Biofeedback stimulation in patients with age-related macular degeneration: comparison between 2 different methods.

OBJECTIVE: To evaluate changes in patient's visual performance after rehabilitation training with 2 different biofeedback training programs offered by the MP-1 microperimeter. Spontaneous retinal location of preferred retinal loci (PRLs) and fixation stability are not always optimal for best visual performances. MP-1 microperimeter biofeedback techniques have been suggested as modalities for training for better fixation stability and to find a better location of the new PRL in a more useful area of the retina in nonoptimal cases. The MP-1 microperimeter offers different biofeedback strategies, such as acoustic biofeedback and structured light stimulus plus acoustic biofeedback. DESIGN: Retrospective study. PARTICIPANTS: Thirty subjects affected by age-related macular degeneration with absolute central scotoma. METHODS: A standard protocol of examination before and after visual rehabilitation training was performed on all study subjects. Assessment included demographics data, visual acuity, fixation stability, retinal sensitivity, and reading speed. Rehabilitation training was performed with standard and structured stimulus biofeedback. The whole sample was divided into 2 groups of 15 patients attending the 2 different stimulation training biofeedback. RESULTS: Mean reading speed was found to be significantly increased for both groups (p < 0.05 and p < 0.01). Also, a statistically significant improvement of fixation stability was registered for both groups (p < 0.01). Only patients trained with the flickering pattern biofeedback stimulation increased retinal sensitivity (p < 0.01). CONCLUSIONS: Both regular biofeedback and flickering pattern biofeedback training seem to improve visual functions. More benefits seem to be accrued, however, with flickering pattern biofeedback training.

Allergic conjunctivitis: a comprehensive review of the literature.

Ocular allergy represents one of the most common conditions encountered by allergists and ophthalmologists. Allergic conjunctivitis is often underdiagnosed and consequently undertreated. Basic and clinical research has provided a better understanding of the cells, mediators, and immunologic events, which occur in ocular allergy. New pharmacological agents have improved the efficacy and safety of ocular allergy treatment. An understanding of the immunologic mechanisms, clinical features, differential diagnosis, and treatment of ocular allergy may be useful to all specialists who deal with these patients. The purpose of this review is to systematically review literature underlining all the forms classified as ocular allergy: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratocongiuntivitis, contact allergy, and giant papillary conjunctivitis.

Relationship between fixation stability measured with MP-1 and reading performance.

BACKGROUND: People with visual impairment have reduced reading performance, which is thought to be related to unstable or eccentric fixation. New microperimeters such as the MP-1 offer straightforward analysis of fixation stability. The aim of this study was to investigate the relationship between fixation stability and reading speed in a large cohort of people with diverse causes of visual impairment and to verify the correlation between reading speed and different methods for the quantification of fixation. METHODS: The better eye of one hundred and twenty subjects was assessed. Fixation values were obtained from the MP-1 microperimeter. Reading speed was evaluated using newspaper text with magnifiers if required. RESULTS: The poorest fixation stability and reading performance was found in people with age-related macular degeneration while the best fixation was in retinitis pigmentosa subjects. A linear relationship was found between reading speed and the proportion of fixations within 2° (r² = 0.51, p < 0.001) and 4° (r² = 0.36, p < 0.001). A negative correlation was found between reading speed and all three bivariate contour ellipse areas (BCEA; for log transformation of 1-S.D., 2-S.D. and 3-S.D.: r² = 0.39, p < 0.001). In a multiple regression model, proportion of points falling within 2° and 4° circle was significantly related to reading speed (r² = 0.55, p < 0.01; r² = 0.43 p < 0.01); also BCEAs values were strongly related to reading ability only in patients with central vision loss (r² = 0.62, p < 0.01 for LogBCEA 68.2%; r² = 0.61, p < 0.01 for LogBCEA 95.4% and 99.6%) and peripheral defect (r² = 0.52, p < 0.01 for LogBCEA 68.2%; r² = 0.50, p < 0.01 for LogBCEA 95.4%; r² = 0.49, p < 0.01 for LogBCEA 99.6%) but not in combined defect subjects. CONCLUSIONS: The study confirms that in people with visual impairment the reduced reading performance is correlated with fixation instability. Moreover, there is a strong relationship between reading speed and both the proportion of fixations falling within 2° and 4° and bivariate contour ellipse area values.

Pattern ERG and RNFL thickness in hypertensive eyes with normal blue-yellow visual field.

PURPOSE: To evaluate the transient pattern electroretinogram (t-PERG) and the retinal nerve fiber layer (RNFL) thickness in eyes with ocular hypertension (OH) and normal short-wavelength automated perimetry (SWAP). METHODS: In 26 patients with bilateral OH with normal SWAP, and in 26 age and sex matched healthy controls, t-PERG recording and RNFL thickness measurement were performed. Mean deviation (MD) and pattern standard deviation (PSD) of a reliable full threshold 24-2 SWAP were considered. RNFL thickness was determined by OCT3. Monocular PERG were recorded by using a black and white checkerboard pattern (check size 0.9°, contrast 100 %, mean luminance 80 cd/m2) generated on a monitor and reversed in contrast (four reversals per second, 2 Hz) at a distance of 70 cm. Patients had optimal correction at viewing distance; no mydriatic or miotic eye drops were used. Silver/silver chloride skin electrodes were placed over the lower eyelids in the stimulated eye (active electrode) and in the patched eye (reference electrode); ground electrode was in the Fpz scalp. Peak-to peak amplitude of P50 (N35-P50) and N95 (P50-N95) waves, and implicit time of P50, were considered. RESULTS: Compared to controls, in OH eyes, a reduction of N35-P50 amplitude (2.86 ± 1.49 vs. 3.77 ± 1.08 microvolts, -24.1 %, t-test p = 0.015), of average RNFL thickness (88 ± 11 vs. 96 ± 10 µm, -9.5 %, t-test p = 0.002), and of RNFL thickness in superior (p = 0.015) and inferior quadrant (p < 0.001), were found. Multivariate analysis showed that in OH eyes, N35-P50 amplitude was inversely related to intraocular pressure (IOP) (p = 0.001); no correlation was found between N35-P50 amplitude and MD, PSD, CCT or RNFL thickness. CONCLUSIONS: In OH eyes, both PERG and RNFL thickness changes occur in hypertensive eyes with undamaged SWAP; the correlation of PERG amplitude with IOP, but not with RNFL thickness, suggests that such PERG changes are an effect of the IOP on retinal ganglion cells, rather than a sign of their loss.

Diathermy of leaking sclerotomies after 23-gauge transconjunctival pars plana vitrectomy: a prospective study.

PURPOSE: To evaluate the efficacy of bipolar diathermy in ensuring closure of leaking sclerotomies after complete 23-gauge transconjunctival sutureless vitrectomy. METHODS: In this prospective, interventional case series, in 136 eyes of 136 patients with at least one leaking sclerotomy at the end of a complete 23-gauge transconjunctival sutureless vitrectomy, external bipolar wet-field diathermy was applied to leaking sclerotomies, including the conjunctiva and sclera. Intraoperative wound closure, and postoperatively, at 6 hours, 1 day and 3 days, sclerotomies leakage, intraocular pressure, hypotony, and hypotony-related complications were evaluated. RESULTS: Intraoperative closure was achieved in 231 of 238 leaking sclerotomies (97%) that received diathermy. One of these with postoperative leakage needed suture. Compared with baseline (14.4 ± 2.8 mmHg), mean intraocular pressure was lower at 6 hours (13.2 ± 3.8 mmHg, Tukey-Kramer P < 0.001) and not different at 24 hours or 72 hours. Hypotony (intraocular pressure <5 mmHg) was observed in 6 eyes (4.5%) at 6 hours, in 2 (1.5%) at 24 hours, and in none at 3 days. Logistic regression analysis showed that, 6 hours postoperatively, hypotony was related to younger age (≤50 years) at surgery (P = 0.031). No hypotony-related complications were recorded. CONCLUSION: Bipolar wet-field diathermy of sutureless sclerotomies is an effective method for ensuring a leaking sclerotomies closure.

Foveal microstructure and functional parameters in lamellar macular hole.

PURPOSE: To evaluate the morphologic features of the photoreceptor layer (by spectral-domain optical coherence tomography) and functional parameters in patients with a lamellar macular hole. DESIGN: Prospective, multicenter, observational case series. METHODS: Fifty-four patients with lamellar macular hole were enrolled in the study. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) testing, MP1 microperimetry, and spectral-domain optical coherence tomography. For each patient, 2 experienced masked observers evaluated the integrity of photoreceptor inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM) line. RESULTS: Spectral-domain optical coherence tomography analysis showed complete integrity of the IS/OS junction and ELM line in 40 eyes (group A), partial or complete disruption of the IS/OS junction with an intact ELM line in 8 eyes (group B), and an alteration of both IS/OS junction and ELM line in 6 eyes (group C). Mean BCVA, total retinal sensitivity, and fixation stability were significantly better in groups A and B than in group C (both P < .05, Tukey-Kramer test), whereas there was no significant difference between groups A and B. Mean central retinal sensitivity was significantly different among all 3 groups (all P < .05, Tukey-Kramer test). The grade of integrity of the foveal photoreceptor layer was correlated significantly with mean BCVA (r = -0.57; P < .001), mean central retinal sensitivity (r = 0.52; P < .001), and total retinal sensitivity (r = 0.44; P < .001). CONCLUSIONS: In lamellar macular hole, the morphologic features of the foveal photoreceptor layer consistently are correlated with BCVA and central retinal sensitivity. Preservation of the ELM is related to the maintenance of visual acuity.

Ultrasound biomicroscopic analysis of iris-fixed acrylic intraocular lens in the absence of capsule support.

The aim of the study was to investigate postoperative complications and to determine with ultrasound biomicroscopy (UBM) the position of a foldable acrylic intraocular lens (IOL) implanted with a surgical technique of iris suturing in eyes without capsule support. Six eyes with iris-sutured IOLs were examined postoperatively with UBM. The examination included the position of haptics and their relationship to the surrounding structures. Other parameters studied were central anterior chamber depth, IOL iris contact and pigment dispersion. The position of all 12 haptics was determined. All haptics were in touch with the iris. Pigment dispersion was seen in two cases. The anterior chamber depth of the sutured eyes was normal. There was neither cystoid macular edema nor chronic uveitis postoperatively. In conclusion, in most cases surgical placement of iris-fixed lenses is a blind procedure and UBM could be an appropriate method to determine the position of IOL haptics postoperatively and to demonstrate that this surgical technique is reproducible, safe, and effective with the limitation of the difficulty of iris suturing IOL.

The role of ultrasound biomicroscopy in the diagnosis of temporal arteritis.

Temporal artery biopsy is considered the gold standard for the diagnosis of temporal arteritis (TA). The aim of the study was to determine whether ultrasound biomicroscopy (UBM) findings are useful in predicting the result (positive or negative) of temporal artery biopsy in patients with TA. Sixteen consecutive patients (ten women and six men) with clinical diagnosis of TA seen at the Ophthalmology Unit, S. Marta Hospital, Catania University, were included in the study. All patients were submitted to UBM (50-MHz transducer, P45 Plus Paradigm Medical Instruments, Salt Lake City, UT, USA) before temporal artery biopsy. The results were correlated with histopathologic changes. Seven patients presented histopathologic findings consistent with the diagnosis of TA. Thus, UBM findings of these patients were compared with those of the nine patients with negative biopsy. On UBM, we searched for the presence of a hypoechoic effect surrounding the walls of temporal arteries, so-called halo sign, as well as for the intra-arterial middle reflexive filling, so-called intra-arterial filling. The halo sign and intra-arterial filling were found in all seven (100%) patients with biopsy-proven TA. However, in five (55.5%) patients, the absence of these two parameters on UBM of patients with suspected TA strongly suggested that temporal artery biopsy would be negative (negative predictive value, 100%). On the other hand, four (44.5%) of nine patients with negative biopsy presented one of these two UBM findings. In conclusion, this preliminary work suggested UBM to be an appropriate noninvasive tool for morphological imaging and evaluation of temporal arteries, helpful in obtaining an indication of the side and segment for biopsy, and may play a role in predicting negative result of temporal artery biopsy in patients with TA; however, for the time being we cannot recommend any change in the current practice.

Intrasession reproducibility of RNFL thickness measurements using SD-OCT in eyes with keratoconus.

BACKGROUND AND OBJECTIVE: To evaluate the intrasession reproducibility of the peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained by spectral-domain optical coherence tomography (SD-OCT) in eyes with keratoconus and normal eyes. PATIENTS AND METHODS: Peripapillary RNFL thickness measurements with SD-OCT were repeated three times during the same visit using the eye tracker and retest function in one eye of each participant. Reproducibility was evaluated using within-subject standard deviation (Sw), coefficient of variation (CV), and intraclass correlation coefficient (ICC). RESULTS: For the overall global RNFL thickness, the values of the three parameters were Sw (± 1.96 standard error) 1.43 ± 0.24, CV 1.28%, ICC (95% confidence interval) 0.969 (range: 0.947-0.983) in control eyes and Sw (± 1.96 standard error) from 1.41 ± 0.26 to 1.57 ± 0.34, CV from 1.18% to 1.37%, and ICC (95% confidence interval) from 0.951 (range: 0.909-0.976) to 0.977 (range: 0.938-0.993) in eyes with keratoconus. CONCLUSION: Measurement of peripapillary RNFL thickness by SD-OCT shows a good intrasession reproducibility in eyes with keratoconus.

Intraocular pressure and central corneal thickness in premature and full-term newborns.

PURPOSE: To evaluate the intraocular pressure (IOP) and central corneal thickness (CCT) in premature and full-term newborns. METHODS: IOP and CCT were determined in 33 premature (mean [± SD] gestational age 31 ± 3 weeks, mean birth weight 1474 ± 354 g) and in 33 full-term white newborns (mean gestational age 39 ± 1 weeks, mean birth weight 2763 ± 574 g). The mean age after birth at measurement was respectively 3 ± 1 weeks and 1 ± 1 weeks. Infants with any ocular abnormalities, such as corneal and iris alterations, congenital cataract, retinopathy, glaucomatous corneal and optic disk changes (horizontal corneal diameter >10 mm Hg, C/D >0.4), or familial congenital glaucoma were excluded. IOP was determined with the use of only topical anesthesia with a Tono-Pen XL tonometer and a wire lid retractor, and then CCT was determined by means of a portable pachymeter. RESULTS: Mean IOP was 18.9 ± 3.7 mm Hg (range, 13-25) in premature and 17 ± 2.6 mm Hg (range, 12-22) in full-term newborns (P = 0.018 after correction by age after birth). Mean CCT was 599 ± 36 µm (range, 524-720 µm) in premature infants and 576 ± 26 µm (range, 489-650 µm) in the full-term group (P < 0.001 after correction by age after birth). Multivariate analysis showed that IOP increased with increasing CCT (P = 0.025) and that CCT declined with increasing birth weight (P = 0.026). CONCLUSIONS: In premature newborns, IOP measurements were slightly greater than in full-term newborns because of an increased CCT.

Functional retinal changes measured by microperimetry in standard-fluence vs low-fluence photodynamic therapy in chronic central serous chorioretinopathy.

PURPOSE: To evaluate the effect of low-fluence photodynamic therapy (PDT) on central retinal sensitivity and fixation stability as compared with standard-fluence PDT for treating chronic central serous chorioretinopathy (CSC). DESIGN: Prospective longitudinal follow-up of patients enrolled in a nonrandomized clinical trial of standard-fluence vs low-fluence PDT in chronic CSC. METHODS: Forty-two eyes (42 patients) with chronic CSC were enrolled; 19 eyes received indocyanine green angiography-guided standard-fluence PDT (50 J/cm(2)) and 23 received indocyanine green angiography-guided low-fluence PDT (25 J/cm(2)). Retinal sensitivity in the central 12 degrees and fixation stability were evaluated by MP-1 microperimeter at baseline and at 3 and 12 months after PDT. RESULTS: Mean central retinal sensitivity improved significantly at all time points (at 12 months vs baseline P < .01, Tukey-Kramer test), in the standard-fluence group from 11.9 to 14.4 at 12 months, and in the low-fluence-group from 11.8 to 16.3, with a significant difference between the 2 groups (P = .04, t test). Fixation stability did not change in either group (not significant, analysis of variance). At 12 months' follow-up the retinal sensitivity significantly correlated with best-corrected visual acuity in both groups (standard-fluence, r = -0.52, P = .02; low-fluence, r = -0.54, P = .01). CONCLUSIONS: The study shows a significant improvement in macular sensitivity after PDT in eyes with chronic CSC, with greater efficacy in low-fluence-treated eyes. Microperimetry data suggest that low-fluence PDT may be a good treatment option in patients with chronic CSC.

Enhanced depth imaging optical coherence tomography of the choroid in idiopathic macular hole: A cross-sectional prospective study.

PURPOSE: To determine the choroidal thickness in the macular area in patients with idiopathic macular hole in one eye and an unaffected fellow eye and in healthy controls. DESIGN: Cross-sectional, prospective study. METHODS: Twenty-two patients with a full-thickness unilateral idiopathic macular hole and 22 age- and sex-matched controls were recruited. Enhanced depth imaging optical coherence tomography images were obtained by using spectral-domain optical coherence tomography. The choroidal thickness was measured in the subfoveal area and 1000 µm and 2000 µm away from the fovea in the nasal and temporal regions. The diameter of the macular hole and the axial length were determined. RESULTS: Choroidal thickness was significantly different across the 3 groups at all locations (P < .001, analysis of variance). The choroid was significantly thinner in eyes with idiopathic macular hole and in unaffected fellow eyes than in the control group (P < .01, Tukey-Kramer test). The mean subfoveal choroidal thickness was 183.2 µm in the idiopathic macular hole group, 196.6 µm in the fellow-eye group, and 245.0 µm in the control group. A negative correlation between subfoveal choroidal thickness and axial length was found in all groups (macular hole, r = -0.53, P = .01; fellow eyes, r = -0.56, P < .01; controls, r = -0.52, P = .01); in control eyes, a negative correlation was found between choroidal thickness and age (r = -0.48, P = .02). CONCLUSIONS: Choroidal thickness was reduced in eyes with idiopathic macular hole and also in fellow unaffected eyes. This may suggest a contributing role of the choroid in the pathogenesis of idiopathic macular hole.

Scleral buckle for progressive symptomatic retinal detachment complicating retinoschisis versus primary rhegmatogenous retinal detachment.

OBJECTIVE: To compare the functional and anatomic outcomes of encircling scleral buckle placement for the repair of progressive symptomatic retinal detachment complicating retinoschisis (PSRDCR) with outer-layer breaks (OLBs) posterior to the equator versus primary rhegmatogenous retinal detachment (RRD). DESIGN: Retrospective comparative case series. PARTICIPANTS: Thirty-seven patients with PSRDCR with OLBs posterior to the equator (group A) and 703 patients with primary RRD (group B). METHODS: All eyes were treated with an encircling scleral silicone band (style 240). External drainage of subretinal and retinoschisis cavity fluid and cryopexy or laser photocoagulation around the tears and the OLBs were performed in all eyes. Best-corrected visual acuity at 6 months postoperatively and final retinal reattachment rate were analyzed. RESULTS: There was no statistically significant difference between the 2 groups in terms of patient age, gender, percentage of retinal detachments that were macula-off (p = 0.241), and preoperative best-corrected Snellen visual acuity (p = 0.927). Best-corrected Snellen visual acuity at 6 months postoperatively was < or =20/100 in 35% of eyes, 20/100-20/50 in 14% of eyes, and > or =20/40 in 51% of eyes in group A versus > or =20/100 in 37% of eyes, 20/100-20/50 in 33% of eyes, and > or =20/40 in 30% of eyes in group B (p = 0.12); the final retinal reattachment rate was 97% in group A versus 98% in group B (p = 0.77). CONCLUSIONS: Placement of an encircling scleral buckle may be an effective method to manage both PSRDCR with OLBs posterior to the equator and primary RRDs. The procedure is associated with comparable visual acuity and anatomic outcomes for both types of retinal detachment.

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.

Correlation of optical coherence tomography pattern and visual recovery after vitrectomy with silicone oil for retinal detachment.

PURPOSE: To assess prospectively the features of the macular surface in silicone oil-filled eyes after surgery by analyzing whether silicone oil affects optical coherence tomography (OCT) measurements and their reproducibility and whether a statistical correlation exists between postoperative best-corrected visual acuity (BCVA) and foveal thickness measured by OCT. METHODS: Twenty eyes of 20 patients underwent vitrectomy with silicone oil tamponade for retinal detachment. After vitrectomy, complete ophthalmic examination including determination of BCVA and OCT was performed to quantify the visual recovery and the foveal thickness. RESULTS: Ophthalmoscopy revealed that the retina appeared to be reattached in all 20 eyes at 3 months after surgery. BCVA ranged from 0.4 logMAR to 1.7 logMAR, and foveal thickness ranged from 80 microm to 500 microm. Postoperative foveal thickness and BCVA had a strong correlation (r = 0.93; P = 0.003). CONCLUSION: The presence of silicone oil in the vitreous chamber does not change the reproducibility of OCT measurements of foveal thickness (coefficient of reproducibility, 1.48%). This study showed high statistical correlation between BCVA and foveal thickness. Therefore, postoperative BCVA is affected by postoperative foveal thickness, and visual improvement is limited in eyes with increased or decreased foveal thickness.

The effect of timolol-dorzolamide and timolol-pilocarpine combinations on ocular blood flow in patients with glaucoma.

PURPOSE: To investigate the effect of timolol-dorzolamide and timolol-pilocarpine fixed combinations on retrobulbar vessel blood flow. DESIGN: Prospective, randomized, masked, crossover clinical trial. METHODS: Sixteen patients with primary open angle glaucoma, treated with timolol 0.5%, received timolol 0.5%-dorzolamide 2% and timolol 0.5%-pilocarpine 2% for four weeks each. Heart rate, blood pressure, intraocular pressure (IOP), and peak systolic (PSV) and end diastolic velocities (EDV) in ophthalmic, central retinal, and short posterior ciliary arteries were measured before and after each treatment, and resistivity index was calculated. RESULTS: The IOP was reduced (P < .01) by timolol-dorzolamide and, more effectively, timolol-pilocarpine combinations. In central retinal artery, the end diastolic velocity was increased by the timolol-dorzolamide combination (P < .01), resulting in higher end diastolic velocity and lower resistivity index values (both P < .01) compared with the timolol-pilocarpine combination. CONCLUSIONS: The timolol-dorzolamide combination increases the end diastolic velocity in central retinal artery, despite a lower intraocular pressure decrease, suggesting an effect on retinal circulation.

Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema.

PURPOSE: To evaluate the outcome of cystoid macular edema (CME) treated with intravitreal injections of triamcinolone acetonide (TA), macular laser grid photocoagulation (MLG), or both (TA+MLG). DESIGN: Prospective, randomized, interventional, parallel, three-arm clinical trial. SETTING: Institutional clinical study. PATIENTS: Fifty-six patients (63 eyes) affected by diabetic or retinal vein occlusion CME. PROCEDURES: Twenty-two eyes received intravitreal injections of 4 mg TA; 21 eyes underwent MLG; and 20 eyes received intravitreal injection of 4 mg TA, and after 3 months, MLG. MAIN OUTCOME MEASURES: Best-corrected visual acuity (VA), central macular thickness (CMT) (by optical coherence tomography), and postoperative complications. RESULTS: Mean follow-up was 9 +/- 2 months (range 6 to 12 months). Baseline VA (logarithm of minimal angle of resolution [logMAR]) and CMT were, respectively, 0.82 +/- 0.19 and 556 +/- 139 microm microns for the TA group, 0.84 +/- 0.15 and 601 +/- 102 microm microns for the MLG group, and 0.83 +/- 0.22 and 573 +/- 106 microm microns for the TA+MLG group (no statistically significant difference among the groups). After the treatment, at 45 days, 3, 6, and 9 months in the TA group, VA had improved (P = .004) by 0.26, 0.25, 0.22, and 0.23 logMAR and CMT had decreased by 37%, 33%, 29%, and 31% (P = < .001). In the MLG group, VA was unchanged although CMT had decreased by 5%, 13%, 14%, and 16% (P = .021). In the TA+MLG group, VA had improved (P = .003) by 0.26, 0.24, 0.19, and 0.20 logMAR, and CMT had decreased by 36%, 34%, 28%, and 29% (P = < .001). The groups receiving triamcinolone had better VA and lower CMT values at all time points (P < .05). A reinjection was performed in eight eyes; intraocular pressure increased in nine eyes (treated with medical therapy), and cataract progressed in one eye. No injection-related complications occurred. CONCLUSIONS: TA intravitreal injection improves VA and reduces CMT more than MLG, which in triamcinolone-treated eyes does not offer further advantages. Intravitreal TA injection could be used as primary treatment in patients with CME.

A randomized prospective study of rhegmatogenous retinal detachment cases treated with cryopexy versus frequency-doubled Nd:YAG laser-retinopexy during episcleral surgery.

PURPOSE: To evaluate the efficacy of cryopexy versus transpupillary frequency-doubled (532 nm) Nd:YAG laser-retinopexy according to anatomic and functional success and postoperative complications. METHODS: Seven hundred three patients with primary rhegmatogenous retinal detachment were enrolled. They underwent scleral-buckling surgery using randomly transpupillary frequency-doubled Nd:YAG laser or cryotherapy for retinopexy: patients were observed for a period of 6 months. The primary outcome was anatomic success at 6 months. Secondary outcomes included anterior segment complications, posterior segment complications, and postoperative visual acuity. RESULTS: There was no significant difference between the primary and secondary outcomes in the two treatment groups: the anatomic success rate was 83% in the transpupillary frequency-doubled Nd:YAG laser group and 83.1% in the cryotherapy group; the rate of postoperative complications and the postoperative visual acuity results are also similar in the two groups; the only barely statistically significant difference (P = 0.045) was the rate of macular holes, which were present only in five myopic patients treated with transscleral cryopexy. CONCLUSION: Transpupillary frequency-doubled Nd:YAG laser retinopexy, as cryopexy, served as a safe and effective means of creating chorioretinal adhesion during retinal reattachment surgery. The rate of postoperative complications was not influenced by the type of retinopexy.

Keratoconus staging: a computer-assisted ultrabiomicroscopic method compared with videokeratographic analysis.

PURPOSE: The aim of this study was to introduce a new paradigm for keratoconus assessment, the keratoconus index (KI), generated from the ratio of peripheral corneal thickness (PCT) to the thinnest corneal thickness (TCT), and calculated by a computer-assisted procedure after ultrabiomicroscope (UBM) examination. Then we compared KI and the keratoconus severity index (KSI), obtained by videokeratography in patients with different stages of keratoconus. METHODS: We studied 60 eyes with different forms of keratoconus using the TMS-3 autotopographer, provided with a keratoconus screening program (using Smolek-Klyce methods) and the commercial version of the ultrasound biomicroscope (Paradigm UBM Plus Model P45) equipped with a 50-MHz probe, which was provided with our computer-assisted program. The proportion test Z and the correlation coefficient R were applied to the outcomes. RESULTS: The keratoconus severity index, KSI, obtained by color-coded videokeratographic maps, was in the range 95% to 32% (mean 52.22%). By means of UBM examination, we obtained 60 images and found values of TCT 0.278-0.592 mm and PCT 0.475-0.704 mm. Applying the computer-assisted method, we obtained values for KI of 1.112-2.159 (mean 1.428). CONCLUSIONS: KI is correlated as well as KSI with the severity of the keratoconus (R = 0.76, P < 0.0001). It can be used as a similar parameter to measure the evolution of the disease, on the basis of corneal thickness rather than the curvature.

Prophylactic treatment of the fellow eye of patients with retinal detachment: a retrospective study.

BACKGROUND: Controversy exists over the prophylactic treatment of predisposing lesions to prevent retinal detachment. METHODS: Seven hundred sixty consecutive phakic fellow eyes with rhegmatogenous retinal detachment in the first eye were examined by the same vitreoretinal surgeon before detachment surgery and for a follow-up period ranging from 1 to 72 months, with a mean of 36 months. During this period, in 305 fellow eyes (40.1%) predisposing retinal lesions were present and prophylactic treatments (photocoagulation, cryotherapy or scleral buckle) were performed independently of vitreous status. The results were then compared with the incidence of bilateral RD without prophylaxis reported in Folk and Burton's study of 1982; the two study's data were well matched and showed no significant difference in regards to age, sex, incidence myopia > or =-2.5 and incidence of lattice degeneration. The objective was to investigate whether or not prophylactic treatment is able to avert retinal detachment in the fellow eye. RESULTS: The age of the patients with peripheral retinal lesions was correlated inversely with the presence of myopia. Nine eyes out of 305 eyes treated (2.9%) developed a retinal detachment, reducing the rate of bilateral retinal detachment to 1.2% (9 eyes out of 760). CONCLUSIONS: This incidence of bilaterality (1.2%) was lower than the incidence of retinal detachment in fellow eyes not prophylactically treated as reported in the literature, and there exists a highly statistically significant difference between this study's data of 1.2% after prophylaxis and a 13.4% rate of bilaterality as reported by Folk without prophylaxis (P=0.0000).