THE INCIDENCE OF NEOVASCULARIZATION IN CENTRAL SEROUS CHORIORETINOPATHY BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To evaluate the incidence of neovascularization (NV) secondary to central serous chorioretinopathy (CSC)-a condition belonging to the spectrum of pachychoroid disorders by means of optical coherence tomography angiography. METHODS: One hundred and seventy five eyes with CSC were evaluated in this retrospective observational study. The eyes with acute or chronic CSC with no NV were included in Group 1, and those with NV were evaluated in Group 2. Only eyes that had undergone structural optical coherence tomography and optical coherence tomography angiography were included. Age, best-corrected visual acuity, and subfoveal choroidal thickness were evaluated in all eyes. In Group 2, the type and morphology of NV and the occurrence of exudation were considered. RESULTS: Of a total of 175 eyes with CSC, 86 had the acute form and 89 the chronic. Approximately 140 belonged to Group 1 (80%) and 35 to Group 2 (20%). Approximately 39.2% of all patient with chronic CSC developed NV. Mean age in Groups 1 and 2 was 53.3 years (±10.9) and 66.6 years (±10.2), respectively. Mean best-corrected visual acuity in Groups 1 and 2 was 45.7 (±11.7) and 30.9 (±17.9) early treatment diabetic retinopathy study letters, respectively. Mean CCT in Group 1 and 2 was 417.5 µm (±123) and 344.2 µm (±165.9), respectively. In Group 2, all patients had Type 1 NV (100%); 29 eyes (83%) had filamentous feature, and 6 eyes (17%) had irregular shape. Silent nonexudative NV was observed in 7 eyes (20%), all belonging to Group 2. CONCLUSION: The use of optical coherence tomography angiography in everyday clinical practice allows for the accurate analysis of the chorioretinal vascular setting, with the identification of new vessels that could remain misdiagnosed.

A new method to assess foveal morphology with optical coherence tomography.

PURPOSE: To measure foveal morphology using optical coherence tomography (OCT). METHODS: Three examiners classified normal subjects and patients with macular edema and epiretinal membranes from a normative database (299 OCT scans) and a study sample (80 OCT scans) on the basis of the foveal depression appearance (reference classification). The following parameters were measured for each OCT scan: Central Foveal Thickness (CFT), Central Subfield Thickness (CST), Central Subfield Volume (CSV), Centrofoveal Index (CI), Parafoveal Index (PI), and Foveal Indices (FI1, FI2, FI3). Foveal depression of OCT scans in the study sample were classified based on the values of OCT parameters using Bayesian statistics (test classifications). RESULTS: Agreement between reference and test classifications was of 70% for CFT, 58.7% for CST, 60% for CSV, 80% for CI, 72.5% for PI, 88.7% for FI1, 96.2% for FI2 and 97.5% for FI3. CONCLUSIONS: IF3 seems to provide a reliable measure of the foveal morphology.

Halide and hydroxide anion binding in water.

The formation of halide and hydroxide anion complexes with two ligands L1 (3,6-bis(morpholin-4-ylmethyl)-1,2,4,5-tetrazine) and L2 (3,6-bis(morpholin-4-ylethyl)-1,2,4,5-tetrazine) was studied in aqueous solution, by means of potentiometric and ITC procedures. In the solid state, HF2-, Cl- and Br- complexes of H2L22+ were analysed by single crystal XRD measurements. Further information on the latter was obtained with the use of density functional theory (DFT) calculations in combination with the polarizable continuum model (PCM). The presence of two halide or bifluoride HF2- (F-H-F-) anions forming anion-π interactions, respectively above and below the ligand tetrazine ring, is the leitmotiv of the [(H2L2)X2] (X = HF2, Cl, Br, I) complexes in the solid state, while hydrogen bonding between the anions and protonated morpholine ligand groups contributes to strengthen the anion-ligand interaction, in particular in the case of Cl- and Br-. In contrast to the solid state, only the anion : ligand complexes of 1 : 1 stoichiometry were found in solution. The stability of these complexes displays the peculiar trend I- > F- > Br- > Cl- which was rationalized in terms of electrostatic, hydrogen bond, anion-π interactions and solvent effects. DFT calculations performed on [(H2L2)X]+ (X = F, Cl, Br, I) in PCM water suggested that the ligand assumes a U-shaped conformation to form one anion-π and two salt bridge interactions with the included anions and furnished structural information to interpret the solvation effects affecting complex formation. The formation of hydroxide anion complexes with neutral (not protonated) L1 and L2 molecules represents an unprecedented case in water. The stability of the [L(OH)]- (L = L1, L2) complexes is comparable to or higher than the stability of halide complexes with protonated ligand molecules, their formation being promoted by largely favourable enthalpic contributions that prevail over unfavourable entropic changes.

Reduced-fluence verteporfin photodynamic therapy plus ranibizumab for choroidal neovascularization in pathologic myopia.

BACKGROUND: To demonstrate the efficacy of intravitreal ranibizumab (IVR) in combination with reduced-fluence photodynamic therapy (RF-PDT) in patients with choroidal neovascularization (CNV) secondary to pathologic myopia. METHODS: Sixty patients affected by myopic CNV (mCNV) were randomized to receive either ranibizumab 0.5 mg monotherapy (RM; n = 20), standard fluence PDT (SF-PDT, n = 20) or RF-PDT combination therapy (n = 20). Subsequently, IVR was injected as needed. All patients were evaluated for 48 weeks. RESULTS: Mean BCVA change at 48 weeks was + 0.2 and +15 letters with SF or RFPDT plus ranibizumab, respectively, compared with +16.8 letters with RM. At 48 weeks, mean central foveal thickness (CFT) decrease from baseline was 58 ± 15 µm, 91.4 ± 43.8 µm, and 85 ± 41.5 µm for the verteporfin SF, RF and RM groups, respectively. Macular sensitivity improvement was + 0.4 db, + 1.9 dB and + 2.7 dB for the verteporfin SF, RF and RM groups, respectively. CONCLUSIONS: Ranibizumab monotherapy or combined with RF-PDT improved BCVA and macular sensitivity in patients affected by mCNV, whereas CFT results were reduced. SF-PDT combination regimen mostly stabilized vision at 48 weeks. Among all groups, the RF-PDT seemed to reduce the number of ranibizumab retreatments.

A longitudinal follow-up study of saffron supplementation in early age-related macular degeneration: sustained benefits to central retinal function.

Objectives. In a previous randomized clinical trial (Falsini et al. (2010)), it was shown that short-term Saffron supplementation improves retinal flicker sensitivity in early age-related macular degeneration (AMD). The aim of this study was to evaluate whether the observed functional benefits from Saffron supplementation may extend over a longer follow-up duration. Design. Longitudinal, interventional open-label study. Setting. Outpatient ophthalmology setting. Participants. Twenty-nine early AMD patients (age range: 55-85 years) with a baseline visual acuity >0.3. Intervention. Saffron oral supplementation (20 mg/day) over an average period of treatment of 14 (±2) months. Measurements. Clinical examination and focal-electroretinogram-(fERG-) derived macular (18°) flicker sensitivity estimate (Falsini et al. (2010)) every three months over a followup of 14 (±2) months. Retinal sensitivity, the reciprocal value of the estimated fERG amplitude threshold, was the main outcome measure. Results. After three months of supplementation, mean fERG sensitivity improved by 0.3 log units compared to baseline values (P < 0.01), and mean visual acuity improved by two Snellen lines compared to baseline values (0.75 to 0.9, P < 0.01). These changes remained stable over the follow-up period. Conclusion. These results indicate that in early AMD Saffron supplementation induces macular function improvements from baseline that are extended over a long-term followup.

Sensorineural hearing loss in ankylosing spondylitis treated with TNF blockers.

OBJECTIVES: Sensorineural hearing loss (SNHL) in the uncommon disease ankylosing spondylitis (AS) has been previously reported. We analysed the relationships between AS, anti-TNF drug treatment, and SNHL. METHODOLOGY: We determined pure tone thresholds in 28 consecutive patients with AS who were treated with the TNFalpha inhibitors etanercept or infliximab, or with a TNFalpha inhibitor plus methotrexate (MTX). RESULTS: SNHL was diagnosed in 16 patients (57.1%): 7/7 (100%) of those treated with anti-TNFalpha plus MTX, and 9/21 (43%) of those treated with anti-TNFalpha alone. We found a significant association between SNHL and treatment modality (p = 0.011) or treatment time in months (p = 0.020). CONCLUSIONS: The SNHL rate was significantly higher in patients treated with anti-TNFalpha plus MTX than those treated with anti-TNFalpha alone. The culpability of anti-TNF therapy was supported by the association between SNHL and treatment time, which was longer for anti-TNFalpha plus MTX than for anti-TNFalpha alone. SNHL may be due not only to AS, but also to drug-induced vasculitis of the labyrinthine artery or its cochlear branch.

Evaluation of magnetic resonance signal modification induced by hyaluronic acid therapy in chondromalacia patellae: a preliminary study.

Hyaluronic Acid (HA) is an alternative method for the treatment of osteoarthritis (OA), which acts on pain through a double action: anti-inflammatory and synovial fluid (SF) visco-supplementation. Magnetic Resonance Imaging (MRI), utilizing specific sequences, is a valid method for studying the initial phase of chondral damage. The analysis of the data, obtained through the intensity of values taken by positioning Region of Interest (ROIs) within the lesion, determining the differences before and after treatment with HA injected into the knee. The results obtained after six months and one year from the injection were statistically different in respect to those taken before, immediately and after three months of treatment. MRI represents a valid tool to evaluate the grade of chondromalacia patellae and also to follow the cartilage modification induced by HA therapy.

Poly-L-lactic acid beta-tricalcium phosphate screws: a preliminary in vivo biocompatibility study.

The aim of this study is to assess the biocompatibility of two types of Poly-L-lactic acid (PLLA) screws (with either hydroxyapatite (HA) or beta-tricalcium phosphate (beta-TCP)) implanted in the left femur of four sheep euthanized at 42, 50, 57 and 84 days after surgery. Titanium screws were also implanted for comparison purposes. No signs of inflammation were seen in the 240 specimens. A rating of "+/-" for macrophages and "-" for neutrophils was assigned to all specimens. All specimens were assigned a rating which ranged from "+/-" to "+++" for fibroblasts and osteoblasts. The presence of macrophages, neutrophils and fibroblasts/osteoblasts was not statistically different for the four implantation periods. PLLA implants with beta-TCP have a biocompatibility comparable to PLLA implants with HA.

Characteristics of tinnitus in childhood.

Despite its incidence, there are still few reports in literature relating to tinnitus in children. Almost all data were collected by means of questionnaires or in a limited population of children. In order to collect data in a homogeneous way and directly from the patients, the protocol of study proposed by Savastano has been applied to 1,100 children. The results showed tinnitus as present in 374 children but only 6.5% of the cases complained spontaneously about it. In all, 76.4% of the children demonstrated normal hearing, whereas 64.5% reported being bothered by their tinnitus. Tinnitus measurements were obtained and are reproducible in all patients older than 8 years of age. The loudness level was <10 dB in 48.6% of cases, which was higher than 10 dB in 51.4%. As for the frequency distribution, in most cases it appears to be between 0 and 1,000 Hz. There is a correspondence between the loudness level and masking level. A total inhibition of <60 s for most children with lower loudness was obtained. The present study demonstrates that the application in the infancy of a specific protocol of study allows the presence of tinnitus to be discovered, giving specific and detailed information about it so as to minimize its damage to be obtained. Moreover, for the first time, data regarding the measurement of tinnitus in childhood has been gathered.

Superficial inflammatory and primary neoplastic lymphadenopathy: diagnostic accuracy of power-doppler sonography.

OBJECTIVE: To evaluate the sensitivity, specificity and diagnostic accuracy of a cut-off of the resistive index of 0.5 for the differentiation between inflammatory and neoplastic primary lymphadenopathies. SUBJECTS AND METHODS: We measured the resistive index of superficial enlarged lymph nodes in a total of 50 patients (29 males and 21 females; age range 12-72 years, mean age 41.6 year) using an ATL 5000 HDI. A resistive index greater than or equal to 0.5 indicated an inflammatory lymph node and a resistive index <0.5 was consistent with neoplastic primary lymphadenopathies. The gold standard was either surgical biopsy or lymph-node reduction seen with ultrasound examination after antibiotic therapy. RESULTS: The sensitivity of the resistive index for distinguishing inflammatory from neoplastic lymphadenopathy was 84.6%, the specificity 100% and the diagnostic accuracy 95.7% (P < 0.001, statistically significant). CONCLUSION: The results of this study indicate that power-Doppler using a resistive index cut-off of 0.5 was a valid technique for distinguishing between inflammatory and primary neoplastic lymph nodes in patients with superficial lymphadenopathies.

Osteo-articular, mammographic and thoracic films: clinical evaluation of digital view box versus conventional view box.

PURPOSE: To compare in a clinical setting a conventional view box with a digital view box (Smart Light 2000 Digital Film Viewer System, Smart Light, Israel) in the identification of osteo-articular, mammographic and thoracic lesions. MATERIALS AND METHODS: Six radiologists (two for each imaging procedure), experts in osteo-articular, mammographic and thoracic diseases, independently, compared 600 plain films (100 patient with two projections for each imaging procedure). The radiologists evaluated the films by filling-out a multiple choice questionnaire containing questions concerning the type of pathology seen and the technical quality of the radiography in terms of exposure along with specific questions concerning each of the imaging procedures. RESULTS: We observed a higher sensitivity of the digital view box for lesion identification (p<0.05); furthermore, we analyzed a greater number of radiographs, recovering technically unsuitable films, because of over or under-exposure (high or low optical density). The interreader agreement was also good (> 0.75). The better lesion perception derived from the increase luminance of the digital view box in the evaluation of higher film densities, such as in overexposed films. DISCUSSION. The technical characteristics of the digital view box reduce or eliminate negative factors that reduce perceptional performance, and often permit the recovery of films that would have otherwise been considered technically unreadable.

[Topical anesthesia for cataract surgery with phacoemulsification: lidocaine 2% vs ropivacaine 1%. Preliminary results]. / Anestesia topica nella chirurgia della cataratta con facoemulsione: lidocaina 2% vs ropivacaina 1%. Risultati preliminari.

BACKGROUND: The safety, tolerability and efficacy of ropivacaine 1% vs lidocaine 2% for phacoemulsification using topical anesthesia during cataract surgery, are compared. METHODS: A prospective, randomized, double-blind study comparing two agents for topical anesthesia is reported. ENVIRONMENT: Operative Unit of Ophthalmology, general Hospital. 1893 consecutively patients were studied (ASA 1-3, 738 males, 1155 females, age 71.8+/-9.7 years, range 35-90 years) undergoing routine phacoemulsification under topical 2% lidocaine (group I) and 1% ropivacaine (group II). The mains outcome measures of the study were: - the total dose of local anesthetic for obtaining a reduction of corneal sensation measured with the Cochet-Bonnet esthesiometer (value>3); - the pain recorded with visual analogic scale and verbal scale at: T1 = the first injection of local anesthetic; T2 = corneal incision; T3 = the end of surgery; T4 = 1h after surgery; T5 = the first postoperative day; - any requirement for additional intraoperative injection anesthesia and systemic sedation when needed; - surgeon assessments of operative conditions and patient cooperation; - patients' subjective level of comfort; - complications. RESULTS: Topical anesthesia using lidocaine 2% was significantly more painful than the ropivacaine 1%. The onset of anesthesia adequate for surgery was similar in all two groups. There were differences between the groups with respect to perioperative analgesia because the VAS was significantly higher in lidocaine group than in ropivacaine group. There were no statistically differences between the two groups at the follow-up. Inadequate anesthesia was seen in 8.05% (74/919 patients) cases of group I vs 0.9% (22/974 patients) of group II. Sedation was needed only in 10 patients and 6 patients of group I and II respectively. The surgeon assessment showed more patient cooperation in the ropivacaine group (83%). Satisfactory comfort (level 1) was reported by 60.4% in the lidocaine group and 86.8% in the ropivacaine group. In both groups there were cases of postoperative epithelial edema (29 patients in group I vs 36 patients in group II) although it decreased after the first postoperative day. No other significant side-effects were observed with the use of either formulations. CONCLUSIONS: Lidocaine 2% and ropivacaine 1% were safe and effective agents in patients having phacoemulsification with IOL implantation. However, ropivacaine provides more good operative conditions than lidocaine for the surgeon and comfortable surgical circumstances for the patient.

Intradermal injection vs. oral treatment of tinnitus.

Local pharmacological intradermal infiltration is a therapy being used more and more thanks to the positive results achieved, particularly for all those therapies acting on the microcirculation. In trying to better the results obtained with medical therapy for tinnitus sufferers, to assess the effect of a vasoactive drug, the method of administration by the intradermal route, which allows a strengthening of the pharmacological effect, has been added. The present study comprised 120 tinnitus sufferers who underwent intradermal auricle infiltration with a vasoactive drug. The control group includes 115 tinnitus sufferers who underwent systemic vasoactive therapy with the same drug. Forty-five days after beginning intradermal treatment the symptom improved and continued to do so following further infiltrations which patients underwent every 15 days. In the control group we noticed a moderate improvement 45 days after the beginning of oral therapy; thereafter the results reached a plateau by the 60th day. Intradermal vasoactive therapy for idiopathic tinnitus seems to be a new success, which will be an interesting progression in the therapy of this kind of symptom.

Audiometric and epidemiological analysis of elderly in the Veneto region.

BACKGROUND: Presbyacusis, or age-related hearing loss, has become a problem of increasing social interest due to the rise in the mean age of the population. Investigations performed to date have generally been carried out with the aid of self-reporting questionnaires, without the support of objective findings. OBJECTIVE: The purpose of this study was to analyze an extensive series of elderly people from different areas of the Veneto region to obtain an epidemiological descriptive analysis, as detailed as possible, of their presbyacusis, considering their hearing thresholds at various frequencies, distinguishing findings according to sex and age in classes and the geographical area where the survey was performed. METHODS: The survey was carried out collecting information from the audiometric reports on 13,710 subjects of both sexes aged 60 years and over, with a proportion of males (M/F x 100) of 92.02%, referred spontaneously for hearing examination to the ENT departments of eight hospitals between 1986 and 1994. The catchment area includes three provincial capitals and five mainly rural municipalities. RESULTS: The results show that the hearing threshold rises progressively with age in both sexes. The hearing loss is milder in women than in men, especially at the higher frequencies. No important differences emerged among findings recorded in their 80s and in their 90s or among findings in the different geographical areas considered. CONCLUSIONS: Statistical descriptive analysis confirms the typical trend of the audiometric curve in presbyacusis, tracing the typical audiometric curve of old age described in the literature. The mean values of the audiometric curve reveal no significant differences between people residing in the country and people living in the cities.

Otorhinolaryngological assessment and psychological adjustment in tanning industry workers.

The purpose of the study was to verify the presence of any symptoms and otorhinolaryngological pathologies and to determine any discomfort and psychophysical changes among workers in the tanning industry. The study involved 129 subjects working in tanning industries in the Chiampo valley (Veneto region of Italy). Their clinical history was recorded and they underwent objective ENT examination and pure-tone audiometry. For the psychodiagnostic evaluation, four questionnaires were administered (EPI, STAI, ZUNG and GHQ). ENT assessment revealed no objective problems and findings were within the normal range in the majority of cases. Hearing function was also generally normal or within the normal range for an individual's age. Psychological evaluation revealed a valid psychological adjustment in almost all cases, despite the majority of workers reporting some subjective discomfort attached mainly to the particularly unpleasant smell in a micro-climate with a high rate of humidity. The findings of this preliminary investigation enable us to claim that the working environment in the tanning industries is not severely harmful for the upper airways and hearing function. It is worth noting the normality of the workers' psychological adjustment, which indicates a valid psycho-physical balance in these subjects who operate in an environment with unpleasant features.

Importance of behavior in response to tinnitus symptoms.

Among subjects affected by tinnitus, two groups are distinguished: patients who can cope positively with the symptom and patients who cannot cope with it. These differing attitudes suggest the necessity to study affected patients' "illness behavior" (i.e., a subjective interpretation of symptoms concerning body functioning). Our study considered 125 idiopathic tinnitus sufferers who requested a visit by an otorhinolaryngologist expressly for this symptom. All patients were invited to complete the illness behavior questionnaire (IBQ). IBQ mean score results were lower for affective inhibition and irritability and resulted in higher denial. Patients with more psychological suffering presented higher levels of hypochondria, disease convinction, and dysphoria. Results revealed a correlation between psychological suffering and tinnitus intensity: The group of patients with stronger psychological suffering included more subjects with a higher intensity level. The other group included more subjects with a moderate intensity level. Within the psychological evaluation of tinnitus sufferers, the IBQ results demonstrated particular sensitivity in revealing patients' nonadaptation area in coping with the symptom.