Strabismus and postural control: a systematic review.

The primary aim of this systematic review is to evaluate how postural balance and visual system are related in cross-eyed patients. The secondary goal is to assess the benefits of eye realignment on motor skills and body balance. Analyzing two different approaches: surgical or conservative, a systematic literature search was conducted using PubMed-Medline, Google Scholar and Cochrane Central in order to identify randomized controlled trials, case series and case-control studies which contained clinical evaluation of balance in strabismic patients as well as re-evaluation after surgery or conservative treatments via posturography to evaluate surface, length and mean speed of the center of pressure (CoP). A total of 11 studies were included in this review. The MINORS score is used to assess the methodological quality of the included studies, and its mean value was 12.8 for non-comparative studies and 17.5 for comparative studies. The postural balance was lower in strabismic patients compared with the control group, with statically higher value (p < 0.05) of surface, length and mean speed of the CoP in the study group. All patients show improvement in stability after surgery, as surface, length and mean speed of the CoP decreased after surgery in all the studies with statistical significance (p < 0.05).

A novel index for predicting macular thickening after cataract surgery.

PURPOSE: In this study, we tried to investigate weather or not the preoperative anterior chamber depth, the lens thickness (LT) and the relation between these variables by the ratio (K) of the distance from the corneal peak to the posterior side of the lens (A) (K = A/LT) could be predictive for a surgically induced foveal thickening following uneventful cataract surgery in normal, emmetropic eyes. PATIENTS AND METHODS: A total amount of 45 eyes, 25 females and 20 males, were enrolled in this study and underwent uncomplicated phacoemulsification under topical anesthesia. A complete ophthalmological examination was performed preoperatively, including refraction, best corrected visual acuity, slit-lamp examination, biometry and optical coherence tomography of both eyes. These examinations, with the exception of the biometric examination, were repeated one day, one week and four weeks after surgery. RESULTS: The K ratio was positively correlated with the macular thickness changes after cataract surgery. The Pearson correlation analysis of K ratio and foveal thickness changes was 0.792 (y = 36.457x - 52.558, R2 = 0.6266). CONCLUSIONS: A novel ratio that incorporates preoperative ocular parameters has been described. It could be easily measured in a clinical setting, and appears to be strongly predictive for macular thickening following cataract surgery. Of course, further studies enrolling a larger amount of patients are necessary in order to confirm these preliminary data.

Changes in vital signs during cataract phacoemulsification by using peribulbar or topical anesthesia.

AIMS: To compare changes in vital signs and pain level experienced by patients during phacoemulsification and foldable intraocular lens (IOL) implantation using either topical/intracameral or peribulbar anesthesia. MATERIALS AND METHODS: In this prospective, parallel-group clinical study 46 consecutive patients (mean age 72.9 +/- 8.1 years) undergoing cataract surgery were randomized to receive topical/intracameral (group1) or peribulbar (group 2) anesthesia. Systolic, diastolic and mean blood pressures, hearth rate, oxygen saturation and pain level were recorded before and during the anesthesiological procedure and thereafter during each surgical step. RESULTS: Diastolic blood pressure during phacoemulsification and after surgery as well as mean arterial pressure after surgery were significantly higher in group 1 compared to group 2. Variability of systolic and mean arterial pressures across the study phases was significantly higher in group 2 compared to group 1. A significantly higher percentage of patients in group 2 compared to group 1 (35.3% vs 3.4%, p=0.007) showed a heart rate reduction greater than 10% from the anesthesiological to the following surgical phase. Higher incidence of moderate pain in group 2 was reported during the anesthesiological procedure (64.7% vs 3.4%, p<0.00001) while higher incidence of moderate pain was reported in group 1 during phacoemulsification (31% vs 5.9%, p=0.047) and IOL implantation (21.7% vs 2.2%, p=0.02). DISCUSSION: Our short study seems to recommend the use of topical/ intracameral anesthesia for cataract surgery due to more stable heart rate, diastolic and mean blood pressures. However, further studies enrolling a higher amount of patients are necessary to confirm our preliminary data.

Optical devices in highly myopic eyes with low vision: a prospective study.

AIMS: To compare, in relation to the cause of visual impairment, the possibility of rehabilitation, the corrective systems already in use and the finally prescribed optical devices in highly myopic patients with low vision. Some considerations about the rehabilitation of these subjects, especially in relation to their different pathologies, have also been made. MATERIALS AND METHODS: 25 highly myopic subjects were enrolled. We evaluated both visual acuity and retinal sensitivity by Scanning Laser Ophthalmoscope (SLO) microperimetry. RESULTS: 20 patients (80%) were rehabilitated by means of monocular optical devices while five patients (20%) were rehabilitated binocularly. We found a good correlation between visual acuity and retinal sensitivity only when the macular pathology did not induce large areas of chorioretinal atrophy that cause lack of stabilization of the preferential retinal locus. In fact, the best results in reading and performing daily visual tasks were obtained by maximizing the residual vision in patients with retinal sensitivity greater than 10 dB. A well circumscribed area of absolute scotoma with a defined new retinal fixation locus could be considered as a positive predictive factor for the final rehabilitation process. DISCUSSION: A more careful evaluation of visual acuity, retinal sensitivity and preferential fixation locus is necessary in order to prescribe the best optical devices to patients with low vision, thus reducing the impact of the disability on their daily life.

Early lamellar macular hole in Alport syndrome: case report and review of the literature.

PURPOSE AND METHOD: To present a 26-year-old Italian woman affected by genetically ascertained Alport syndrome. The patient underwent a complete ophthalmological examination including: visual acuity, anterior and posterior segment biomicroscopy, MP1-microperimetry, colour fundus retinography, electrofunctional examinations (electrooculogram, electroretinogram, visually evoked potentials), computerized perimetry and Spectral Domain Optical Cohrence Tomography. RESULTS AND CONCLUSIONS: Nephritis, haematuria but no hearing impairment was observed. Visual function was normal, also confirmed by electrofunctional tests and computerized perimetry. The ocular involvement was only expressed by an early lamellar macular hole characterized by a density rarefaction in the tomographic images of both inner retina and superficial choroid. A rarefaction of the inner choroid in the whole macular region and in the peripapillary area, unusual for the young age of the patient, was also evident. We suppose that these tomographic findings might be caused by alterations of type IV collagen, typical of Alport syndrome.

Spontaneous closure of bilateral full thickness macular holes without surgery: an eleven-year follow-up.

PURPOSE AND METHOD: To present a 60-year-old woman affected by bilateral full thickness macular hole, showing without surgery a spontaneous resolution of the disease in both eyes that remains unchanged during an eleven-year follow-up. To our knowledge, this clinical case is uncommon as no similar reports with such a long follow-up have been published in the scientific literature at this time. RESULTS AND CONCLUSIONS: A spontaneous and bilateral closure of full thickness macular holes was detected, as a consequence of a complete posterior vitreous detachment documented by optical coherence tomography images. An initial reduction up to a complete resolution of the central macular scotoma was also observed by performing scanning laser ophthalmoscope microperimetry. Both these anatomical and functional results did not change during the whole period of follow-up. According to this study, the release or the weakening of the vitreous tractions at the foveal edges seems to play a key role in the spontaneous resolution of macular holes in not surgically treated patients.

Prevalence and incidence of age-related cataract in a population sample from Priverno, Italy.

PURPOSE: To study the prevalence and incidence of age-related cataract in a random population sample from the town of Priverno in the Lazio Region, Italy. METHODS: In 1987, 860 people between the ages of 45 and 69 years, already participating in a study on cardiovascular risk factors, underwent an ophthalmological examination. Patients with lens opacities, assessed by a clinical biomicroscopy and a best-corrected VA equal to or worse than 0.2 LogMar (20/30), were defined as age-related cataract cases. Of the 828 patients without age-related cataract at the baseline, 602 were re-examined in 1994. The 7-year Cumulative Incidence was calculated in three ways, as follows: - referring to the baseline sample without age-related cataract; - referring to the follow-up sample without age-related cataract at baseline; and - adjusted for non-response to the follow-up. RESULTS: In the baseline sample, the prevalence of age-related cataract was 3.7% (2.7%-5.2%, 95% C.I.). Cumulative Incidence referring to the baseline sample was 6.5% (4. 8%-8.2%, 95% C.I.); Cumulative Incidence referring to the follow-up sample was 9.0% (6.7%-11.3%, 95% C.I.). Adjusted Cumulative Incidence of age-related cataract was 7.6% (5.6%-9.5%, 95% C.I.). CONCLUSIONS: The study suggests that, in the Priverno sample, aging, but not gender, is a very important risk factor for cataract. The authors conclude that more information is needed on incidence of age-related cataract needing surgical rehabilitation and on risk factors causing both progression of lens opacities and visual loss.