Alessandro Finzi

ET-1 plasma levels, choroidal thickness and multifocal electroretinogram in retinitis pigmentosa

AIM To assess the relationship between both photoreceptor function and choroidal thickness and endothelin-1 (ET-1) plasma levels in patients with early stage retinitis pigmentosa (RP). MAIN METHODS We compared 24 RP patients (14 males and 10 females), 25 to 42 years of age (mean age: 34±7 years) with 24 healthy controls (12 males and 12 females) aged between 28 and 45 years (mean 36±6.8 years). All patients underwent visual field test, electroretinogram and multifocal-electroretinogram and choroidal thickness measurement by using spectral domain optical coherence tomography. KEY FINDINGS RP patients had a visual acuity of 0.95, a mean defect of the visual field of -7.90±1.75 dB, a pattern standard deviation index of 6.09±4.22 dB and a b-wave ERG amplitude of 45.08±8.24 μV. Notably RP subjects showed significantly increased ET-1 plasma levels and reduced choroidal thickness compared with controls: respectively, 2.143±0.258 pg/ml vs. 1.219±0.236 pg/ml; p<0.002 and 226.75±76.37 μm vs. 303.9±39.87 μm; p<0.03. Spearmans correlation test highlighted that the increase of ET-1 plasma levels was related with the decrease of choroidal thickness (r=-0.702; p<0.023) and the increase of implicit time in both ring 2 (r=-0.669; p<0.034) and ring 3 (r=-0.883; p<0.007) of mfERG. SIGNIFICANCE Increased ET-1 plasma levels may play a key role in the impairment of retinal and choroidal blood flow due to the vasoconstriction induced by ET-1. This could lead to worsening of the abiotrophic process of the macular photoreceptors.

Hemifield pattern electroretinogram in ocular hypertension: comparison with frequency doubling technology and optical coherence tomography to detect early optic neuropathy

Background To assess the sensitivity and specificity of hemifield pattern electroretinogram (HF-PERG) for detecting early retinal ganglion cell (RGC) damage in ocular hypertensive (OH) patients. Methods Fifty-two OH patients (mean age 56±9.6 years) with an intraocular pressure (IOP) .21 mmHg were assessed. All subjects underwent HF-PERG, optical coherence tomography (OCT), and frequency doubling technology (FDT) visual field. Results OH patients showed a significant increase of peak-time of the N95 (P=0.027) compared to controls. The amplitude of the N95 of the lower and upper HF-PERG showed significant differences (P=0.037 and P=0.023, respectively) between the two groups. A significant intraocular (P=0.006) and interocular (P=0.018) asymmetry of N95 amplitude was found. Receiver operating characteristic (ROC) curve analysis revealed a sensitivity of 93% for the N95 of the lower HF-PERG, whereas full-field pattern electroretinogram (PERG) N95 peak-time had a sensitivity of 88%. In OH patients, we found a thinning of OCT - retinal nerve fiber layer (RNFL), especially in the superior and inferior quadrant, although not statistically significant, and a significantly higher FDT pattern standard deviation (FDT-PSD; P=0.001). In the OCT-RNFL inferior quadrant, a sensitivity of 82% was recorded. Finally, the sensitivity of the FDT-PSD was 92%. Conclusion Our study shows that HF-PERG is a very sensitive test for detecting early damage of the RGC.

Autologous Choroidal RPE Patch Transplantation in Hemorrhagic Age-Related Macular Degeneration

Autologous RPE-choroidal transplantation has shown to improve visual function in eyes with hemorrhagic CNV secondary to AMD, both in terms of distance vision, reading vision, and fixation. Performed by experienced vitreoretinal surgeons, autologous RPE-choroidal transplantation is a valuable treatment alternative, in particular in patients with poor vision in the fellow eye. While cell-based therapy and preloaded RPE artificial Bruch’s membrane patches might be the future treatment for patients with maculopathies, RPE-choroidal patch transplantation can be considered, at the present time, as a good alternative in the treatment of wet AMD for patients who are not responding to anti-VEGF or PDT therapy.

The Comparative Efficacy and Tolerability of Diclofenac 0.1% and Bromfenac 0.09% Ophthalmic Solutions after Cataract Surgery

ABSTRACT Purpose: To compare the efficacy and tolerability of diclofenac and bromfenac ophthalmic solutions as adjunctive therapy after cataract surgery. Materials and Methods: This prospective randomized controlled study included 130 patients who underwent cataract surgery. One hundred patients were randomized to receive postoperatively diclofenac 0.1% (four times daily for 28 days, Group 1) or bromfenac 0.09% (twice daily for 14 days, Group 2) ophthalmic solutions in addition to steroid-antibiotic combination. Thirty patients instilled only steroid-antibiotic combination (Control Group 3). Laser flare-cell photometry and optical coherence tomography scans with central foveal thickness (CFT) measurement were performed before (V0) and 7 (V1), 14 (V2) and 28 days (V3) after surgery. Treatment tolerability was scored using the Ocular Comfort Grading Assessment. Results: Laser flare-cell photometry values were significantly higher at V1, V2 and V3 compared to V0 in all the groups (respectively 13.3 ± 1.0, 12.7 ± 0.9 and 9.6 ± 0.9 vs 8.4 ± 0.6 ph/ms for Group 1; 13.4 ± 1.0, 12.7 ± 0.9 and 12.7 ± 1.0 vs 8.1 ± 0.6 for Group 2; 15.9 ± 0.8, 15.4 ± 0.7 and 14.5 ± 0.7 vs 7.5 ± 0.5 for Group 3) (p < 0.001); flare increase was significantly lower in Group 1 compared to Groups 2 and 3 (p < 0.001). CFT values were higher after surgery in all the three groups; the increase was significantly lower in Group 1 compared to Groups 2 and 3 (p < 0.0002). The percentage of symptoms-free patients after study treatment was significantly higher in Group 2 compared to Group 1 (respectively 74% vs 14% of the total; p < 0.001). Conclusion: The addition of diclofenac or bromfenac ophthalmic solutions contributed to further reduce both inflammation and cystoid macular edema after cataract surgery compared to steroid-antibiotic combination alone. Diclofenac appeared to be more effective in reducing postoperative intraocular inflammation with a more intense and prolonged regimen, while bromfenac more tolerated with lower daily dose and treatment duration.

Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety

Background Postoperative endophthalmitis is a severe complication after intraocular surgery. The aim of this pilot study was to investigate the safety of intracameral cefuroxime in combined vitrectomy and phacoemulsification for cataract and various vitreoretinal disease. Methods The charts of 152 patients who underwent combined phacoemulsification, intraocular lens implant and pars plana vitrectomy were reviewed. The final tamponade was chosen among fluid, air, gas or silicone oil, based on the requirement of each single case. Patients were operated on by four different surgeons. At the end of surgery, 1 mg/0.1 mL of intracameral cefuroxime (Aprokam) was administered. Results The mean follow-up was 6.26±7.78 months (range 1–12). No retinal complication, such as retinal infarction or hemorrhages were observed. No acute macular serous detachment and no new intraretinal cysts were noted, in those patients who received optical coherence tomography within the fifth day after surgery. No endophthalmitis was recorded. Conclusion Intracameral cefuroxime, at the end of combined phacoemulsification and pars plana vitrectomy, is safe as it has no toxicity on the retina and maybe could be considered effective in endophthalmitis prevention. Due to the relatively small number of patients, further studies are advisable. Summary statement The standard dose of intracameral cefuroxime at the end of combined phacoemulsification and pars plana vitrectomy has no toxic effects on the retina. This paper/The abstract of this paper was presented at the European Vitreo Retinal Society Conference 2017 as a conference talk with interim findings. The poster’s abstract was not published.

Steady-state pattern electroretinogram and frequency doubling technology in anisometropic amblyopia

Background Steady-state pattern electroretinogram (PERG) and frequency doubling technology (FDT) perimetry can be used to selectively investigate the activity of the M-Y ganglion cells in adult anisometropic amblyopes. Methods Fifteen normal subjects (mean 27.8±4.1 years) and 15 adults with anisometropic amblyopia (mean 28.7±5.9 years) were analyzed using steady-state PERG and FDT. Results The amplitude of steady-state PERG was significantly different not only among the control group and both the amblyopic eye (P=0.0001) and the sound eye group (P=0.0001), but also between the latter two groups (P=0.006). The difference in FDT mean deviation was statistically significant not only between the control group and amblyopic eye group (P=0.0002), but also between the control group and the sound eye group (P=0.0009). The FDT pattern standard deviation was significantly higher in the control group rather than in the amblyopic eye (P=0.0001) or the sound eye group (P=0.0001). A correlation was found between the reduction in PERG amplitude and the increase in FDT-pattern standard deviation index not only in amblyopic (P=0.0025) and sound (P=0.0023) eyes, but also in the healthy control group (P=0.0001). Conclusion These data demonstrate that in anisometropic amblyopia, there is an abnormal functionality of a subgroup of the magnocellular ganglion cells (M-Y), and the involvement of these cells, together with the parvocellular pathway, may play a key role in the clinical expression of the disease.

Alterations Induced by Bangerter Filters on the Visual Field: A Frequency Doubling Technology and Standard Automated Perimetry Study

Purpose. To investigate the effects of Bangerter filters on the visual field in healthy and in amblyopic patients. Materials and Methods. Fifteen normal adults and fifteen anisometropic amblyopia patients were analysed with standard automated perimetry (SAP) and frequency doubling technology (FDT) at baseline and with filters 0.8 and 0.1. Results. With 0.1 filter in SAP there was an increase of MD compared with controls (−10.24 ± 1.09 dB) in either the amblyopic (−11.34 ± 2.06 dB; P < 0.050) or sound eyes (−11.34 ± 1.66 dB; P < 0.030). With filters 0.8 the PSD was increased in the amblyopic eyes (2.09 ± 0.70 dB; P < 0.007) and in the sound eyes (1.92 ± 0.29 dB; P < 0.004) compared with controls. The FDT-PSD values in the control group were increased with the interposition of the filters compared to baseline (0.8; P < 0.0004 and 0.1; P < 0.0010). We did not find significant differences of the baseline PSD between amblyopic eyes (3.80 ± 2.21 dB) and the sound eyes (4.33 ± 1.31 dB) and when comparing the filters 0.8 (4.55 ± 1.50 versus 4.53 ± 1.76 dB) and 0.1 (4.66 ± 1.80 versus 5.10 ± 2.04 dB). Conclusions. The use of Bangerter filters leads to a reduction of the functionality of the magno- and parvocellular pathway.