A Lepri

Orbital radiotherapy combined with high dose systemic glucocorticoids for Graves’ ophthalmopathy is more effective than radiotherapy alone: results of a prospective randomized study

We have carried out a prospective study to investigate whether orbital radiotherapy combined with high dose systemic glucocorticoids is more effective than orbital radiotherapy alone for Graves’ ophthalmopathy. Thirty consecutive patients with relevant and active Graves’ ophthalmopathy were randomly assigned to treatment either with orbital radiotherapy combined with systemic glucocorticoids (Group 1, n =15) or with orbital radiotherapy alone (Group 2, n = 15). The final evaluation was made 6–9 months after beginning treatment. Two patients in each group were lost to follow-up. Ocular involvement and response to treatment were evaluated by the ophthalmopathy index and by clinical assessment. Mean ophthalmopathy index values were 5.85 in Group 1 and 5.46 in Group 2 (p = NS) before treatment, and 2.46 in Group 1 and 3.61 in Group 2 after treatment (p = 0.0001 and p = 0.003 vs initial value, respectively). The mean ophthalmopathy index decrease in Group 1 (−3.39) was significantly greater (p = 0.043) than that in Group 2 (−1.85). Favorable responses on clinical ground occurred in 9 patients (69%) in Group 1 and in 5 patients (38%) in Group 2. The difference was particularly evident on soft tissue changes and extraocular muscle involvement. Severe eye muscle restriction was substantially unaffected by either treatment. In conclusion, the association of orbital irradiation and high dose systemic glucocorticoids in the treatment of severe Graves’ ophthalmopathy provides more favorable responses than orbital radiotherapy alone.

Effects of strabismus surgery on corneal topography

BACKGROUND Changes in refraction follow surgery on the extraocular muscles. We examined corneal topography before and after medial or lateral rectus muscle recession using a computer-assisted topographic analysis system. METHODS A total of 36 patients (52 eyes) were examined. Measurements were taken 1 day before surgery and 1, 15, and 30 days after surgery. RESULTS A significant change in astigmatic power was detected 1 day after surgery in the meridian of the recessed muscle, evidencing a localized flattening of the cornea. Induced astigmatism decreased over time. At 30 days following surgery, 6% of patients evidenced a residual change higher than 1 diopter (D); 12% evidenced a residual change higher than 0.5 D. CONCLUSION The increase of astigmatic power recorded 1 day after surgery is higher for medial rectus muscle recession than for lateral rectus muscle recession. Corneal topography changes, located mainly in the meridian of the recessed muscle and the optical zone, are greatly reduced or gone within 1 month of surgery.

Effect of Suleparoide on Fibrinolysis in the Anterior Chamber of Rabbits

Intra-ocular fibrin deposition following ocular surgery is a serious postoperative complication. The current management of severe postoperative fibrin response is usually ineffective. A quantitative model of fibrin deposition in the rabbit anterior chamber was used to assess the efficacy of Suleparoide I.N.N. (HHS-5) in preventing fibrin formation and in promoting the clearance of fibrinous membranes. Citrated human plasma was injected intracamerally after paracentesis to induce the formation of fibrin clots: 10 min or 24 h after plasma injection, solutions of HHS-5 at different concentrations were injected into the anterior chamber of rabbits. Intra-ocular HHS-5 injection 10 min after plasma injection prevented the formation of fibrinous membranes in a dose-dependent fashion in almost all treated animals. When HHS-5 was injected at 24 h after fibrin clot formation, a reduction of clot areas was observed but the membranes did not completely disappear. No evidence of ocular toxicity was detected by slit-lamp biomicroscopy, intra-ocular pressure and corneal thickness measurements. On the basis of the results obtained with the present animal model, HHS-5 appears as an effective and safe agent for the prevention of fibrinous membrane formation. The data suggest a potential use of HHS-5 for the prophylaxis of fibrin formation in human eyes undergoing extensive intraocular surgery, or in diabetic patients where a hypercoagulable state may be present.

A new counter-intuitive therapy for adult amblyopia

Visual cortex plasticity is high during a critical period of early postnatal development, but rapidly diminishes with the transition to adulthood. Accordingly, visual disorders such as amblyopia (lazy eye), can be treated early in life by long-term occlusion of the non-amblyopic eye, but may become irreversible in adults, because of the decline in brain plasticity. Here we show that a novel counter-intuitive approach can promote the recovery of visual function in adult amblyopic patients: short-term occlusion of the amblyopic (not the fellow) eye, combined with physical exercise (cycling). After six brief (2h) training sessions, visual acuity improved in all ten patients (0.15±0.02 LogMar), and six of them also recovered stereopsis. The improvement was preserved for up to one year after training. A control experiment revealed that physical activity was crucial for the recovery of visual acuity and stereopsis. Thus, we propose a non-invasive therapeutic strategy for adult human amblyopia based an inverse-occlusion and physical exercise procedure.Visual cortex plasticity is high during a critical period of early postnatal development, but rapidly diminishes with the transition to adulthood. Accordingly, visual disorders such as amblyopia (lazy eye), can be treated early in life by long-term occlusion of the non-amblyopic eye, but may become irreversible in adults, because of the decline in brain plasticity. Here we show that a novel counter-intuitive approach can promote the recovery of visual function in adult amblyopic patients: short-term occlusion of the amblyopic (not the fellow) eye, combined with physical exercise (cycling). After six brief (2h) training sessions, visual acuity improved in all ten patients (0.15+-0.02 LogMar), and six of them also recovered stereopsis. The improvement was preserved for up to one year after training. A control experiment revealed that physical activity was crucial for the recovery of visual acuity and stereopsis. Thus, we propose a non-invasive therapeutic strategy for adult human amblyopia based an inverse-occlusion and physical exercise procedure.

Treatment of Graves’ Ophthalmopathy by Retrobulbar Corticosteroids Associated With Orbital Cobalt Radiotherapy

Combined therapy with systemic corticosteroids and orbital cobalt radiotherapy (RT) has proven an effective method for treatment of severe Graves’ ophthalmopathy (1). The use of large doses of systemic corticosteroids is potentially risky. In more than 100 patients treated so far at our Institution with systemic corticosteroids either alone or in combination with radiotherapy, relevant side effects have been observed in 4 cases: one patient had an increase of intraocular tension, one showed depressive psychosis, one developed diabetic syndrome requiring insulin, and one had infective encephalitis within the first month of treatment (2). This prompted us to assess the therapeutic effectiveness of retrobulbar long-acting corticosteroids (RBC) in substitution for systemic corticosteroids in the combined therapy in a group of 44 consecutive patients with active Graves’ ophthalmopathy.