Autologous cultivated limbal stem cell transplantation after failed previous limbal graft.

PURPOSE: To describe a case of unilateral limbal stem cell deficiency (LSCD) with previously failed autologous graft, resolved by ocular surface reconstruction using cultured autologous limbal stem cells from the contralateral eye. CASE REPORT: A 35-year-old patient presented to our clinic with LSCD due to a unilateral alkali burn. The patient had received a previous limbal graft from the contralateral eye that had failed to impede corneal conjunctivalization. We decided to repeat limbal stem cell transplantation using an ex vivo cultivation procedure to reduce the risk of tissue harvesting on the healthy fellow eye. A small limbal biopsy (1.5 × 1.5 mm) near the previously excised limbus was performed. Stem cells were then isolated and cultured on fibrin and a 3T3 feeder cell layer using a standard protocol. Four months later, the cultivated cells on fibrin were grafted after pannus removal. In the subsequent months, the ocular surface stabilized and inflammation decreased. Two years later, the patient underwent large tectonic lamellar keratoplasty for severe corneal thinning involving the entire cornea, and 6 months later central penetrating keratoplasty and extracapsular cataract extraction with intraocular lens implantation and pupilloplasty was performed. Following reconstruction, the patient showed improved best-corrected vision from count fingers to 20/200 due to amblyopia, and the ocular surface was stable with a transparent corneal graft. CONCLUSIONS: Ex vivo limbal stem cell transplantation is a valid technique for treating LSCD and can be utilized for treating patients who have had previous failed limbal grafts.

Intravitreal bevacizumab for juxtafoveal choroidal neovascularization secondary to multifocal choroiditis.

PURPOSE: To assess the effects of intravitreal bevacizumab injections in the treatment of juxtafoveal choroidal neovascularization associated with multifocal choroiditis. METHODS: Prospective interventional case series. Fourteen patients (14 eyes) affected by juxtafoveal choroidal neovascularization secondary to multifocal choroiditis were examined. All patients underwent a complete ophthalmologic examination, including measurement of best-corrected visual acuity using Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography, and fluorescein angiography. The protocol treatment included a first injection, followed by repeated intravitreal bevacizumab injections over a 12-month follow-up period on the basis of optical coherence tomography parameters and angiographic features. RESULTS: Mean best-corrected visual acuity changed from 0.41 logarithm of the minimum angle of resolution (approximately corresponding to 20/51 Snellen equivalent), at baseline, to 0.16 ± 0.13 logarithm of the minimum angle of resolution (approximately corresponding to 20/28 Snellen equivalent), at the 12-month examination (P < 0.002). A functional improvement of at least 3 Early Treatment Diabetic Retinopathy Study lines was achieved by 6 eyes (43%) at the 12-month examination. Mean central macular thickness at baseline was 318 µm, reducing to 239 µm at the 12-month examination (P < 0.001). No eye showed choroidal neovascularization extension to the fovea. CONCLUSION: Intravitreal bevacizumab is a beneficial treatment for juxtafoveal choroidal neovascularization associated with multifocal choroiditis. Further studies are warranted to confirm these preliminary results.

Bilateral choroidal neovascularization associated with bilateral ABCA4 gene mutation.

PURPOSE: To describe a case of ABCA4 gene mutation (G1961E) associated with bilateral choroidal neovascularization (CNV) treated with intravitreal ranibizumab injections. METHODS: A 52-year-old man with bilateral CNV associated with ABCA4 gene mutation underwent complete ophthalmologic examination over a 30-month follow-up and was treated with intravitreal ranibizumab injections on an as-needed basis. RESULTS: Baseline best-corrected visual acuity (BCVA) was 20/32 in the right eye (RE) and 20/63 in the left eye (LE). Two small CNVs with juxtafoveal location were detectable in the RE, whereas a single subfoveal CNV was visible in the LE. Overall, 6 and 9 intravitreal ranibizumab injections were administered in RE and LE, respectively, during the 30-month follow-up. At the end of the follow-up, BCVA was 20/100 in the RE and 20/200 in the LE. CONCLUSIONS: This case report reveals that ABCA4 gene mutation may be complicated by multiple and bilateral CNVs. Intravitreal injection of ranibizumab can achieve temporary CNV stabilization, but cannot guarantee complete quiescence over a long-term follow-up. Other therapeutic approaches could be necessary to accomplish visual acuity preservation.

New perspectives in the management of post-surgical macular edema.

Post-surgical macular edema is the most common cause of vision loss after phacoemulsification, and one of the main causes of reduced vision in patients undergoing other ocular surgery. At present, there are no reliable randomized clinical trials specifically designed to define the best therapeutic approach, and little information is available regarding the treatment algorithm of acute or chronic forms. As a consequence, there is no agreement regarding the current management of post-surgical macular edema. Many therapeutic options have been proposed on the basis of the hypothesized pathogenetic mechanism of post-surgical macular edema. New therapies for post-surgical macular edema include non-steroidal anti-flammatory drugs and intraocular steroid implants. Aim of the review is to update the current management of postsurgical macular edema, reporting on the most recent therapeutic advances. In particular, we discuss the potential applications of recent patents with topical and intravitreal drugs.