Comparison of IOP obtained in different kind of eyes with contact and no contact tonometers.

BACKGROUND: The aim of this study is to analyze and compare the intraocular pressure (IOP) values measured in three different kinds of participants such as healthy subjects (HS), keratoconus patients (KP), and those who underwent myopic photorefractive keratectomy (MPRK). The devices used in this study are the Goldmann Applanation Tonometry (GAT), the dynamic contour tonometry (DCT), the ocular response analyzer (ORA), and the Corvis ST (CST). SUBJECTS AND METHODS: This research included 92 eyes of 92 h, 63 eyes of 63 KP, and 58 eyes of 58 MPRKM. Each participant underwent a complete ophthalmic evaluation and IOP measurement with GAT, DCT, ORA, and CST. A statistical analysis was conducted to detect possible differences and correlations. RESULTS: First, according to the observed data, HS eyes displayed mean IOP values measured with GAT, DCT, ORA, and CST, respectively, 15.82 ± 2.74 mmHg, 17.63 ± 2.28 mmHg, 16.24 ± 3.14 mmHg, and 17.31 ± 3.21 mmHg. Then, KP eyes showed mean IOP values measured with GAT, DCT, ORA, and CST of, respectively, 14.89 ± 1.64 mmHg, 16.97 ± 2.08 mmHg, 13.09 ± 3.12 mmHg, and 13.78 ± 2.11 mmHg. Finally, MPRK eyes showed mean IOP values measured with GAT, DCT, ORA, and CST of, respectively, 13.92 ± 1.34 mmHg, 15.39 ± 2.86 mmHg, 16.63 ± 2.51 mmHg, and 15.06 ± 1.56 mmHg. CONCLUSION: According to the observed data, ORA and GAT might be used interchangeably in HS, whereas GAT, ORA, and CST in KP eyes. Moreover, it has been noticed that in those eyes that previously undergone a myopic PRK, GAT provided lower values of IOP in comparison with other devices.

Evaluation of efficacy and safety of new high-density dyes for chromovitrectomy.

The purpose of this study is to evaluate the safety and efficacy of two novel heavy dyes for macular surgery: DoubledyneTM and TwinTM. One eye from each of 144 patients undergoing surgery for macular hole or macular pucker was included in the study. The eyes were randomly divided into two groups according to the dye used during surgery. Best correct visual acuity (BCVA), intraocular pressure (IOP) and retinal morphology assessed by ocular coherence tomography (OCT) were evaluated before and 1, 3, 6 and 12 months after surgery. Only one surgeon performed each operation and provided a score ranging from 1 (poor) to 10 (excellent) for quality of staining and comfort in surgery. Statistical analysis was carried out with SPSS to compare parameters before and after surgery and between the two groups. No statistical differences were recorded in quality of staining (p = 0.11), in surgery comfort (p = 0.17) and total time of surgery (p = 0.44) between the two groups. BCVA statistically improved and central macular thickness (CMT) statistically decreased after surgery in both groups (p < 0.05). No toxic dye-related complications or long-term ones affecting the retina were observed in either group. According to this data, although confirmation in further studies with larger populations and longer follow up is required, DoubledyneTM and TwinTM proved to be safe and effective dyes for macular surgery.

Clinical and Molecular Characterization of Achromatopsia Patients: A Longitudinal Study.

Achromatopsia (ACHM) is a rare genetic disorder of infantile onset affecting cone photoreceptors. To determine the extent of progressive retinal changes in achromatopsia, we performed a detailed longitudinal phenotyping and genetic characterization of an Italian cohort comprising 21 ACHM patients (17 unrelated families). Molecular genetic testing identified biallelic pathogenic mutations in known ACHM genes, including four novel variants. At baseline, the patients presented a reduced best corrected visual acuity (BCVA), reduced macular sensitivity (MS), normal dark-adapted electroretinogram (ERG) responses and undetectable or severely reduced light-adapted ERG. The longitudinal analysis of 16 patients (mean follow-up: 5.4 ± 1.0 years) showed a significant decline of BCVA (0.012 logMAR/year) and MS (-0.16 dB/year). Light-adapted and flicker ERG responses decreased below noise level in three and two patients, respectively. Only two patients (12.5%) progressed to a worst OCT grading during the follow-up. Our findings corroborate the notion that ACHM is a progressive disease in terms of BCVA, MS and ERG responses, and affects slowly the structural integrity of the retina. These observations can serve towards the development of guidelines for patient selection and intervention timing in forthcoming gene replacement therapies.

To estimate the safety and efficacy of a 3-D visualization helmet for vitreoretinal surgery.

PURPOSE: To evaluate a 3-D visualization helmet (3DVH) during 23-gauge pars plana vitrectomy (PPV) for macular holes (MH) and macular puckers (MP). METHODS: A total of 184 eyes of 184 patients undergoing PPV for MH or MP were randomly selected for surgery with 3DVH or standard Galilean microscope (GM). Only one highly trained surgeon performed each PPV. A surgical comfort score, ranging from 1 to 10 was recorded after each operation. Statistical analysis was run with SPSS to compare parameters before and after surgery and between the two groups. RESULTS: No statistical differences were found between the two groups for mean best correct visual acuity improvement after surgery (p < 0.001). Mean surgery comfort evaluation was 7.63 ± 0.48 in 3DVH eyes and 8.21 ± 0.62 in GM ones (p = 0.09); mean overall surgical time was 35.12 ± 3.8 min in 3DVH eyes and 32.7 ± 2.27 min in GM ones (p < 0.001); mean peeling time was 14.24 ± 3.42 min in 3DVH eyes and 13.61 ± 4.63 min in GM ones (p = 0.11). CONCLUSIONS: According to the data observed in this study, the 3DVH provides adequate safety and efficacy in retinal and macular visualization during PPV for MH and MP.

Echographic Evaluation of a Subconjunctival Cystic Lesion.

Migration of intraocular silicone oil, used in the treatment of complicated retinal detachment, has been rarely described, but when it happens it can arise with a differential diagnosis with scleral buckling extrusion, tumor, dermoid, ocular cysticercosis, and abscess. The presence of silicone oil in the eye gives very ugly echographic pictures, but these kinds of pictures can be very useful in making a differential diagnosis in the above-mentioned cases. A 39-year-old white female complained of the presence of conjunctival hyperemia and tearing in the right eye (RE); her visual acuity was hand motion, and the intraocular pressure was 14 mmHg. In the upper nasal quadrant a dome shaped lesion was detected. Due to the lens opacities, the patient underwent an echographic examination, which revealed the presence of silicon oil both in the vitreous chamber and in a large subconjunctival space, corresponding to the lesion. This article in addition provides a possible explanation of such cystic formation and discusses the risk factors and the role of the echographic examination in such cases.

Choroidal thickness in open-angle glaucoma measured by spectral-domain scanning laser ophthalmoscopy/optical coherence tomography.

AIMS: To measure macular choroidal thickness in healthy and glaucomatous eyes using spectral-domain scanning laser ophthalmoscopy/optical coherence tomography. METHODS: Choroidal thickness was measured in 21 healthy eyes and 16 glaucomatous eyes. Choroidal thickness was measured under the fovea and at 500-µm intervals from the foveal center to 4 mm in the nasal and temporal directions. Vessels were counted in a macular area of 8,000 µm(2). Only choroidal vessels with a horizontal diameter of at least 155 µm and a vertical diameter of at least 50 µm were considered. RESULTS: The mean choroidal thickness was greatest below the fovea, i.e. 343.8 µm (SD ± 29.06) in controls and 411.56 µm (SD ± 33.60; p < 0.001) in the glaucomatous group. The mean vertical diameter was significantly greater (p = 0.008) in glaucomatous eyes (112.18 ± 37.64 µm) than in healthy eyes (103.98 ± 25.67 µm), whereas the luminal area of vessels was significantly larger (p = 0.3) in glaucomatous eyes (39,157.34 ± 21,657.23 µm(2)) than in healthy eyes (43,779.84 ± 22,874.87 µm(2)). CONCLUSIONS: We show that choroidal thickness is increased in glaucomatous eyes due to an increase in both the vertical diameter and the luminal area of the vessels. This seems to implicate the choroid in the pathogenesis of open-angle glaucoma.

Evaluation of morning glory syndrome with spectral optical coherence tomography and echography.

PURPOSE: To evaluate eyes affected by morning glory syndrome (MGS) with spectral-domain optical coherence tomography (SD OCT) and echography. DESIGN: Prospective case series. PARTICIPANTS: Nineteen patients (22 eyes) with MGS observed at the Eye Department, University of Naples Federico II, Naples, Italy. METHODS: All patients underwent a complete ophthalmologic examination that included best-correct visual acuity, fundus photography, and echography. Nine patients underwent SD OCT and high-frequency B-scan echography (20 MHz). MAIN OUTCOME MEASURES: Spectral-domain optical coherence tomography and echographic findings in MGS. RESULTS: Spectral-domain optical coherence tomography revealed retinal detachment in the conus area of 5 eyes: 4 with noncontractile MGS (NCMGS) and 1 with contractile MGS (CMGS). There was evidence of a retinal break in only 2 cases. All 5 eyes had an abnormal communication between the subarachnoid space and the subretinal space. Spectral-domain optical coherence tomography did not reveal differences between CMGS and NCMGS. Echographic examination did not reveal any anatomic abnormalities of the optic nerve or orbit. CONCLUSIONS: Spectral-domain optical coherence tomography provides more information than echography about the posterior pole, whereas echographic examination is the only technique that can confirm the anatomic integrity of the optic nerve in the orbital wall. Retinal detachment in MGS generally is ascribed to abnormal communication between the subretinal and subarachnoid or vitreous compartments. These data suggest that myopialike retinal detachment without a retinal break may result from tissue stretching around the peripapillary conus.

Evaluation of posterior pole with echography and optical coherence tomography in patients with Behçet's disease.

BACKGROUND: In Behçet's disease posterior segment involvement is very frequent (about 80%). Macular edema is the most commonly observed complication and is related to reduction of visual acuity. The purpose of the study was to evaluate choroidal involvement during posterior vasculitis due to Behçet's disease. METHODS: Thirty eyes (15 patients) presenting with posterior vasculitis due to Behçet's disease were studied. All patients had been evaluated with optical coherence tomography (Stratus OCT, Zeiss) to evaluate the retinal thickness (RT) and with standardized 8-MHz A scan echography to determine the retinochoroidal thickness (RCT). Echographic evaluation with 10- and 20-MHz probes was performed in all cases. RESULTS: In 7 eyes (23.3%), both RT and RCT were normal. In 5 eyes (16.6%), they were both increased. In the other 18 eyes (60%), the RCT was increased while the RT was normal, thus indicating a thickening of the choroid alone. No significant correlation was found between choroidal thickness and the presence of vitreal abnormalities. Neither increases in RT nor those in RCT were significantly related to visual acuity. No correlation was found between RT or RCT and pharmacological treatment. CONCLUSION: Choroidal inflammation could often play a primary etiological role during posterior vasculitis in Behçet's disease. Echographic detection of choroidal thickening in patients with Behçet's disease not presenting with retinal alterations or visual symptoms could represent a useful way to detect an early inflammation, in order to start a proper therapy and to influence the final visual prognosis.

Reliability of a new correcting factor in calculating intraocular lens power after refractive corneal surgery.

PURPOSE: To test the reliability of a corneal radius correcting factor (R factor) in calculating intraocular lens (IOL) power in eyes that developed cataract after refractive surgery and compare it with the clinical history (CHM) and double-K (DKM) methods. SETTING: Department of Ophthalmology, Second University of Naples, Naples, Italy. METHODS: Nineteen eyes from the literature that underwent cataract extraction and IOL implantation after refractive surgery were used to compare actual postoperative and expected refractive errors utilizing the R factor, CHM, and DKM. Intraocular lens powers were calculated with 3 formulas: SRK/T, Hoffer Q and Holladay 1. The differences were evaluated with the Wilcoxon test and Spearman correlation. RESULTS: With the R factor SRK/T and Holladay 1 formulas gave the best results; 16 (84.2%) and 17 (89.5%) eyes were within +/-2 diopters (D) of emmetropia. With CHM, the best results were obtained using the SRK/T and Holladay 1 formulas; with both formulas 12 (63.2%) eyes were within +/-2 D of emmetropia. With DKM, the best results were obtained using SRK/T and Holladay 1 formulas; with both formulas 10 eyes (52.63%) were in the range of +/-2 D from emmetropia. CONCLUSIONS: The R factor can be used with the SRK/T or Holladay 1 formula because this method seems comparable or superior to DKM and CHM.

An unusual intaocular foreign body.

An unusual foreign body in a 60-year-old man with ocular siderosis is described. A surgical needle was found in the eye after magnetic resonance imaging was performed for cerebral ischemia. As a general precaution in patients who have undergone any kind of surgery, it might be better to perform a plain x-ray before performing magnetic resonance imaging to identify such foreign bodies.

Mesalazine-associated benign intracranial hypertension in a patient with ulcerative colitis.

PURPOSE: To report a case of benign intracranial hypertension related to mesalazine use. DESIGN: Observational case report. METHODS: A 23-year-old-woman with sudden visual loss, headache, and a history of ulcerative colitis treated with mesalazine underwent ophthalmologic examination, echography, magnetic resonance imaging, and lumbar puncture. RESULTS: The examinations disclosed benign intracranial hypertension that resolved when mesalazine was discontinued and recurred when the drug was restarted. CONCLUSIONS: We recommend periodic ocular fundus examination for patients undergoing long-term therapy with mesalazine, especially if decreased vision, headaches, or neck stiffness are present, to avoid potentially severe complications of intracranial hypertension

Expulsive hemorrhage before phacoemulsification.

A 65-year-old white man who was scheduled for cataract extraction experienced a sudden increase in intraocular pressure (IOP) with flattening of the anterior chamber immediately after the anterior capsule incision. The eye was sutured, and because no decrease in pressure was noted, surgery was postponed. The presence of the cataract prevented ophthalmoscopic examination. Echographic examination revealed a hemorrhagic choroidal detachment with involvement of the ciliary body. The patient was examined regularly until the choroidal detachment disappeared 4 weeks later. He then had uneventful phacoemulsification and intraocular lens implantation.