Retinal phakomatosis and Von Hippel-Lindau peripheral capillary hemangioblastoma: proposal for staged surgery.

PURPOSE: Retinal capillary hemangioblastoma (RCH) is present in about half of the carriers of the VHL (von Hippel-Lindau) gene mutation and can lead to the evolution of blindness. Herewith is a proposal for surgical intraretinal feeder vessel ligature to induce ischemia the phakoma and to resolve the exudative secondary retinal detachment, with satisfying results at the 6 months follow-up end point. METHODS: The patient underwent a chandelier-assisted 23 G pars plana vitrectomy with valved trocars. A bimanual transretinal ligature of the hemangioblastoma's feeder vessel was performed, followed by localized endolaser to ablate the surrounding retina and capillaries, and a Polydimethylsiloxane 1000 (PDMS 1000) final tamponade. After 3 months, exchange PDMS/air/balanced salt solution (BSS), phacoemulsification, and in-the-bag intraocular lens (IOL) implantation were performed. RESULTS: At sixth month, fundus fluorescein angiography (FFA) showed a significant reduction of blood flow in the phakoma. Final best-corrected visual acuity (BCVA) was 6/6 (9 lines gain obtained compared to the baseline time). CONCLUSIONS: This surgical technique seems to be effective and promising for the treatment of VHL retinal capillary hemangioblastomas and their related retinal complications.

Herbal and Natural Treatments for the Management of the Glaucoma: An Update.

Glaucoma causes the degeneration of the retinal ganglion cells (RGCs) and their axons, inducing a tissue reshaping that affects both the retina and the optic nerve head. Glaucoma care especially focuses on reducing intraocular pressure, a significant risk factor for progressive damage to the optic nerve. The use of natural treatments, such as herbs, vitamins, and minerals, is becoming increasingly popular today. While plants are a rich source of novel biologically active compounds, only a small percentage of them have been phytochemically examined and evaluated for their medicinal potential. It is necessary for eye care professionals to inform their glaucoma patients about the therapy, protection, and efficacy of commonly used herbal medicines, considering the widespread use of herbal medicines. The purpose of this review is to examine evidence related to the most widely used herbal medicines for the management and treatment of glaucoma, to better understand the potential benefits of these natural compounds as supplementary therapy.

Evaluation of Tropicamide-Phenylephrine Mydriatic Eye Drop Instillation on Choroidal Thickness.

The purpose of this study is to evaluate choroidal thickness (ChT) at the subfoveal and peripheral level after the instillation of 0.5% tropicamide + 10% phenylephrine 9 hydrochloride eye drops by using OCT scans in enhanced depth image (EDI) mode. In total, 53 patients (30 males and 23 females) were involved, and the mean age was 25.62 ± 2.41 (age range: 23-36). The dominant eye was treated with tropicamide + phenylephrine (Visumidriatic Fenil 100 mg/mL + 5 mg/mL, Visufarma) while the nondominant eye was used as the control. An OCT analysis was performed on both eyes before and 30 min after the instillation of a drop of mydriatic in the dominant eye. The ChT was measured by using the OCT software measurement tool (Spectralis; Heidelberg Engineering; Heidelberg, Germany, version 6.0). The results showed a statistically significant ChT decrease (p = 0.009) in the temporal sector after the treatment with tropicamide + phenylephrine. In the subfoveal and nasal sectors, no statistically significant ChT changes were detected (p = 0.94; p = 0.85) following the administration of the mydriatic eye drops. The ChT thinning in the temporal sector following the instillation of the tropicamide + phenylephrine eye drops suggests that in the case of ChT studies, mydriatic administration should be avoided.

Comparison between dynamic contour tonometry and Goldmann applanation tonometry correcting equations.

In order to investigate the reliability of correcting GAT formulas in comparison with dynamic contour tonometry (DCT), this study included 112 right eyes of 112 healthy subjects aged from 21 to 77 years, whose eyes underwent to a full ophthalmologic exam. IOP was measured in each eye with DCT and then with GAT. IOP values obtained with GAT were corrected with 10 equations and then compared with those provided by DCT. Participants mean age was 42.24 ± 14.08 years; mean IOP measured with DCT was 17.61 ± 2.87 and 15.50 ± 2.47 mmHg, measured with GAT. The mean discordance between DCT and GAT measurements was 2.11 ± 2.24 mmHg. All the correcting formulas, but Srodka one (p ˂ 0.001), tend to increase the difference between GAT and DCT. According to these results Sródka equation provides the best correction, reducing the difference between the two IOP measurement methods of - 0.03 ± 0.85 mmHg. Other equations do not provide a valid improvement of the agreement between the two methods or they provide a worsening of the agreement.

Optic Nerve Ultrasound Evaluation in Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is a disease with a heterogeneity of possible causes, which needs to be quickly diagnosed. Ocular ultrasonography could be considered a useful tool to diagnose this condition in a fast and non-invasive way. In fact, Karl Ossoinig had already proposed this diagnostic tool in the 1970s for the evaluation of intracranial pressure changes under several pathological conditions, including idiopathic intracranial hypertension. The aim of this review is to analyze scientific articles published in the last 30 years concerning the use of ocular ultrasonography to assess optic nerve indices in patients with idiopathic intracranial hypertension. Specifically, 15 published articles found in PubMed database were included and analyzed in the present review. Our conclusion suggests that ocular ultrasonography is a reliable diagnostic technique to be utilized in all the cases of suspected raised intracranial pressure. To obtain the best possible accuracy and precision in the least invasive way, standardized A-scan seems to be the best choice.

Comparison between two devices in the detection of corneal thickness changes after cataract surgery.

This study compared corneal thickness (CT) changes obtained with specular microscopy (SM) and a rotating Scheimpflug camera (RSC) after conventional phacoemulsification surgery (PS). One hundred sixty six eyes of 83 patients were analyzed before and one month after PS. One eye underwent PS, while the fellow phakic one was used as control. CT was measured with SM at the center of the cornea and with RSC at the pupil center, at the corneal apex and at the thinnest point. In the operated eye, SM showed a larger CT mean increase than those one detected at the three different measurements' points evaluated by RSC. Inversely, in the fellow phakic eye, SM showed a greater CT mean decrease than those one registered by RSC at its three measurement's points. Thus, one month after surgery, even if cornea appears clear at the slit-lamp, a significant thickness increase is still present. This is even more evident if the slight decrease of the fellow phakic eye is considered. The differences between the two devices are probably related to the different measured areas.

A case of late-onset larynx angioedema after ranibizumab intravitreal injection: Ranibizumab-related angioedema.

This case report describes an unusual case of late-onset larynx angioedema after ranibizumab intravitreal injection. A 72-year-old female patient presented to our clinic for decreased vision; right eye (RE) fundoscopy and optical coherence tomography (OCT) revealed mild chorioretinal atrophy and choroidal neovascularization with subretinal fluid. A ranibizumab injection was planned in the RE, with standard pretreatment with daily oral administration of betamethasone, cetirizine, and ranitidine because her medical history revealed two adverse drug reactions (ADRs) to contrast media (CM). Despite the premedication, 2 h after injection, the patient referred throat closing sensation and dyspnea that resolved within few hours by betamethasone 4 mg intramuscular injection, without further reoccurrence. In occasion of the second intravitreal injection, video rhinofibrolaryngoscopy revealed subglottic edema that resolved within few hours by betamethasone 4 mg intramuscular injection. This report suggests that, even in cases of intravitreal injection, patients with history of allergy, despite the anti-allergic treatment, should be hospitalized to detect late onset of such a life-threatening complication.

Measurement of corneal thickness using Pentacam HR versus Nidek CEM-530 specular microscopy.

OBJECTIVE: To compare corneal thickness (CT) measurements using the CEM-530 (Nidal, Gamagori, Japan) and Pentacam HR (Oculus, Wetzlar, Germany). METHODS: The CT of 209 healthy subjects (209 right eyes) aged 24 to 89 years (71.35 ± 10.72 years) was measured at the corneal apex (CA), pupil center (PC), and thinnest point (TP) with the Pentacam HR and at the corneal center with the CEM-530 in random order at the same time of day. RESULTS: A good correlation but statistically significant difference was found between the CEM-530 and Pentacam HR measurements at the CA (6.10 ± 8.12 µm, R2 = 0.8947), PC (7.46 ± 8.57 µm, R2 = 0.8826), and TP (12.44 ± 10.04 µm, R2 = 0.8392). Comparison of the two devices produced the following regression formulas: y = 0.8859x + 57.644 for the CA, y = 0.8852x +56.657 for the PC, and y = 0.8557x + 68.148 for the TP, where x is the CT obtained with the CEM-530 and y is that obtained with the Pentacam HR. CONCLUSIONS: These findings indicate that the CEM-530 produces a thicker corneal measurement than the Pentacam HR. The herein-proposed correcting factors are needed to reliably compare these devices.