Retinal angiomatous proliferation.

Retinal angiomatous proliferation (RAP) is a distinct form of choroidal neovascularization which may complicate a wet age related macular degeneration (AMD). This exudative-AMD has a peculiar clinical history and prognosis. RAP accounts from 8% to 22% of newly diagnosed cases among patients previously diagnosed as exudative AMD, and up to 25% of the occult or minimally classic CNV. The disease is more prevalent in women (90% of cases) and in elderly patients (around 75 years), and is characterized by a very poor prognosis. The neovascular process, whose retinal or choroidal origin is still object of discussion, often hesitates in the formation of a disciform scar, that evolves into a severe loss of central vision. Treatment for RAP is not yet well established; herein are described the most used therapeutic strategies, starting from laser photocoagulation until the nearest anti VEGF. The opportunity of combination among various treatments to obtain a better effectiveness and a lower frequency of recurrence is also discussed.

Intravitreal bevacizumab vs intravitreal triamcinolone combined with macular laser grid for diffuse diabetic macular oedema.

OBJECTIVE: To evaluate the 12-month clinical outcome of patients with persistent non-ischaemic diffuse diabetic macular oedema (DME) treated with intravitreal bevacizumab (IVB) or with intravitreal injection of triamcinolone combined with macular laser grid (IVTA-MLG) from September 2005 to February 2008. METHODS: Retrospective interventional comparative study. Best-corrected visual acuity (BCVA, ETDRS LogMAR scale) and foveal thickness (FT) at optical coherence tomography (OCT) were obtained at baseline and during 12 months after first treatment. Re-treatment was based on clinical or OCT-based evidence of persistent macular oedema or deterioration in visual acuity. RESULTS: Forty-three eyes (32 patients) with DME were treated with IVB. Ninety-six eyes (52 patients) with DME were treated with combined laser grid treatment and intravitreal triamcinolone. At baseline, mean BCVA and FT were 0.92+/-0.34 LogMAR and 372+/-22 microm in the IVTA-MLG group, and 1.07+/-0.49 LogMAR and 423+/-33 microm in the IVB group, respectively. At 1- and 3-month visits, BCVA and FT had significantly improved in both groups. After 6 and 12 months, the IVB group experienced a statistically significant improvement in visual acuity (0.83+/-0.21 LogMAR, P<0.001 at 6 months; BCVA 0.86+/-0.24 LogMAR, P<0.001 at 12 months) and FT (248+/-18 microm, P<0.001 at 6 months; 262+/-28 microm, P=0.001 at 12 months) when compared with baseline, whereas the IVTA-MLG group did not show statistically significant improvement in vision and FT. An increase in intraocular pressure (IOP) was present in 10 of 96 (10.4%) eyes treated with IVTA-MLG, and in two cases it was resistant to topical treatment. No significant side effects were reported in the IVB group. CONCLUSIONS: At 6 and 12 months after first treatment for chronic DME IVB provided significant improvement of BCVA and FT, whereas improvement after IVTA-MLG was not significant. Increased IOP occurred in 10.4% of patients who received IVTA, with two patients requiring trabeculectomy.

Comparison of time domain Stratus OCT and spectral domain SLO/OCT for assessment of macular thickness and volume.

PURPOSE: To compare retinal thickness and volume measurements obtained with Stratus time domain optical coherence tomography (OCT) and spectral domain scanning laser ophthalmoscope OCT (SD-SLO/OCT). METHODS: In a cross-sectional study, 52 eyes with a normal macula, 30 eyes with retinal oedema, and 10 eyes with a myopia higher than 6 D have been evaluated with both time domain OCT (TD-OCT, Stratus OCT, Carl Zeiss Meditec, USA) and SD-SLO/OCT (OTI, Toronto, Canada). Retinal thickness and volume measurements in the nine areas of the 6-mm ETDRS ring were compared. Artefacts were defined as the discordance between the automatically detected anterior and posterior retinal boundaries and the boundaries detected by the examiner. RESULTS: Artefacts were more frequent with TD-OCT (35 vs26%). Mean retinal thickness was significantly higher with SD-SLO/OCT by 30.1 microm (+/-25.8) (P=0.003) in presence of the artefacts and by 39.2 microm (+/-25.8) (P=0.003) after their exclusion. The correlation between the two retinal thickness data sets before exclusion of the artefacts (r=0.59, P<0.001) increased after their removal (r=0.84, P<0.001). A strong correlation was present between the two retinal volume data sets before (r=0.94, P<0.001) and after exclusion of the artefacts (r=0.96, P<0.001). CONCLUSIONS: SD-SLO/OCT produced fewer artefacts than Stratus TD-OCT. This could be attributed to the greater resolution and acquisition speed of SD-SLO/OCT. The macular retinal thickness values measured with SD-SLO/OCT were significantly higher than those measured with Stratus TD-OCT. Retinal volumes measured with Stratus TD-OCT and SD-SLO/OCT were strongly correlated.

Impression cytology with scanning electron microscopy: a new method in the study of conjunctival microvilli.

PURPOSE: Recent studies used impression cytology with scanning electron microscopy (SEM) to study the conjunctival surface of bovine eyes and normal human eyes. The purpose of this study was to evaluate the use impression cytology and SEM (ICSEM) in patients affected by tear film abnormalities. METHODS: Forty-five patients were divided into three groups according to mild, moderate or severe subjective sensation of dry eye. Fifteen asymptomatic subjects served as control group. In all patients the tear film was evaluated with break-up time (BUT), Schirmer's, and Ferning test, whereas conjunctival epithelium was evaluated with impression cytology and optic microscopy (ICOM), and ICSEM. The Spearman rank correlation test was used to compare the outcome of these examinations with the subjective sensation of dry eye in each group, and to identify correlations among the five tests. RESULTS: ICSEM findings highly correlated with subjective dry eye sensation (Spearman correlation coefficient, 796; P<0.01). ICSEM revealed incipient epithelial damage (reduction or absence of microvilli) before the appearance of alterations of nucleus and cytoplasm of epithelial cells revealed by optic microscopy. The number of microvilli was correlated with the degree of tear film abnormalities and subjective sensation of dry eye (Spearman correlation coefficient, 796; P<0.01). CONCLUSION: ICSEM was very effective in detecting the reduction in the number of microvilli. Therefore, it could represent an effective method to detect alterations in the conjunctival epithelium resulting from tear film damage even before the epithelial damage occurs and is detected by optic microscopy.