Clinical Efficacy of an Eyedrop Containing Hyaluronic Acid and Ginkgo Biloba in the Management of Dry Eye Disease Induced by Cataract Surgery.

Purpose: To evaluate the prevalence of dry eye disease (DED) after cataract surgery, and the impact of hyaluronic acid and ginkgo biloba eyedrops (HA-GB). Methods: Forty patients with no DED received Ocular Surface Disease Index (OSDI) questionnaire, assessment of conjunctival hyperemia and epithelial damage, fluorescein tear break-up time (TBUT) at baseline, day 1, week 1, and 4; adherence and tolerability were checked at weeks 1 and 4. At day 0 patients underwent cataract surgery and were randomized to standard postoperative care (control group) or standard postoperative care + HA-GB 3 times a day for 4 weeks (HA-GB group). Results: At baseline, TBUT was 9.6 ± 2.6 sec in controls and 9.0 ± 1.6 in HA-GB; thereafter it was higher in HA-GB group: 5.8 ± 2.3 versus 7.8 ± 3.2 (week 1, P = 0.03) and 6.4 ± 2.3 versus 8.5 ± 2.5 (week 4, P = 0.009). OSDI and conjunctival hyperemia were better in HA-GB group at week 4; respectively, 9.0 ± 5.7 versus 14.8 ± 7.3 (P = 0.004) and 5% versus 35% (P = 0.04). In the last 2 visits 50% of controls were symptomatic (OSDI of 13 or higher) compared with 16% on HA-GB group (P < 0.001). In addition, tolerability was higher in HA-GB group (week 1: 0.81 ± 0.20 versus 0.70 ± 0.24, P = 0.007; week 4: 0.93 ± 0.17 versus 0.80 ± 0.28, P = 0.001). Conclusion: Treatment with HA-GB is effective in reducing DED signs and symptoms in patients receiving cataract surgery, with high tolerability and safety profiles. clinicaltrials.gov (ID number NCT05002036).

A Review of Topical and Systemic Vitamin Supplementation in Ocular Surface Diseases.

In the homeostasis of the ocular surface, vitamins play a critical role in regulating inflammatory responses and promoting cell differentiation, development and correct function. Systemic vitamin supplementation has been available for many decades; in recent years, thanks to pharmacological advancements, topical vitamin delivery has also become available in an attempt to better treat ocular surface disease (OSD) and dry eye disease (DED). In this paper, we reviewed the current evidence on the role of vitamin supplementation in OSD and DED. We originally searched the PubMed archive, inspected the references and restricted the search to pertinent papers. The body of evidence was evaluated using the amelioration of both signs and symptoms as the outcome, when available. We found that in patients with vitamin deficiency, systemic supplementation of Vitamin A is effective in treating OSD, reducing both DED signs and symptoms. Additionally, systemic supplementation of vitamin D is useful in reducing DED symptoms and increasing tear volume. Vitamin A is also effective in reducing DED signs and symptoms when administered locally. The efficacy of supplementation with other vitamins is still not fully proven. In conclusion, the inclusion of vitamins into the treatment strategies for OSD and DED allows for better treatment customization and better outcomes in these patients.

Surgically Induced Macular Detachment for Treatment of Refractory Full-Thickness Macular Hole: Anatomical and Functional Results.

PURPOSE: The purpose of this study was to investigate the efficacy and safety of surgically induced macular detachment (MD) for the treatment of refractory full-thickness macular hole (FTMH). MATERIALS AND METHODS: Clinical data were age, gender, lens status, and best corrected visual acuity (BCVA). Preoperative tomographic parameters were: FTMH morphology (intraretinal cyst and elevated or flat edges) and FTMH diameter. Postoperative FTMH closure and outer retinal layer (ORL) restoration were evaluated. Fundus autofluorescence (FAF), optical coherence tomography (OCT) findings, and BCVA were analyzed at the 1st, 3rd, and 6th postoperative month. The interval between the first surgery for idiopathic FTMH and the surgically induced MD for refractory FTMH was collected (intersurgical interval, days). RESULTS: Ten eyes of 10 patients were included. The mean age was 68.8 ± 6.8 years. FTMH closure was obtained in 9 patients; in 8 patients, ORL restoration was detected. BCVA improved from 1.06 ± 0.1 (baseline) to 0.56 ± 0.2 (final) logMAR (p = 0.0001). A negative correlation between the intersurgical interval and postoperative visual gain was demonstrated (r = -0.3618). FAF and OCT showed a permanent retinal pigment epithelium (RPE) damage corresponding to the retinotomy points. CONCLUSION: This study demonstrates the efficacy of this technique and highlights the risk of RPE damage, suggesting the need to perform the retinotomy points outside the macula.

Spectral domain-optical coherence tomography and fundus autofluorescence findings in a case of purtscher-like retinopathy.

PURPOSE: The purpose of this study is to describe spectral domain-optical coherence tomography and autofluorescence images in a case of bilateral Purtscher-like retinopathy. METHODS: This is an observational case report of a 31-year-old man suffering with Purtscher-like retinopathy postpancreatitis. RESULTS: In the acute phase, spectral domain-optical coherence tomography showed hyperreflectivity in the inner retinal layers, corresponding to cotton-wool exudation as a result of precapillary ischemia. The follow-up using spectral domain-optical coherence tomography showed that the inner retina is the most involved layer by ischemic damage in the acute phase. In the regression phase, signs of suffering in the outer retinal layers became visible as well, although after the resolution of the pathology, there was no evident spectral domain-optical coherence tomography abnormality in the photoreceptors layers. Autofluorescence images after resolution showed hyperautofluorescent vessels affected by ischemia as a possible result of long-lasting retention of intraretinal blood. CONCLUSION: Spectral domain-optical coherence tomography and autofluorescence are sensitive and noninvasive imaging modalities to evaluate retinal alterations after Purtscher-like retinopathy. Spectral domain-optical coherence tomography confirms that ischemia causes an alteration primarily in the inner retinal layers, but the process also involves the outer retinal layers.

Artifacts in automatic retinal segmentation using different optical coherence tomography instruments.

PURPOSE: The purpose of this study was to compare and evaluate artifact errors in automatic inner and outer retinal boundary detection produced by different time-domain and spectral-domain optical coherence tomography (OCT) instruments. METHODS: Normal and pathologic eyes were imaged by six different OCT devices. For each instrument, standard analysis protocols were used for macular thickness evaluation. Error frequencies, defined as the percentage of examinations affected by at least one error in retinal segmentation (EF-exam) and the percentage of total errors per total B-scans, were assessed for each instrument. In addition, inner versus outer retinal boundary delimitation and central (1,000 microm) versus noncentral location of errors were studied. RESULTS: The study population of the EF-exam for all instruments was 25.8%. The EF-exam of normal eyes was 6.9%, whereas in all pathologic eyes, it was 32.7% (P < 0.0001). The EF-exam was highest in eyes with macular holes, 83.3%, followed by epiretinal membrane with cystoid macular edema, 66.6%, and neovascular age-related macular degeneration, 50.3%. The different OCT instruments produced different EF-exam values (P < 0.0001). The Zeiss Stratus produced the highest percentage of total errors per total B-scans compared with the other OCT systems, and this was statistically significant for all devices (P < or = 0.005) except the Optovue RTvue-100 (P = 0.165). CONCLUSION: Spectral-domain OCT instruments reduce, but do not eliminate, errors in retinal segmentation. Moreover, accurate segmentation is lower in pathologic eyes compared with normal eyes for all instruments. The important differences in EF among the instruments studied are probably attributable to analysis algorithms used to set retinal inner and outer boundaries. Manual adjustments of retinal segmentations could reduce errors, but it will be important to evaluate interoperator variability.

Spectral-domain OCT evaluation of Nd:YAG laser treatment for Valsalva retinopathy.

PURPOSE: To describe the spectral-domain optical coherence tomography (SD-OCT) findings in a patient with a premacular hemorrhage due to Valsalva retinopathy treated with Nd:YAG laser. METHODS: Serial SD-OCT examinations were performed before and after Nd:YAG laser treatment to identify the cleavage plane of blood accumulation, as well as the exact location of the areas targeted by the laser spots and the different involvement of the affected retinal layers. RESULTS: The SD-OCT scan above the level of settled blood showed that the cleavage plane was located under the internal limiting membrane (ILM). A raster box of 48 horizontal scans centered on the treatment area identified the two spots of ILM targeted by laser. The hyporeflective perforations appeared along an ILM still detached from the underlying retinal layers. Two months after treatment, the blood was completely reabsorbed. The ILM appeared reattached in the previously detached area. Only a mild thickening of the ILM remained visible at the laser-treated spots. CONCLUSIONS: SD-OCT evaluation of Nd:YAG laser treatment for Valsalva retinopathy confirmed the cleavage plane of the premacular hemorrhage. In addition, it revealed the exact location of the ILM disruptions caused by the laser spots, and the safety of the procedure, with no involvement of the underlying retinal layers.