Correlation Between Choriocapillaris Density and Retinal Sensitivity in Age-Related Macular Degeneration.

Purpose: The purpose of this study was to investigate the relationship between perfusion of the choriocapillaris (CC) and retinal sensitivity in eyes with intermediate age-related macular degeneration (iAMD). Methods: This prospective study included patients with iAMD and healthy controls. All enrolled subjects underwent optical coherence tomography angiography (OCT-A) in order to compute the percent perfused choriocapillaris area (PPCA). In patients with iAMD, microperimetry (MP) testing was performed in order to quantify: mean retinal sensitivity (MRS), over an area of 10 degrees; mean macular sensitivity (MMS), over the macular area scanned with OCT-A; and retinal sensitivity (RS) in each macular point. Results: Eighteen eyes of 13 patients were included in the analysis. In addition, 18 eyes of 12 healthy subjects were enrolled as controls. No statistically significant difference (P value > 0.2) was observed in age between patients (73.9 ± 2.0 years) and controls (70.1 ± 2.8 years). We observed significantly lower values of PPCA between patients with iAMD and healthy controls (42.0% ± 3.8% vs. 66.4% ± 3.0%; -ß = 23.8%; P value < 0.001). Among iAMD eyes, higher values of PPCA were significantly associated with higher values of MRS (P value = 0.002) and MMS (P value = 0.013). Finally, higher values of RS in each macular point analyzed with MP were significantly (P value < 0.001) associated with higher values of PPCA computed in circular regions of interest (ROIs) centered in each analyzed MP point with radii of 0.5 degrees and 1.0 degree. Conclusions: Using OCT-A, we demonstrated a significant association between CC impairment and macular dysfunction, quantified by MP, in iAMD eyes. Translational Relevance: OCT-A could be a useful tool for detecting CC alterations and to monitor disease progression.

Corneal confocal microscopy alterations in Sjögren's syndrome dry eye.

PURPOSE: To evaluate light backscattering (LB) in corneal layers in patients with primary Sjögren's syndrome dry eye (SSDE) utilizing in vivo corneal confocal microscopy (IVCM) and to determine the eventual association with the lacrimal functional test values. METHODS: A complete ophthalmic evaluation, Schirmer test with and without stimulation, break-up time (BUT) and IVCM were performed on 55 patients affected by SSDE and in an age- and sex-matched cohort of healthy participants (HP). Light backscattering, measures as light reflectivity unit (LRU), detected by IVCM at Bowman's membrane (BM) at 50 µm, at 100 µm and at 200 µm deeper than BM was compared in the two groups. The correlations between LB values and lacrimal function results were evaluated. RESULTS: In patients affected by SSDE, LB was significantly higher (p < 0.001) in each corneal layer examined (+14 ± 6.33 LRU at BM), compared with HP. A good reverse correlation between the light reflectivity measures at BM with Schirmer test with (r = -0.91) and without (r = -0.90) stimulation and BUT (r = -0.88) was found. Correlations were lower in the deeper corneal layers. CONCLUSION: Even if our results should be confirmed in further studies with a larger population, these findings show that IVCM is a device able to detect alterations in corneal layers in SSDE patients related to the lacrimal function. Light backscattering (LB) could be very useful for clinical diagnosis and management of SSDE.

In vivo human corneal deformation analysis with a Scheimpflug camera, a critical review.

Corneal morphological analysis has greatly improved in recent years, providing physicians with new and reliable parameters to study. Moreover, today corneal functional too is a routine analysis, thanks to biomechanical evaluation allowed by an ocular response analyzer (Reichert Ophthalmic Instrument, Depew, NY, USA). Corvis ST (OCULUS Optikgeräte GmbH, Wetzlar, Germany), that relies on the ultrahigh speed Scheimpflug camera, is a new device providing corneal deformation parameters measured ny scanning the cornea response to an air puff; it is an instrument able to measure intraocular pressure too. This device could open up a whole new prospective in screening, detecting and managing corneal diseases, intraocular pressure measurement and in evaluating surgical procedures involving the cornea. This paper provides a comprehensive explanation of Corvis ST measurement principles and parameters and a literature review of scientific studies.

Intraocular pressure evaluation in healthy eyes and diseased ones using contact and non contact devices.

PURPOSE: To analyze and compare intraocular pressure (IOP) values measured in healthy subjects (HS), keratoconus (KC) patients and patients that underwent myopic photorefractive keratectomy (REF), using Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), ocular response analyzer (ORA) and Corvis ST (CST). METHODS: The study included 76 eyes of 76HS, 15 eyes of 15 KC patients and 18 eyes of 18 subjects that underwent REF. Each participant underwent a complete ophthalmic evaluation, IOP measurement with GAT, DCT, ORA and CST. RESULTS: HS showed a mean GAT value of 15.62±2.33 mm Hg, a mean DCT value of 17.44±2.51 mm Hg, a mean ORA value of 15.99±3.58 mm Hg and a mean CST value of 17.24±3.44 mm Hg. KC showed a mean GAT value of 15.07±1.83 mm Hg, a mean DCT value of 17.01±1.96 mm Hg, a mean ORA value of 13.58±2.99 mm Hg and a mean CST value of 14.37±1.89 mm Hg. REF showed a mean GAT value of 14.06±1.51 mm Hg, a mean DCT value of 15.12±2.34 mm Hg, a mean ORA value of 16.85±2.4 mm Hg and a mean CST value of 15.57±1.77 mm Hg. CONCLUSION: Our data suggest that ORA and GAT could be used interchangeably in HS; GAT, ORA and CST could be used interchangeably in KC patients and that GAT provides lower IOP values compared to the other devices in eyes previously submitted to myopic PRK.

Central corneal thickness evaluation in healthy eyes with three different optical devices.

PURPOSE: To compare corneal pachymetry values measured by three different optical devices: Orbscan II, Pentacam HR and Sirius in healthy eyes. METHODS: The central corneal thickness (CCT) of 102 eyes of 102 healthy subjects (mean age of 33.09 ± 8.72 years and mean refractive defect -4.11 ± 4.74 D) was measured by three different physicians using Orbscan II, Pentacam HR and Sirius. The normality of the distribution was evaluated by with Kolmogorov-Smirnov test. The correlations between CCT obtained from each device and refractive defect and age were evaluated using the Pearson test. The differences were evaluated by the Student paired t-test using SPSS 18.0 (IBM Corp. Armonk, New York). RESULTS: Orbscan II provided significant (p < 0.0001) lower CCT measurements then both Pentacam HR (-13.66 ± 16.53 µm) and Sirius (-15.18 ± 17.16 µm); Sirius showed values slightly higher than Oculus Pentacam HR (+1.52 ± 6.21 µm) that appeared to be statistically significant (p < 0.015). CONCLUSIONS: The measurement of CCT by Sirius and Pentacam HR provides similar results. By contrast, the results obtained by Orbscan II are different from those obtained from both Sirius and Pentacam HR.

Evaluation of corneal deformation analyzed with a Scheimpflug based device.

PURPOSE: To evaluate the correlation between corneal biomechanical and morphological data in healthy eyes. METHODS: A complete clinical eye examination of naïve eyes was followed by tomographic (Pentacam, Oculus, Wetzlar, Germany) and biomechanical (Corvis ST, Oculus, Wetzlar, Germany) evaluation. Linear regression between central corneal thickness (CCT), corneal volume (CV) and anterior corneal curvature measured with Sim'K (SK), versus corneal deformation parameters measured with Corvis ST have been run using SPSS software version 18.0. RESULTS: Seventy-six eyes of 76 healthy subjects (44 women and 32 men) with a mean age of 36.84 ± 10.74 years and a mean refractive error of -0.55 ± 1.68 D (measured as spherical equivalent) were evaluated. Corneal deformation parameters were weakly correlated with corneal morphological parameters and with spherical equivalent. Although the correlations between deformation amplitude versus SK and between SK versus Velocity of Applanation 2, were higher than the others (R(2) = 0.28 and 0.26 respectively), none of them was statistically significant (p>0.01). CONCLUSIONS: According with these findings, Corvis ST seems to be able to provide an analysis of corneal deformation independent from corneal morphological characteristics. If these data will be confirmed in further studies, this device could be useful in the management and screening of eyes with corneal diseases.

Evaluation of corneal deformation analyzed with Scheimpflug based device in healthy eyes and diseased ones.

This study was designed to evaluate the correlation between corneal biomechanical and morphological data in healthy eyes, eyes that underwent myopic photorefractive keratectomy (PRK), keratoconus affected eyes, and keratoconus affected eyes that underwent corneal collagen crosslinking (CCC). Complete clinical eye examination of all eyes was followed by tomographic (Pentacam, Oculus, Wetzlar, Germany) and biomechanical (Corvis ST, Oculus, Wetzlar, Germany) evaluation. Differences among Corvis ST (CST) parameters in the different groups have been performed. Linear regression between central corneal thickness (CCT), intraocular pressure (IOP), and anterior corneal curvature measured with Sim'K (KM), versus corneal deformation parameters measured with Corvis ST in the different groups, has been run using SPSS software version 18.0. We evaluated 64 healthy eyes of 64 patients with a mean refractive error of -0.65 ± 1.68 D (measured as spherical equivalent), 17 eyes of 17 patients that underwent myopic PRK for a mean refractive defect of -4.91 ± 2.05 D (measured as spherical equivalent), 16 eyes of 16 patients affected by keratconus (stage 2-3 of Amsler Classification), and 13 eyes of 13 patients affected by keratoconus that underwent CCC. Our data suggest that corneal curvature would have a greater influence on corneal deformation than CCT; in fact KM values are more strongly associated with more CST parameters both about corneal change in shape and both about the corneal ability to come back at original shape.

Corneal confocal microscopy anomalies associated with cowden syndrome: a case report.

PURPOSE: To describe bilateral corneal alterations through confocal microscopy in a patient affected by Cowden syndrome (CS). METHODS: Evaluation of Schirmer's, fluorescein, and lissamine green dye tests. Confocal microscopy was performed in both eyes to investigate corneal abnormalities. RESULTS: Slit lamp observation showed the focal involvement of anterior stromal and epithelial layers. Schirmer's, fluorescein, and lissamine green dye test results were regular, while corneal confocal examination confirmed the disorganization of anterior stromal and epithelial layers in both eyes. CONCLUSION: CS is a rare autosomal-dominant systemic disorder. In our case, confocal analysis revealed predominance of alterations in the anterior stromal corneal layer, showing an increase of reflectivity, and a totally unstructured architecture in the epithelium layer. Even though the main purpose remains the prevention and the early diagnosis of different systemic tumors that could occur in affected patients, corneal confocal evaluation could play an important role in the early diagnosis of this rare disease.

Aniridia associated with lens coloboma and secondary glaucoma treated with transcorneal argon laser ciliary body photocoagulation: a case report.

PURPOSE: The aim of this study is to describe the management of cataract and refractory glaucoma in a case of congenital aniridia (AN)-1. METHODS: In an 18-year-old female patient affected by congenital AN, bilateral coloboma of the zonula and lens, cataract and glaucoma, pars plana vitrectomy, cataract extraction and subsequent transcorneal ciliary body argon laser photocoagulation were performed. RESULTS: Five years after laser treatment, the best-corrected visual acuity was 20/50 and the intraocular pressure was stable at 18 mm Hg with topical pharmacological management consisting of timolol 0.5% and latanoprost 0.005%. CONCLUSIONS: From our experience, transcorneal ciliary body photocoagulation after cataract extraction and vitrectomy could be a useful technique to manage high ocular pressure in eyes affected by congenital AN.

Potential role of intravitreal human placental stem cell implants in inhibiting progression of diabetic retinopathy in type 2 diabetes: neuroprotective growth factors in the vitreous.

BACKGROUND: Intravitreal injection of human mesenchymal stem cells has been shown to be effective in slowing the progression of diabetic retinopathy in an animal model of chemically induced diabetes mellitus. We studied changes in growth factor levels released from human mesenchymal stem cells in the vitreous cavity as well as changes in growth factor levels in host retinal neurons following intravitreal injection. METHODS: Twenty-two Lewis rats were treated with an intravitreal human mesenchymal stem cell microinjection. Determination of neurotrophic factors released by human mesenchymal stem cells in the vitreous was carried out using real-time polymerase chain reaction. RESULTS: Detectable levels of neurotrophic factors were identified postoperatively in the vitreous of all rats. CONCLUSION: Increased intravitreal and retinal concentrations of neuroprotective growth factors in rats confirm the neuroprotective activity of human mesenchymal stem cells in diabetic retinopathy.

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.

An Italian family affected by autosomal dominant microcephaly with chorioretinal degeneration.

PURPOSE: We studied an Italian family affected by the autosomal dominant form of microcephaly and chorioretinal degeneration that was characterized by various degrees of clinical expression. METHODS: An ophthalmologic examination, including visual acuity, visual field testing, an electroretinogram, and fundus photography, and a neurologic examination, including neurodevelopmental status and neuroimaging studies, were performed for all subjects. Skeletal radiography, chromosome studies, and serologic investigations were also performed. RESULTS: In this family, only two of the six affected members had an association of microcephaly, myopia, and chorioretinal degeneration. The other family members showed microcephaly, slight mental retardation, and short stature, but not chorioretinopathy. CONCLUSIONS: The significant finding in members from this dominant pedigree of microcephaly was the association of short stature and high myopia, heretofore seen only in families with recessive microcephaly. These findings could be useful for genetic counseling in the apparently isolated forms of microcephaly with chorioretinopathy.