Corneal iontophoresis and cross linking: a preliminary report of our experience.

PURPOSE: To evaluate the effect induced by UVA radiation with corneal iontophoresis and cross-linking. MATERIALS AND METHODS: From February 2013 to August 2014 we saw 15 eyes of 15 patients, age range 19-38 years (10 women and 5 men) keratoconus stage 1-2. Vision evaluation was carried out with ETDRS scale and Topography and Pachymetry. To evaluate line of demarcation with the confocal microscope and corneal optical coherence tomography (OCT) and the pain with the Faces Pain Scale. RESULTS: At 6 months there was a stabilization of vision and topography, with a slight improvement at 1 year of vision of 1 line and of the Km of 0.5 diopters. The in vivo microscopic examination with the confocal microscope showed that the line of demarcation was not particularly evident, it was irregular and when present was more evident at 150-200 µ depth, there was a keratinocyte activation in the anterior stroma with slight oedema. There were also superficial epithelial alterations present and only slight involvement of the subepithelial nervous plexus, there were no alterations of the endothelium. The Faces Pain Scale the pain score was 2±1. We have to stress the usefulness of Corneal optical coherence tomography (OCT) also pre and post iontophoretic treatment. CONCLUSIONS: Further, larger studies and longer follow-ups are needed, recent studies have shown the absorption of riboflavin with iontophoresis is 50% with respect to the classic technique, the percentage of riboflavin in the anterior 2/3 of the corneal stroma would be, however, efficacious to provide good results.

Endoscopic laser-assisted dacryocistorhinostomy DCR with the placement of a customised silicone and Teflon bicanalicular stent Endoscopic laser-assisted dacryocystorhinostomy (DCR).

INTRODUCTION: We present our experience in endoscopic laser assisted dacryocystorhinostomy (DCR) analyzing the results obtained with a new technique that involves placing bicanalicolar silicone stent more Teflon tube, in combination with paraseptal silastic sheet. MATERIALS AND METHODS: In our study 49 of 57 patients (85%) at a mean follow up of at least 12 months have not reported epiphora or more episodes of acute dacryocystitis. RESULTS: 49 out of the 57 patients (85%) in our group reported no additional epiphora or episodes of acute dacryocystitis. CONCLUSIONS: Endoscopic DCR is currently the gold standard for sac and post-sac stenosis given the minimal invasiveness of the procedure and the long-term results that appear comparable to those obtained with extrinsic DCR. The principal problem is cicatricial stenosis that can occlude the stoma over time.

Primitive eyelid Merkel carcinoma.

Primitive Merkel Cell Carcinoma (MCC) of the eyelid is a malign cutaneous neuro-endocrine tumour that originates in Merkel cells; which are situated along the border of the eyelid between the eyelashes. It is a rare, very aggressive and metastasising tumour. The histo-pathological diagnosis may require an immuno-histochemical and ultrastructural analysis. The authors describe the clinical case of a 65-year-old woman with palpebral MCC that appeared suddenly over a period of three months. The correct therapeutic strategy for Merkel cell cancer is a radical, aggressive and early removal of the tumour at its initial stage, in order to reduce the risk of a distant recurrence and to improve the survival rate. The tumour must be resected with a broad safety margin and radiotherapy may be required post surgery.

Lattice Corneal Dystrophy-Variant: a report of three new cases due to p.V631D mutation in the TGFBI gene.

PURPOSE: To report clinical findings and molecular defect in three subjects affected by Biber-Haab-Dimmer dystrophy or Lattice Corneal Dystrophy Type I (LCD1), a corneal dystrophy transmitted as an autosomal dominant tract. MATERIALS AND METHODS: Three subjects underwent a complete ophthalmic examination and confocal microscopy study. Following the collection of DNA from the patients, the TGFBI gene was screened for mutations by direct sequencing. RESULTS: Confocal microscopy study revealed that the opacity typical of the disease was assembled in the axial region of the cornea. The causative TGFBI mutation p.Val631Asp was identified in all subjects. CONCLUSIONS: The finding of the p.Val631Asp mutation responsible for this form of LCD-Variant highlights the utility of molecular genetic analysis of the TGFBI gene in order to offer early diagnosis. These results provide more data for molecular diagnosis and prognosis of this clinical and genetic heterogeneous disease.

Atipic pigmented retinitis: a case report.

The Authors describe a clinical case of pigmented paravenous retinochoroidal atrophy in a young patient (12 years old). In the mid-peripheral area spots of accumulated pigment were observed, in particular along the veins. The exams are: funduscopy, elettroretinogram. The already examined pathology is an inherited retinic dystrophy with an uncertain transmission. According to Literature a young male case his described. Because of rarity, it is impossible describe hereditary transmission mechanism.

Massive corneal edema treated with corneal cross-linking.

INTRODUCTION: Massive corneal edema disrupts the fine architecture of corneal stroma that guarantees its transparency, causing opacities that seriously impair clear vision and are usually solved by corneal transplant. Corneal cross-linking, a treatment developed to halt keratoconus progression, results in a loss of water and a compaction of corneal stroma. It might therefore be useful to improve the pathologic edematous condition of some corneas, ameliorating visual acuity and allowing more time for a surgical procedure of keratoplasty. PATIENTS AND METHODS: Six patients with visual impairing corneal edemas further to lens phacoemulsification, penetrating keratoplasty, or post-infective neovascularization were treated with corneal cross-linking alone, or in combination with amniotic membrane apposition with or without anti-angiogenic therapy. RESULTS: All patients partly resolved the edematous condition, improving both corneal transparency and visual acuity. CONCLUSIONS: Corneal cross-linking appears to be a useful method to treat massive corneal edemas, so that keratoplasty can be at least delayed, and need not to be an emergency treatment in these cases.