Choroidal neovascularization secondary to vitrectomy for idiopathic epiretinal membrane: report of an unusual case.

PURPOSE: Epiretinal membranes (ERM) are a common finding in old patients. Pars plana vitrectomy is effective for removing ERM from the macula, but some postoperative complications are relatively frequent. In the present report, we describe a 73-year-old man in whom extrafoveal choroidal neovascularization developed four months after surgery. METHODS: Choroidal neovascularization was treated by argon laser photocoagulation. RESULTS: Six months after treatment, the choroidal neovascularization was obliterated, with no recurrence of ERM. CONCLUSIONS: Choroidal neovascularization can be an unusual complication of ERM surgery, and should be suspected in case of poor visual outcome or recurrence of symptoms.

A randomised, double masked, clinical trial of high dose vitamin A and vitamin E supplementation after photorefractive keratectomy.

AIM: To evaluate the effect of a high dose vitamin A and E supplementation on corneal re-epithelialisation time, visual acuity and haze following photorefractive keratectomy (PRK). METHODS: Two groups of 20 patients who underwent myopic PRK were supplemented with either 25 000 IU retinol palmitate and 230 mg alpha tocopheryl nicotinate or a placebo. Clinical outcomes were evaluated up to 360 days. RESULTS: In the vitamin treated group, re-epithelialisation time was significantly faster (p = 0.029) and haze incidence was reduced (p = 0.035), especially for high myopic corrections (p = 0.043). This group also reported a significantly better uncorrected visual acuity (p = 0.043). CONCLUSIONS: High dose vitamin A and E oral supplementation may accelerate re-epithelialisation time and may reduce corneal haze formation after PRK.

The effect of early steroid treatment after PRK on clinical and refractive outcomes.

PURPOSE: To evaluate the effects of steroid treatment administered in the first days after excimer laser keratectomy (PRK) on re-epithelialization time, postoperative pain, haze and refractive outcome. METHODS: A randomised, double masked trial was carried out on two groups of patients (40 patients each), who underwent PRK. Group A (steroid group) received 0.1% fluorometholone acetate whereas group B (NSAID group) received 0.5% ketorolac tromethamine until re-epithelialization was completed. Subsequently, all 80 patients received the same steroid treatment: 0.1%, fluorometholone acetate for myopic corrections up to -5 D, or dexamethasone for myopic corrections exceeding -5 D. Both drugs were tapered off over approximately 3 months. Follow-up examinations were planned at 1, 3, 6, 12 months after surgery. RESULTS: Re-epithelialization was completed after three days, without any significant difference between groups. A higher hyperopic shift was shown in the steroid group and a more severe regression was reported in the NSAID group (p<0.001). Haze was significantly reduced in the steroid group (p=0.005), especially for myopic corrections over -5 D (p=0.015). Pain was significantly reduced in the NSAID group (p=0.002). CONCLUSION: Steroid eyedrops administered in the first days after PRK did not affect re-epithelialization time. Moreover, a modulation of the inflammatory response in this period appears to reduce haze and myopic regression in high myopic patients.

A randomized, comparative open-label study on the efficacy of latanoprost and timolol in steroid induced ocular hypertension after photorefractive keratectomy.

PURPOSE: To evaluate the effect of 0.005% latanoprost and 0.50% timolol for the treatment of steroid-induced ocular hypertension (SIOH) after excimer laser photorefractive keratectomy (PRK). METHODS: In this comparative, open-label study we enrolled 29 patients who received steroid therapy after PRK and developed intraocular pressure (IOP) elevation within 30 days of treatment. Fifteen were randomized to 0.005% latanoprost (group A) and 14 to 0.50% timolol (group B). IOP measurements were scheduled at 1, 3, 7, 15, 30, 60, 90 and 120 days of therapy. RESULTS; We did not find any real differences between latanoprost and timolol except at the 7-day and 15-day timepoints, when latanoprost reduced IOP significantly more than timolol (p=0.033, 0.035, respectively). After 7 days of therapy two of the 14 timolol-treated patients had high IOP (24 and 26 mmHg) but these promptly returned to normal when latanoprost was added. No significant differences were observed in the ocular side effects considered. CONCLUSIONS: 0.005% latanoprost is as safe and effective as 0.50% timolol in the treatment of SIOH after PRK. Both drugs provide a significant and stable IOP reduction in the majority of patients after short-term treatment. These findings are encouraging for the use of latanoprost in the management of SIOH after PRK, although further trials are necessary to consider it as a primary treatment.

A randomized, double-masked, clinical study of the efficacy of four nonsteroidal anti-inflammatory drugs in pain control after excimer laser photorefractive keratectomy.

OBJECTIVE: This study assessed the efficacy of 4 nonsteroidal anti-inflammatory drugs (NSAIDs) after excimer laser photorefractive keratectomy (PRK). BACKGROUND: Inadequate control of pain after PRK surgery can be a severe source of distress to patients and can interfere with their willingness to undergo a second PRK procedure. METHODS: This randomized, double-masked, placebo-controlled clinical study was conducted in 125 patients. Four NSAIDs (diclofenac, flurbiprofen, ketorolac, and indomethacin) were tested against a placebo group (artificial tears). Pain levels after PRK were quantified using Present Pain Intensity (PPI) and Pain Rating Indices based on rank values (PRI[R]) scores, both of which were calculated using patient responses to a modified McGill Pain Questionnaire. The PRI(R) consisted of 4 subscales-sensory (S), affective (A), evaluative (E), and miscellaneous (M)-as well as a total score (T). RESULTS: Three hours after PRK, no differences in PPI scores were found between the ketorolac, diclofenac, and indomethacin groups, whereas placebo was significantly less effective than the NSAIDs. Patients who received flurbiprofen reported PPI scores that were significantly lower (P < 0.001) than those of patients who received diclofenac and indomethacin, but PPI scores in the flurbiprofen and the ketorolac groups did not differ significantly. Twenty-four hours after surgery, patients treated with flurbiprofen, ketorolac, and diclofenac reported the lowest PPI scores compared with those treated with indomethacin and placebo (P < 0.001). Moreover, flurbiprofen-treated patients also had the lowest PRI(R)T scores (P < 0.001). When the pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the flurbiprofen group at 24 hours (P < 0.001). The PRI(R)A score was significantly higher in the placebo and indomethacin groups compared with the other groups (P < 0.001). At the 48- and 72-hour time points, flurbiprofen-treated patients again reported significantly lower PPI and PRI(R)T scores (P < 0.001 for both) in pair-wise comparisons with the other treatment groups. The number of patients who self-administered additional oral analgesics did not differ significantly between the groups. However, the mean number of analgesic tablets used was significantly higher in the placebo group than in any NSAID group (P < 0.001). The ketorolac group had the largest number of patients complaining of itching (P < 0.043). No other subjective symptoms were significantly different across groups. Finally, all NSAIDs, except flurbiprofen, prolonged the mean reepithelialization period slightly (P < 0.001). CONCLUSIONS: Flurbiprofen appeared to be the most effective NSAID for the treatment of pain, even at 24 hours after surgery when pain was at a maximum.

Contrast sensitivity measured by 2 methods after photorefractive keratectomy.

PURPOSE: To study contrast sensitivity in eyes that had flying-spot excimer laser photorefractive keratectomy (PRK) and to compare a subjective method (Vision Contrast Test System [VCTS] 6500) and an objective method (visual evoked potential [VEP]) of measuring contrast sensitivity. SETTING: Istituto Clinica Oculistica, Università degli Studi, Bari, Italy. METHODS: Contrast sensitivity changes over time were evaluated in 26 eyes. The baseline values were compared with measurements 3, 6, and 12 months after PRK using the VCTS 6500 and VEP. Contrast threshold and VEP amplitude were classified by myopic correction. RESULTS: Contrast threshold values changed significantly over time (P <.001). Significant differences were found between mean contrast threshold preoperatively and 12 months postoperatively (P <.001) at all spatial frequencies. A significant relationship was established between baseline and 12 month measurements at 18 cycles per degree. Mean VEP amplitude measurements also changed significantly over time (P <.001) and showed a significant relationship between baseline and 12 month measurements (P <.001). A significant relationship was also established between baseline and 12 month VEP amplitude values at 100% of grating contrast. Patients with high myopia complained significantly more at a lower contrast threshold and at lower VEP amplitude values than patients with low myopia. CONCLUSIONS: Three months after PRK, contrast threshold and VEP amplitude values were reduced. Partial recovery was established at 6 months, although patients reported permanent impairment under low-contrast conditions, especially if the myopia correction was more than 6.0 diopters.

A randomized, comparative study of fluorometholone 0.2% and fluorometholone 0.1% acetate after photorefractive keratectomy.

PURPOSE: To compare the efficacy and tolerance of fluorometholone 0.1% acetate and fluorometholone 0.2% eyedrops in the postoperative management of photorefractive keratectomy (PRK). METHODS: A randomised single-blind comparative study was performed on two groups of 30 patients who underwent myopic PRK. The first group was given fluorometholone 0.1% acetate and the second fluorometholone 0.2%. Uncorrected and best corrected visual acuity, haze, IOP and local tolerance were evaluated. Statistical analysis was done using parametric and non-parametric tests. RESULTS: Visual acuity did not differ in the two groups; both were homogeneous as far as refractive error and haze were concerned. Three patients (10%) treated with fluorometholone 0.2% and two patients (6.6%) with fluorometholone 0.1% acetate developed ocular hypertension, but this was not statistically significant. CONCLUSIONS: Fluorometholone 0.1% acetate was effective on inflammation after PRK, with the same efficacy as fluorometholone 0.2%.

[The effect of ursodeoxycholic acid in patients with liver cirrhosis and chronic hypertransaminasemia]. / Effetto dell'acido ursodesossicolico in pazienti con cirrosi epatica ed ipertransaminasemia cronica.

The aim of the study was to evaluate the effect of ursodeoxycholic acid (UDCA) oral administration on alanine aminotransferases (ALT) levels in cirrhotic patients with chronic hypertransaminasemia. Ninety consecutive patients with histologically proven liver cirrhosis and ALT levels higher than twice the upper limit of normal for at least six months, were admitted to the study. All the patients were treated with UDCA 10 mg/kg/day for one year. At the end of this period they were randomized to placebo or to continue UDCA therapy for three further months. ALT levels were evaluated before the beginning of UDCA therapy, at twelve and fifteen months by standard methods. After 12 months of UDCA, ALT decreased significantly (-39 UI, 95% confidence intervals -27 to -52 UI). At the 15 th month ALT did not vary with respect to its values at the 12th month in 36 patients randomized to continue UDCA, while it increased significantly in patients taking the placebo (+11 UI 95% confidence intervals +2 to +19). The results of this study suggest that UDCA is effective in controlling the biochemical activity of the liver disease in cirrhotic patients.

[Factors influencing the effect of ursodeoxycholic acid therapy in chronic hypertransaminasemia]. / Studio dei fattori che influenzano l'effetto della terapia con acido ursodesossicolico nelle ipertransaminasemie croniche.

The aim of this work was to detect, in patients with chronic hypertransaminasemia (CH), the factors associated with the changes of ALT serum levels after one year of 10 mg/Kg/die ursodeoxycholic acid (UDCA). One hundred and twenty two consecutive patients with ALT values more than twice the normal upper limit for at least six months were admitted to the study. At the liver biopsy 82 patients were affected by liver cirrhosis (LC), 7 by chronic persistent hepatitis (CPH), and 14 by chronic active hepatitis (CAH). Nineteen patients were classified as unspecified chronic liver disease (UCLD) due to biopsy refusal. Five patients (4 LC and 1 UCLD) did not finish the study. Before and after the beginning of the treatment ALT and the other routine tests of liver function were determined in serum by routine laboratory methods. In all the diagnosis a decrease of ALT was observed after one year UDCA therapy. Particularly, in cirrhotic patients a reduction of 40% in the ALT serum levels was detected (baseline m +/- ds 98 +/- 55 UI, one year transaminase decrease -39 UI with 95% C.I. -27 UI to -52 UI). Furthermore in liver cirrhosis there was an increase of serum albumin (baseline m +/- ds 3.5 +/- 0.6, one year albumin increase +0.2 gr with 95% I.C. +0.1 gr to +0.3 gr). The decrease of ALT showed an inverse association (p < 0.05) with the presence of antibodies to hepatitis C virus and with diagnosis of CAH, and a direct one with the basal values of ALT.(ABSTRACT TRUNCATED AT 250 WORDS)