Prospective, multicenter demographic and epidemiological study on vernal keratoconjunctivitis: a glimpse of ocular surface in Italian population.

PURPOSE: To evaluate the frequency and epidemiological features of vernal keratoconjunctivitis (VKC) in Italy. METHODS: a specific electronic clinical chart for vernal keratoconjunctivitis was created to standardize: 1) medical history; 2) diagnostic criteria; 3) signs and symptoms; and 4) treatments. This study involved 6 Italian referral centers for ocular surface diseases: between March 2005 and March 2006, all referred patients were included, clinical data collected and statistically examined. RESULTS: The mean age of the vernal keratoconjunctivitis population (n = 156) was 13.8 +/- 8.8 with 64.1% of subjects under 14 years of age and a male/female ratio of 3.5:1. Among VKC patients, 48.7% showed associated systemic allergic diseases. Only 32.1% of patients were positive for RAST and/or prick test. The limbal form (53.8%) was the most frequent subtype of vernal keratoconjunctivitis. Approximately 9% of patients showed a severe form of vernal keratoconjunctivitis. At the first visit patients were treated with: multiple action or mast cell stabilizer eye drops (58.1% and 41.3% of cases, respectively), topical corticosteroids alone (0.6%) or in association (26.8% of cases). All patients used topical steroids at least once in the studied year. Systemic antihistamine therapy was used by 25.6% of patients. In this cohort, 32.7% of patients required two or more examinations per year for exacerbations of their symptoms. CONCLUSION: Vernal keratoconjunctivitis is a severe ocular condition that mainly affects young males. Vernal keratoconjunctivitis is characterized by different clinical features and therapeutic responses, suggesting the need for a standardized therapeutic approach on the basis of a grading of disease severity.

Role of cysteine in corneal wound healing after photorefractive keratectomy.

AIMS: To evaluate the efficacy of cysteine oral supplements in corneal wound healing after photorefractive keratectomy (PRK). METHODS: A total of 200 eyes (100 patients) underwent PRK. We divided patients into 2 groups; each group was composed of 50 patients (100 eyes). Group 1 patients were assigned to use oral L-cysteine, with a daily dose of 200 mg (100-mg pills to be taken twice a day) for a duration of 14 days, starting from the week preceding the operation; the patients in group 2 were used as a control, and received the oral supplementation of 40-mg placebo pills to be taken twice a day for a duration of 14 days, starting from the week preceding the operation. RESULTS: All the eyes of patients treated with cysteine oral supplements showed shorter times to re-epithelization than the eyes of the control group. The mean time of corneal wound healing observed in group 1 was 102 +/- 15 h, compared to an average of 159 +/- 9 h in group 2. CONCLUSION: Our research showed that oral cysteine supplementation, in a daily dose of 200 mg, reduces mean corneal wound healing time in patients after PRK.

Scanning laser polarimetry and confocal scanning laser ophthalmoscopy: technical notes on their use in glaucoma.

The mere intraocular pressure (IOP) measurement and the visual field (VF) examination do not allow early primary open-angle glaucoma (POAG) diagnosis. At present, the morphological and morphometric analysis of the optic disk is considered very important for an early diagnosis and follow-up of the disease. The recent introduction of laser systems equipped with new polarimetry techniques (GDx) and confocal tomography (HRT) allows an objective, quantitative, and reproducible evaluation of the morphometry and morphology of the optic disk and retinal nerve fiber layer (RNFL). The GDx, scanning laser polarimetry, studies the RNFL. The HRT, confocal scanning laser tomography, examines several optic disk and peripapillar area parameters. These devices allow obtaining objective and quantitative data concerning RNFL and optic nerve head. They represent complementary and important examinations in case of uncertain POAG diagnosis. The correct evaluation of the parameters studied by these techniques and the knowledge of the instruments' limits are needed for an adequate interpretation of the results obtained.

Treatment of cystoid macular edema in retinitis pigmentosa with intravitreal triamcinolone.

OBJECTIVE: To evaluate the results of treatment with intravitreal triamcinolone acetonide injection in patients with cystoid macular edema secondary to retinitis pigmentosa. METHODS: This prospective, nonrandomized comparative trial included 20 eyes of 20 patients with cystoid macular edema secondary to retinitis pigmentosa (group A) and 20 eyes of 20 control individuals (group B) with the same characteristics who declined treatment. All treated eyes received an intravitreal injection of 0.1 mL of triamcinolone acetonide (4 mg). The total follow-up was 12 months. The main outcome measures were best-corrected visual acuity, central macular thickness measured by optical coherence tomography, and intraocular pressure. RESULTS: No statistically significant changes were observed in best-corrected visual acuity. Central macular thickness showed statistical differences between the 2 groups. Intraocular pressure showed a statistically significant increase after the first day, at 1 month, and at 3 months in both groups but no significant increase afterward. CONCLUSIONS: Intravitreal triamcinolone administration may be useful for select cases of cystoid macular edema in patients with retinitis pigmentosa but its efficacy seems to be limited over time. Therefore, to obtain a good anatomical result and an improvement of best-corrected visual acuity, further treatment would be necessary after 6 months.

One-year clinical results of photorefractive keratectomy with a solid-state laser for refractive surgery.

PURPOSE: To investigate the safety, efficacy, and stability of photorefractive keratectomy (PRK) performed with a newly developed solid-state laser after 1-year follow-up. METHODS: The all-solid-state, Q-switched, frequency-shifted laser (LaserSoft; Katana Technologies, Berlin, Germany) with a Gaussian spot diameter of 0.2 mm and repetition rate of 1 kHz was used. Eleven eyes of six patients were treated with PRK. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal topography, and corneal transparency. All patients were evaluated at 1, 3, 6, and 12 months postoperatively. RESULTS: At 12-month follow-up no eye lost lines of BSCVA and UCVA improved in all eyes. All eyes were within +/- 1.00 diopters (D) and 8 (73%) eyes were within +/- 0.50 D of emmetropia. CONCLUSIONS: Clinical results at 1 year were promising, with good safety, efficacy, and stability of the visual and refractive outcome.

Systemic omega-6 essential fatty acid treatment and pge1 tear content in Sjögren's syndrome patients.

PURPOSE: To determine the effect of oral omega-6 essential fatty acids on PGE(1) tear content and signs and symptoms of ocular discomfort in patients with Sjögren's syndrome (SS). METHODS: This randomized, double-masked, controlled, clinical trial involved 40 patients with primary SS, divided into two groups: group 1: 20 patients (18 women, 2 men; mean age, 36.9 +/- 7.9 years [SD]) treated for 1 month with linoleic acid (LA; 112 mg), and gamma-linolenic acid (GLA; 15 mg) administered twice daily; group 2: 20 patients (19 women, 1 man; mean age, 36.3 +/- 5.5 years) treated twice daily with placebo. Patients underwent three examinations: at baseline (T0), after 1 month of treatment (T1), and 15 days after suspension of treatment (T2). At each examination, the following tests were performed: tear sampling (2 microL) from the inferior meniscus, tear break-up time (BUT), fluorescein stain of the ocular surface, and tear basal secretion. A symptom score was also obtained at each examination. PGE1 was evaluated by enzyme immunoassay. The primary efficacy variable was PGE1 content of tears. RESULTS: The tear PGE1 levels were significantly increased in group 1 at T1 versus T0 (PGE1 level: T0, 44 +/- 5.4 ng/mL; T1, 58.3 +/- 5.5 ng/mL; P < 0.01 versus T0 and group 2 at T1). At examination T2, a statistically significant reduction of PGE1 levels toward baseline was observed (45.7 +/- 5.2 ng/mL; P < 0.01 versus T1). A statistically significant reduction of symptom score was observed in group 1 at examination T1 (P < 0.01 versus T0 and group 2 score). At examination T2, the symptom score was significantly higher than T1 but remained lower than T0. The corneal fluorescein stain in group 1 showed a statistically significant improvement at examination T1 versus T0 and group 2 (P < 0.01). This improvement was also present at T2 (P < 0.02). No statistically significant differences were found for the other tests. No statistically significant changes were observed in the patients in group 2 at all examination time points. CONCLUSIONS: Omega-6 administration increases the PGE1 levels in tears of patients with SS and improves ocular surface signs and symptoms of ocular discomfort.

Experimental and clinical investigation of efficiency and ablation profiles of new solid-state deep-ultraviolet laser for vision correction.

PURPOSE: To investigate the efficiency and ablation profiles of a newly developed, all-solid-state laser platform. SETTING: Experimental investigations performed at Katana Technologies GmbH, Kleinmachnow, Germany, and clinical study, at the Ophthalmology Clinic, University of Messina, Messina, Italy. METHODS: Experimental studies were performed on poly(methyl methacrylate) (PMMA) and in porcine eyes using an all-solid-state, Q-switched, frequency-shifted laser (LaserSoft, Katana Technologies GmbH) with a Gaussian spot with a diameter of 0.2 mm in the target plane, a peak fluence of 350 mJ/cm2, and a repetition rate of 1 kHz. The ablation profiles were determined using a profile meter (MicroProf, Fries Research and Technology GmbH), corneal topography was analyzed with a TMS 2N (Tomey Inc.), and corneal thickness was measured with an ultrasound pachymeter (DGH Technology). In the clinical study, 9 human eyes were treated with photorefractive keratectomy. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal topography, and corneal transparency. The follow-up was 1 month for all eyes and 3 months for 4 eyes. Safety, efficacy, and predictability were evaluated. RESULTS: Smooth profiles were found in the PMMA and the porcine eyes. The topographic maps showed central steepening after the hyperopic ablation and slight central flattening of the surface after the myopic treatment. No eye lost lines of BSCVA; the UCVA improved in all eyes. All eyes were within +/-1.00 diopter (D) of emmetropia, and 89% were within +/-0.50 D. CONCLUSION: The efficacy of the ablation was good, with the profile meter results confirmed by the topographic measurements.

Age-related modifications of the corneal endothelium in adults.

PURPOSE: To obtain the topographical distribution of the corneal endothelial cell density, in different age ranges. METHODS: Three hundred eyes of 204 healthy subjects (110 males (M) and 94 females (F)) aged from 20 to 83 years were evaluated. Participants were divided into three groups according to age. First group (120 eyes) comprised patients aged from 20 to 44 years (mean 32.27 +/- 7.5), the second group (110 eyes) comprised patients aged from 45 to 70 years (mean 54.13 +/- 7.1) and the third group (70 eyes), comprised participants older than 70 years (mean 79.28 +/- 5.9). Specular microscopy was performed in the central zone and in four peripheral points. RESULTS: Central and peripheral cell densities decrease with age (p < 0.05). In young adults the endothelial cell density did not show any significant variation in the central area with respect to the periphery (p > 0.05). In older adults the difference between central and peripheral endothelial cell densities showed the significance level of p = 0.05. CONCLUSIONS: Topographical distribution of the corneal endotheliul cell density is maintained lifelong. Age-related changes involve both center and periphery. The higher peripheral decrement observed in the ancient subjects could be considered as a major finding and in elderly a topographical disparity might occur.

Postural modifications of the oscillatory potentials of the electroretinogram in primary open-angle glaucoma.

The postural variations in the retinal microcirculation in glaucomatous patients were studied by evaluation of the oscillatory potentials (OPs) of the ERG. The OPs in scotopic adaptation were examined in subjects with primary open-angle glaucoma and in an age- and sex-matched normal control group in different body positions (seated, supine, anti-Trendelenburg, Trendelenburg). In the seated position, the difference of mean OP amplitude between the control group and the glaucomatous patients was highly significant (p < 0.001). In the normal subjects the OP amplitude in the Trendelenburg position was statistically lower with respect to the values obtained in all other positions (p < 0.05). In the glaucomatous patient group, the OP amplitude in the anti-Trendelenburg position was increased as compared to the other positions (p < 0.05). The study showed a reduction in amplitude of OPs in glaucomatous patients and their different behaviour in both groups with changes in body position.