tobramycin/dexamethasone eye drops in the treatment of viral conjunctivitis: a randomized clinical trial.

PURPOSE: To determine whether topical tobramycin 0.3%/dexamethasone 0.1% plus ozonized oil eye drops reduces clinical signs and infectious viral titers of presumed viral conjunctivitis more than tobramycin/dexamethasone eye drops alone. METHODS: Prospective, single-blind, randomized, parallel-groups trial. Eighty patients with a clinical diagnosis of presumed viral conjunctivitis were randomizedly divided into two treatment groups: a study group and a control group, 40 for each group. Patients in the study group received topical tobramycin 0.3%/dexamethasone 0.1% eye drops, plus ozonized oil eye drops, both four times daily; patients in the control group received only topical tobramycin 0.3%/dexamethasone eye drops four times daily. The treatment was for seven days in both groups. Swabs were taken from the conjunctival fornix for adenovirus PCR analysis on the day of recruitment and at seven days follow-up. Clinical signs were also recorded on the day of recruitment and at follow-up examination: the main outcomes were conjunctival injection and conjunctival chemosis, graded on a 4-point clinical scale, presence or absence of superficial punctate keratitis and subepithelial corneal infiltrates. RESULTS: No statistically significant difference was reached in adenoviral infection negativization between the two groups, although the study group showed a higher number of PCR negative results at seven days follow-up. PCR real time detected adenoviral infection in 17 of 24 patients on the day of recruitment and it was positive in 4 patients on the seventh day (viral positivity reduction of 76%). In the control group PCR was positive for adenovirus in 18 of 24 patients on the day of recruitment and in 7 patients at seven days follow-up (reduction of 61%). There was statistically significant difference on conjunctival clinical signs between the study and control groups. Significant difference was also found on superficial punctate keratitis resolution between the study and the control group. In the former superficial punctate keratitis was detected in 14 eyes on the first day and in 5 eyes after seven days while in the latter superficial punctate keratitis was found in 124 eyes on the first day and in 6 eyes on the seventh day. No difference was found in subepithelial corneal infiltrates appearance between the two groups. CONCLUSIONS: The use of ozonized-oil containing eye drops in combination with topical tobramycin 0.3%/dexamethasone 0.1% eye drops four times daily seems to reduce the signs of conjunctivitis, and the duration of viral infection, although it does not affect the subepithelial corneal infiltrates appearance.

Confocal scanning laser microscopy in patients with postoperative endophthalmitis.

PURPOSE: To investigate alterations of corneal layers in eyes treated for acute postoperative endophthalmitis. METHODS: In this retrospective, nonrandomized comparative study, eyes treated with 25 gauge pars plana vitrectomy (PPV) for acute post-cataract endophthalmitis (group A) were compared to eyes receiving uneventful cataract surgery (group B) and uneventful 25 gauge PPV for epiretinal membrane (group C). After a minimum follow-up of 8 months from last surgical procedure, laser scanning in vivo confocal microscopy (IVCM) was performed. RESULTS: Twelve eyes for each group were recruited. Comparing study eyes with control eyes of group B and C, no statistical difference was found in corneal epithelial cell density (p = n.s.), in density of nerve fibers (p = n.s.), mean grade of nerve reflectivity (p = n.s.), mean grade of nerve tortuosity (p = n.s.), mean grade of anterior keratocyte activation (p = n.s.), and corneal endothelium cell density (p = n.s.), whereas a statistically higher mean grade of posterior keratocyte activation was found in group A (p < 0.01). Epithelial and endothelial corneal morphologies were graded as regular in all groups. Langerhans cells and corneal dendritic-shaped hyper-reflective endothelial deposits were found in group A. Both findings were absent in group B and C, and the difference was statistically significant (p < 0.01). CONCLUSIONS: IVCM was a useful tool in the detection of microscopic chronic corneal abnormalities caused by postoperative endophthalmitis. These findings confirmed the presence of a subclinical chronic corneal inflammation localized to the posterior stroma that should be related to the infectious process. Future studies might clarify pathological processes in the acute phase of postoperative endophthalmitis.

Correlation of central and peripheral keratometric parameters after corneal collagen cross-linking in keratoconus patients.

PURPOSE: To evaluate the difference in the central and peripheral keratometric parameters in patients with keratoconus after corneal collagen cross-linking (CXL). METHODS: Forty-eight eyes of 32 patients (18 males, 16-28 years) affected by progressive keratoconus in different stages of evolution underwent CXL using the standard epithelium-off protocol. Corneal thickness and corneal curvature before CXL and after 6 and 12 months using the Sirius tomographer were analyzed. The values of the mean corneal thickness at the corneal apex (CAT), center of the pupil (PCT), thinnest point (CTTL) and along concentric circles of 2, 4, 6, 8, 8.5, 9, 9.5 and 10 mm diameter were evaluated; the values of the mean curvature at the corneal apex and at the points in which the inferior, superior, nasal and temporal meridians crossed the above-mentioned concentric circles were also evaluated. RESULTS: The mean preoperative values for CAT, PCT and CTTL were 461.4 ± 30.3, 475.3 ± 30.5 and 441 ± 32.0, respectively. The values after 12 months of CXL were 444.6 ± 36.2, 451.6 ± 36.7 and 418.2 ± 41.4. The peripheral corneal thickness at the eight points ranged from 479 to 733 preoperatively. At 12-month post-CXL, the values ranged from 444.6 to 734.1. The mean posterior curvature from apex to periphery ranged from - 4.5 to - 9.1 days preoperatively and from - 4.5 to - 9.2 days at 12 months. These were not statistically significant (ANOVA and unpaired T test). CONCLUSIONS: Our data suggest that CXL over an 8-mm zone can stabilize the peripheral cornea. Longer-term follow-up studies on the peripheral cornea after CXL will provide useful information.

Binocular cyclotorsion in superior vestibular neuritis.

SUMMARY: Conjugated cyclotorsion of the eyes toward the affected side can commonly be observed in vestibular neuritis. The aim of this study was to assess the differences in cyclotorsion between the ipsi- and contralesional eye during selective involvement of the superior branch of the vestibular nerve. We studied binocular cyclotorsion through ocular fundus photographs in 10 patients affected by acute superior vestibular neuritis (SVN). Cyclotorsion was also studied in 20 normal subjects. All SVN patients showed an ipsilesional cycloversion of the eyes. Normal subjects exhibited a constant mild excyclovergence (6.42 ± 2.34°). In SVN patients, contralateral incyclotorsion (8.4 ± 8.14°) was lower and not normally distributed compared to ipsilateral eye excyclotorsion (17.9 ± 4.36°) with no correlation between them. The interocular difference in cyclodeviation could be related to the starting physiological excyclovergence, to different tonic effects on the extraocular muscles of the two eyes and to the different influence of spontaneous nystagmus on cyclodeviation in the two eyes. We recommend referring only to ipsilateral excyclotorsion in the evaluation of utricular function during SVN and its subsequent compensation. Further studies are required to determine the binocular cyclotorsion in the case of other kinds of selective involvement of the vestibular nerve.

Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine.

PurposeTo investigate the effect of cyclosporine on corneal ultrastructure and on major signs and symptoms of patients with dry eye disease.Patients and methodsIn this prospective cohort study, patients with dry eye disease were treated with a drop of cyclosporine 0.05% twice daily. Clinical evaluation was carried out at baseline and at months 1, 3, and 6. All patients completed the Ocular Surface Disease Index (OSDI) questionnaire, and tear film break-up time (BUT), fluorescein and lissamine green staining, and Schirmer test were carried out. In vivo confocal microscopy was also performed and epithelial cellular density, keratocyte activation, and subbasal plexus morphology were assessed.ResultsA total of 40 patients completed the study. After 6 months, OSDI, BUT, and fluorescein and lissamine green staining showed a clinically significant improvement. During the 6-month follow-up, density of intermediate epithelial cells increased from 1969.5±85.4 cell/mm2 to 4881.2±175.7 cell/mm2 (P<0.01); average grade of keratocyte activation decreased from 3.6±0.1 to 1.8±0.1 (P<0.001); average grade of number of subbasal nerves decreased from 5.3±0.2 to 2.6±0.2 (P<0.001); average grade of nerve reflectivity decreased from 3.8±0.1 to 2.1±0.2 (P<0.001); and average grade of nerve tortuosity decreased from 3.8± 0.1 to 2.2±0.2 (P<0.001).ConclusionCyclosporine was effective in controlling symptoms and signs of dry eye disease. In vivo confocal microscopy showed an increase in cell density of intermediate epithelium cells, a decrease in hyperreflective keratocytes, and a decrease in density, tortuosity, and reflectivity of nerve fibers.

Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study.

The objective of this study is to assess different outcomes between endoscopic dacryocystorhinostomy (En-DCR) with and without silicone intubation. We retrospectively analyzed 84 patients (89 procedures), suffering from chronic epiphora for primary acquired nasolacrimal duct obstruction, treated with En-DCR and divided into two groups depending on silicone stent intubation. The surgical outcomes were evaluated at 7 post-operative controls using Munk's score criteria. Functional success was defined as absence of epiphora, no further episodes of dacryocystitis, and a patent ostium after fluorescein irrigation. 45 En-DCR with stent and 44 En-DCR without stent were performed. Success rate after 18 months follow-up were, respectively, 82.2 % in the stent group and 88.6 % in the non-stent group (OR 0.59) with no statistical differences. The ostial size reduction has been reported in higher percentage in the stent group, mainly due to peristomal granuloma (OR 3.64), scar tissue formation (OR 2.25), and turbinoseptal synaechia (OR 1.76). The benefits of non-intubation are less patient discomfort, reduced surgical time and costs, simpler follow-up regimen and less intubation-associated complications. En-DCR without silicone stent intubation should be the first choice of procedure, stent intubation should be reserved in selected cases with poor local conditions pre and intra-operatively assessed.

Venous graft for reconstruction of neoplastic and post-traumatic eyelid defects.

AIM: The repair of an eyelid-wide full-thickness defect is a challenging procedure, mostly for the tarso-conjunctival layer reconstruction. The Authors illustrate their own experience in reconstructing eyelid-wide defects with a composite venous wall and skin graft to repair both neoplastic and post-traumatic injuries, aiming to reach both functionally and cosmetically satisfactory results. PATIENTS AND METHODS: Eight patients were treated with this procedure; six of them were affected by a local invasive tumor, two had a wide defect following a trauma. RESULTS: Most of the patients had good functional and cosmetic results after a median follow-up of 51 months; only one had a minor complication. CONCLUSION: Eyelid reconstruction with a venous wall and skin graft is a recently introduced technique that represents a reliable alternative to traditional procedures, granting esthetically and functionally good results.

Study of ethane level in exhaled breath in patients with age-related macular degeneration: preliminary study.

PURPOSE: A variety of factors have been implicated in the pathogenesis of age-related macular degeneration (ARMD), and oxidative stress plays an important role in the onset and progression of the disease. Breath ethane is now considered a specific and non-invasive test for determining and monitoring the trend of lipid peroxidation and free radical-induced damage in vivo. This test provides an index of the patients' overall oxidative stress level. We evaluated the breath ethane concentration in exhaled air in patients with advanced ARMD. METHODS: In this study, we enrolled 13 patients with advanced ARMD and a control group, and a breath analysis was carried out by gas chromatography. RESULTS: The mean ethane level in the ARMD patients was 0.82 ± 0.93 nmol/l (range: 0.01-2.7 nmol/l) and the mean ethane value in the control group was 0.12 ± 0.02 nmol/l (range: 0.08-0.16 nmol/l). The difference between the values of the 2 groups was statistically significant (p < 0.005). Receiver operating characteristic analysis showed an elevated area under the curve (0.831; 95% CI: 0.634-0.948), with a significance level of p < 0.0014 (area = 0.5). CONCLUSIONS: These preliminary results seem to indicate that breath ethane levels are higher in most patients with ARMD. The breath ethane test could thus be a useful method for evaluating the level of oxidative stress in patients with ARMD. To our knowledge, there are no data on this type of analysis applied to ARMD.

Cataracts in patients receiving stem cell transplantation after conditioning with total body irradiation.

One hundred and ninety-three patients with hematological malignancies and a follow-up > or =1 year, treated with stem cell transplantation (45 autologous, 99 allogeneic T cell-depleted matched, 49 allogeneic T cell-depleted mismatched) from July 1985 to May 1998, were considered evaluable for the development of cataracts. Total body irradiation (TBI), administered either according to a hyperfractionated scheme (HTBI) or in a single dose (STBI), was employed in the conditioning regimens. HTBI was prescribed in 94% of patients undergoing allogeneic matched transplant, while STBI was used in 71% of patients receiving allogeneic mismatched and in all patients undergoing autologous transplant. The median follow-up was 7.56 years in the HTBI and 3.02 years in the STBI group. Among the different risk factors analyzed by univariate analysis only the TBI scheme and type of transplant reached statistical significance (P < 0.0001 and P < 0.001, respectively). By multivariate analysis only the TBI scheme was an independent factor for cataract development (STBI vs HTBI RR 7.2; P < 0.01). Our results showed that STBI is more cataractogenic than HTBI. The incidence of cataract we observed was among the lowest described in the literature. T cell depletion, because it prevents graft-versus-host disease and reduces the protracted use of post-transplant steroids, explains the results we obtained.

Combined surgery and cryotherapy for melanoma of the conjunctiva: 37 months' follow-up.

A patient with large conjunctival melanoma in the superior fornix is described. The disease was treated by excision of the mass combined with cryotherapy delivered to the surrounding flat intraepithelial areas of involvement. The patient was free from local recurrence and metastatic spread for 37 months after surgery.

Evaluation of functionality of cochlear outer hair cells in patients with retinitis pigmentosa and in their relatives.

Hearing functionality was studied in 36 patients with retinitis pigmentosa (R P) and 29 of their relatives. These patients were defined as having bilateral normal hearing on the basis of tonal-threshold audiometric and acoustic-immittance tests. The transiently evoked otoacoustic emissions (T E O A Es) were studied in these normal hearing patients. T E O A Es represent an extremely sensitive method to study the functionality of the outer hair cells of the organ of Corti. When the values of T E O A E amplitude, intensity, and frequency in R P patients and in their relatives were compared with those in control subjects, they were found to be significantly reduced. The T E O A Es were clearly pathological in 52.8% of patients with R P and in 24.1% of their relatives. During embryologic development, there is one transitory axoneme in the outer hair cells of the organ of Corti; this transitory axoneme is important for the organization of the stereocilia. Axonemes are found in mature hair cells, including photoreceptors. The alteration of cochlear outer hair cells in a high percentage of patients with R P and in some of their relatives corroborates the hypothesis that, in some instances, retinitis pigmentosa may be due to a structural anomaly of the ciliated cells.

Study of functionality of cochlear outer hair cells in patients with retinitis pigmentosa.

Hearing functionality was studied in 30 patients affected by retinitis pigmentosa (RP) and 25 of their relatives. These patients were defined as normal-hearing on the basis of pure-tone threshold audiometric and acoustic immittance tests. The evoked otoacoustic emissions (EOEs) were studied in these normal hearing patients. EOEs are an extremely sensitive method to study the functionality of the outer hair cells of the organ of Corti. In RP patients and in their relatives the values of EOE (amplitude, intensity and frequency) were found to be statistically reduced compared to those of control subjects. The EOEs turned out to be clearly pathological in 60% of patients with RP and in 24% of their relatives. During the embryologic development there is one transitory axoneme in the outer hair cells of the organ of Corti. This axoneme is important for the organization of the stereocilia. The axonemes are found inside a few mature hair cells, including the photoreceptors. The alteration of cochlear outer hair cells in a high percentage of patients with RP and in some of their relatives seems to corroborate the hypothesis that, in many cases, retinitis pigmentosa may be due to a structural anomaly of the ciliated cells.

Evoked otoacoustic emissions behaviour in retinitis pigmentosa.

The hearing function was studied in 26 patients affected by retinitis pigmentosa (RP) and in their relatives. Sixteen patients showed bilateral normal hearing when examined with traditional audiometric methods. In these normoacusic patients evoked otoacoustic emissions (EOE) have been studied. The EOE offer a unique opportunity to measure objectively the function of outer hair cells: they record the amplitude of the energy produced by the outer hair cells of the coclea following an acoustic stimulation. The data have been statistically compared, using the Student's t-test, with those obtained in a homogeneous control-group of normal subjects. In normoacusic subjects with RP the average values of EOE intensity are statistically lower than those of normal subjects in 64 of the 127 frequency bands examined. Moreover, the distribution of the EOE in patients with retinitis pigmentosa proved to be more discontinous than that observed in the normal subjects. The EOE recorded in 14 normoacusic relatives show in some cases small anomalies but the data, on account of the limited sample group, cannot be statistically evaluated. Therefore a subclinical alteration of the Organ of Corti is found in 100% of the patients affected by RP, although they appear to be normoacusic to usual audiometric tests.

[Evoked oto-acoustic emissions in patients with retinitis pigmentosa]. / Le otoemissioni acustiche evocate in pazienti affetti da retinite pigmentosa.

Evoked otoacoustic emissions (EOE) offer a unique opportunity to measure objectively the function of outer hair cells in human beings. In this paper the Authors report a study carried out employing EOE evaluation on cochlear function in subjects with retinitis pigmentosa. Nine patients with retinitis pigmentosa with normal hearing in both ears upon traditional audiometric evaluation were studied. The frequency spectrum of the EOE was taken into consideration, evaluated in frequency bands of 50 Hz, in order to ascertain the presence or absence of the emissions and, when present, their amplitude. These data were compared statistically, using the Student's T Test, to those obtained in a homogeneous control group of normal subjects. In subjects with retinitis pigmentosa, average EOE intensity values were statistically lower than those found in normal subjects. In fact, the Student's T Test evaluation revealed significant differences in EOE intensity in 64 of the 127 frequency bands examined. Moreover, the distribution of the EOE in patients with retinitis pigmentosa proved to be more discontinuous than that observed in the normal subjects. These data appear to indicate authentic alterations in the cochlear mechanics in patients with retinitis pigmentosa. Such alterations may well be related to outer hair cell lesions. It seems likely that the auditory system is involved in retinitis pigmentosa degenerative processes more frequently than traditional audiometric tests have been able to show.

Choroidal granuloma caused by atypical mycobacterium in a patient with AIDS: a case report.

The case presented is a chorioretinal granuloma in a patient with AIDS. The neoformation appeared to be caused by atypical mycobacterium, although it was not possible to isolate the germ. The chorioretinal infection caused by atypical mycobacterium in patients with AIDS occurs very rarely and has so far been described only as a post-mortem finding.

Influences of birthweight upon brainstem maturation as reflected by auditory brainstem response (ABR) evaluation.

The authors have studied auditory brainstem responses (ABR) in 49 preterm (Group A) and in 54 fullterm (Group B) newborns, classified according to the birthweight related to conceptional age, in order to verify the influences of this latter parameter upon ABR. In Group A newborns, 4 recording sessions were performed, while only 3 in Group B, to evaluate data obtained at the same extra-uterine age. The obtained data show that birthweight related to conceptional age seems to play a major role on the development of ABR, since no significant differences were detected between preterm and fullterm newborns, provided the birthweight was appropriate for conceptional age (ACA). On the contrary, small for conceptional age (SCA) newborns showed an abnormal ABR pattern at birth, which tended to normalize at the following recording sessions. The authors conclude that birthweight related to conceptional age represents an important factor in the development of auditory brainstem responses and that the audiological diagnosis has to be very cautious in SCA newborns, regardless if they are pre- or fullterm.