A novel index for predicting macular thickening after cataract surgery.

PURPOSE: In this study, we tried to investigate weather or not the preoperative anterior chamber depth, the lens thickness (LT) and the relation between these variables by the ratio (K) of the distance from the corneal peak to the posterior side of the lens (A) (K = A/LT) could be predictive for a surgically induced foveal thickening following uneventful cataract surgery in normal, emmetropic eyes. PATIENTS AND METHODS: A total amount of 45 eyes, 25 females and 20 males, were enrolled in this study and underwent uncomplicated phacoemulsification under topical anesthesia. A complete ophthalmological examination was performed preoperatively, including refraction, best corrected visual acuity, slit-lamp examination, biometry and optical coherence tomography of both eyes. These examinations, with the exception of the biometric examination, were repeated one day, one week and four weeks after surgery. RESULTS: The K ratio was positively correlated with the macular thickness changes after cataract surgery. The Pearson correlation analysis of K ratio and foveal thickness changes was 0.792 (y = 36.457x - 52.558, R2 = 0.6266). CONCLUSIONS: A novel ratio that incorporates preoperative ocular parameters has been described. It could be easily measured in a clinical setting, and appears to be strongly predictive for macular thickening following cataract surgery. Of course, further studies enrolling a larger amount of patients are necessary in order to confirm these preliminary data.

Changes in vital signs during cataract phacoemulsification by using peribulbar or topical anesthesia.

AIMS: To compare changes in vital signs and pain level experienced by patients during phacoemulsification and foldable intraocular lens (IOL) implantation using either topical/intracameral or peribulbar anesthesia. MATERIALS AND METHODS: In this prospective, parallel-group clinical study 46 consecutive patients (mean age 72.9 +/- 8.1 years) undergoing cataract surgery were randomized to receive topical/intracameral (group1) or peribulbar (group 2) anesthesia. Systolic, diastolic and mean blood pressures, hearth rate, oxygen saturation and pain level were recorded before and during the anesthesiological procedure and thereafter during each surgical step. RESULTS: Diastolic blood pressure during phacoemulsification and after surgery as well as mean arterial pressure after surgery were significantly higher in group 1 compared to group 2. Variability of systolic and mean arterial pressures across the study phases was significantly higher in group 2 compared to group 1. A significantly higher percentage of patients in group 2 compared to group 1 (35.3% vs 3.4%, p=0.007) showed a heart rate reduction greater than 10% from the anesthesiological to the following surgical phase. Higher incidence of moderate pain in group 2 was reported during the anesthesiological procedure (64.7% vs 3.4%, p<0.00001) while higher incidence of moderate pain was reported in group 1 during phacoemulsification (31% vs 5.9%, p=0.047) and IOL implantation (21.7% vs 2.2%, p=0.02). DISCUSSION: Our short study seems to recommend the use of topical/ intracameral anesthesia for cataract surgery due to more stable heart rate, diastolic and mean blood pressures. However, further studies enrolling a higher amount of patients are necessary to confirm our preliminary data.

Immunohistochemical profile of VEGF, TGF-ß and PGE2 in human pterygium and normal conjunctiva: experimental study and review of the literature.

Human pterygium is made up of chronic proliferative fibro-vascular tissue growing on the ocular surface. This disease exhibits both degenerative and hyperplastic properties. Some fibroangiogenic factors have recently been shown to play a potential role in fibrovascular diseases via the angiogenesis process. The aim of this study is to evaluate VEGF, TGF-ß and PGE2 expression in the epithelial, endothelial and stromal cells of human pterygium and normal conjunctiva in order to determine whether these factors participate in the development of pterygium. Ten specimens from patients with pterygium and two normal conjunctivas (cadavers) were analyzed by immunohistochemistry using specific antibodies against these growth factors. The technique used was ABC/HRP (Avidin complexed with biotinylated peroxidase). Immunoreactivity of VEGF was significantly increased in the epithelium, vascular endothelium and stromal cells in primary pterygium as compared with normal conjunctiva. A moderate expression of TGF-ß in the pterygium was observed in the epithelial and stromal layers. On the contrary, immunolabeling of this growth factor in the human normal conjunctiva was weak. PGE2 was strongly expressed in the epithelium of patients with pterygium, as in control conjunctival tissues, and the immunolabeling was moderate in the stroma from the same patients. Our results suggest that these growth factors may contribute to the progression of primary pterygium by increasing angiogenesis, thus leading to the formation of new blood vessels from the pre-existing vasculature. We conclude that VEGF, TGF-ß and PGE2 may be potential therapeutic targets in the treatment of this disease although proof of this evidence requires further studies.

Early lamellar macular hole in Alport syndrome: case report and review of the literature.

PURPOSE AND METHOD: To present a 26-year-old Italian woman affected by genetically ascertained Alport syndrome. The patient underwent a complete ophthalmological examination including: visual acuity, anterior and posterior segment biomicroscopy, MP1-microperimetry, colour fundus retinography, electrofunctional examinations (electrooculogram, electroretinogram, visually evoked potentials), computerized perimetry and Spectral Domain Optical Cohrence Tomography. RESULTS AND CONCLUSIONS: Nephritis, haematuria but no hearing impairment was observed. Visual function was normal, also confirmed by electrofunctional tests and computerized perimetry. The ocular involvement was only expressed by an early lamellar macular hole characterized by a density rarefaction in the tomographic images of both inner retina and superficial choroid. A rarefaction of the inner choroid in the whole macular region and in the peripapillary area, unusual for the young age of the patient, was also evident. We suppose that these tomographic findings might be caused by alterations of type IV collagen, typical of Alport syndrome.

An unusual case of conjunctival irritation and epiphora following external dacryocystorhinostomy.

OBJECTIVE: The authors discuss a case of conjunctival irritation and epiphora in a patient who had undergone dacryocystorhinostomy three years earlier. METHOD: Case report, and a review of the world literature concerning lacrimal canalicular air regurgitation after dacryocystorhinostomy. RESULTS: A 70-year-old woman, who used continuous positive airway pressure therapy during sleep, complained of epiphora and conjunctival irritation. She had undergone dacryocystorhinostomy three years earlier. Her right eye had an augmented tear meniscus, with a predominantly medial conjunctival irritation. Conjunctival irritation from lacrimal canalicular air regurgitation was diagnosed. White petrolatum and mineral oil ophthalmic ointment was prescribed, applied topically before sleeping. After one month of treatment, complete relief of symptoms was obtained. CONCLUSION: There is little current information on managing such patients. It is imperative to discuss this potential complication when considering nasolacrimal surgery in patients using continuous positive airway pressure therapy.

Spontaneous closure of bilateral full thickness macular holes without surgery: an eleven-year follow-up.

PURPOSE AND METHOD: To present a 60-year-old woman affected by bilateral full thickness macular hole, showing without surgery a spontaneous resolution of the disease in both eyes that remains unchanged during an eleven-year follow-up. To our knowledge, this clinical case is uncommon as no similar reports with such a long follow-up have been published in the scientific literature at this time. RESULTS AND CONCLUSIONS: A spontaneous and bilateral closure of full thickness macular holes was detected, as a consequence of a complete posterior vitreous detachment documented by optical coherence tomography images. An initial reduction up to a complete resolution of the central macular scotoma was also observed by performing scanning laser ophthalmoscope microperimetry. Both these anatomical and functional results did not change during the whole period of follow-up. According to this study, the release or the weakening of the vitreous tractions at the foveal edges seems to play a key role in the spontaneous resolution of macular holes in not surgically treated patients.

Association among low whole blood viscosity, haematocrit, haemoglobin and diabetic retinopathy in subjects with type 2 diabetes.

OBJECTIVES: Haemorheological variables influence endothelial function through the release of several factors. Clinical studies have described an association among blood viscosity, haematocrit, haemoglobin and macro-angiopathy. Few data are reported about the association between haemorheological variables and micro-angiopathy. The aim of the present study was to evaluate the association between these variables and retinopathy in subjects with type 2 diabetes. METHODS: 111 men, 79 postmenopausal women, and 95 healthy age- and sex-matched controls were recruited. Haematocrit and haemoglobin were measured by standard methods. Blood viscosity was calculated according to the formula (0.12× haematocrit)+(0.17× (plasma proteins-2.07)). Subjects were grouped according to the presence or absence of diabetic retinopathy, while the severity of retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study scale. RESULTS: Haemoglobin, haematocrit and whole blood viscosity were significantly lower in subjects with retinopathy compared to subjects without retinopathy in both sexes. These variables significantly decreased with increasing severity of retinopathy. A multiple logistic regression analysis confirmed the independent inverse association among viscosity, haematocrit, haemoglobin and retinopathy (p<0.01). CONCLUSION: Results demonstrate the association among low viscosity, haemoglobin, haematocrit and diabetic retinopathy. The mechanisms responsible for this association can be hypothesised. Reduced haemoglobin might cause direct organ damage. Low blood viscosity, through the reduction of shear stress, might inhibit the anti-atherogenic functions of endothelial cells.

Lower eyelid ablative fractional resurfacing: a new technique to treat skin laxity and photoaging.

AIM: The authors describe and validate a new technique of one-session, multiple-pass, low spot density, fractional ablative CO2 resurfacing in order to treat lower eyelid skin laxity and photoaging. METHODS: The investigation was conducted on 25 patients. The YouLaser CO2 (Quanta System s.p.a., Italy), a 10600-nm CO2 ablative fractional laser system, was used to treat the lower eyelids at a pulse energy of 25 to 35 J, with a pulse duration of 1 ms, 200 microm spot size and a density of 100 laser spots/cm2 for every passage. Each patient had 1 session only, and 1 to 3 passes per area, after application of topical anesthesia. Two blinded physicians assessed eyelid tightening from photographs of 25 patients using a 4-point evaluation scale (1 = 1-25%, 2 = 26-50%, 3 = 51-75%, and 4 = 76-100%. The grades of the 2 evaluating physicians were analyzed using t-test and Kruskal-Wallis analysis of variance. The same evaluation scale was used to assess patient satisfaction in a questionnaire. RESULTS: The median grades of the 2 physicians for all patients did not differ significantly (p = .88) from one another, and the Kruskal-Wallis assessment (p = 0.0011) indicated unbiased grading among the physicians. All patients achieved a degree of eyelid tightening; 8% achieved 1% to 25% improvement, 24% achieved 25% to 50%, 40% achieved 50% to 75%, and 28% achieved 75% to 100%. Results of patient questionnaires were similar to that of the physicians' evaluation: 4% achieved 1% to 25% improvement, 28% achieved 25% to 50%, 48% achieved 50% to 75%, and 20% achieved 75% to 100%. CONCLUSIONS: The fractioned form of CO2 laser delivery offers very good results with short downtime and easy patient recuperation. The new technique allowed the operator to control skin contraction immediately after laser skin exposure. Using high energy and lower laser spot density permits a control of the amount of contraction simply by the number of passes. Increasing this variable progressively increased skin damage and consequently the contraction.

Lack of a head in human spermatozoa from sterile patients: a syndrome associated with impaired fertilization.

Three patients with primary sterility in whom the majority of spermatozoa lacked a normally implanted head are presented. A small cephalic knob was evident in most of them by routine colorimetric techniques, and the Feulgen reaction failed to show any deoxyribose nucleic acid. The morphologic features of the tails was normal. Few loose sperm heads were observed in the ejaculates. Even though motility was decreased, there were numerous acephalic sperms with different degrees of forward motility. Electron microscopy showed a well-organized structure of the centrioles and connecting piece, which were located in the neck region within a small cytoplasmic mass, but no chromatin was detected in any case. Studies on immature spermatids present in semen evidenced an independent anomalous development of heads and tails and suggested that they became separated at the end of spermatid maturation. This anomaly, of probable genetic origin, is interpreted to be due either to an alteration in the mechanism of migration and positioning of the tail on the caudal pole of the nucleus or to an interference with the formation of the implantation fossa of the head, which normally accommodates the connecting piece.