Alessio Cerquaglia

Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine

PurposeTo investigate the effect of cyclosporine on corneal ultrastructure and on major signs and symptoms of patients with dry eye disease.Patients and methodsIn this prospective cohort study, patients with dry eye disease were treated with a drop of cyclosporine 0.05% twice daily. Clinical evaluation was carried out at baseline and at months 1, 3, and 6. All patients completed the Ocular Surface Disease Index (OSDI) questionnaire, and tear film break-up time (BUT), fluorescein and lissamine green staining, and Schirmer test were carried out. In vivo confocal microscopy was also performed and epithelial cellular density, keratocyte activation, and subbasal plexus morphology were assessed.ResultsA total of 40 patients completed the study. After 6 months, OSDI, BUT, and fluorescein and lissamine green staining showed a clinically significant improvement. During the 6-month follow-up, density of intermediate epithelial cells increased from 1969.5±85.4 cell/mm2 to 4881.2±175.7 cell/mm2 (P<0.01); average grade of keratocyte activation decreased from 3.6±0.1 to 1.8±0.1 (P<0.001); average grade of number of subbasal nerves decreased from 5.3±0.2 to 2.6±0.2 (P<0.001); average grade of nerve reflectivity decreased from 3.8±0.1 to 2.1±0.2 (P<0.001); and average grade of nerve tortuosity decreased from 3.8± 0.1 to 2.2±0.2 (P<0.001).ConclusionCyclosporine was effective in controlling symptoms and signs of dry eye disease. In vivo confocal microscopy showed an increase in cell density of intermediate epithelium cells, a decrease in hyperreflective keratocytes, and a decrease in density, tortuosity, and reflectivity of nerve fibers.

Deep inside Multifocal Choroiditis: an Optical Coherence Tomography Angiography approach

The aim of the study was to report the clinical utility of optical coherence tomography angiography (OCT-A) in characterizing and differentiating inflammatory lesions and choroidal neovascularization (CNV) in multifocal choroiditis (MFC). A patient affected by MFC complaining central visual loss and scotoma in his left eye was fully investigated with dye-based angiographies, structural OCT and OCT-A. A reactivation of macular CNV was initially suspected, while OCT-A revealed the absence of any decorrelation signal both over the retinal pigment epithelium (RPE) and between RPE and Bruchs’ membrane. OCT-A is a promising tool in detecting inflammatory CNV and in differentiating CNV from primitive inflammatory damage. Finely characterizing the aspect of a lesion allows us to choose the best therapeutic strategy for managing these potentially blinding diseases.

Outer Retinal and Choroidal Evaluation in Multiple Evanescent White Dot Syndrome (MEWDS): An Enhanced Depth Imaging Optical Coherence Tomography Study

ABSTRACT Purpose: To perform an analysis of optical coherence tomography (OCT) abnormalities in patients with MEWDS, during the acute and recovery stages, using enhanced depth imaging-OCT (EDI-OCT). Methods: A retrospective case series of five patients with MEWDS was included. EDI-OCT imaging was evaluated to detect retinal and choroidal features. Results: In the acute phase, focal impairment of the ellipsoid zone and external limiting membrane, hyperreflective dots in the inner choroid, and full-thickness increase of the choroidal profile were observed in the affected eye; disappearance of these findings and restoration of the choroidal thickness (p = 0.046) was appreciated in the recovery phase. No OCT abnormalities were assessed in the unaffected eye. Conclusions: EDI-OCT revealed transient outer retinal layer changes and inner choroidal hyperreflective dots. A transient increased thickness of the whole choroid was also identified. This might confirm a short-lasting inflammatory involvement of the whole choroidal tissue in the active phase of MEWDS.

Transient therapeutic effect of vitrectomy in primary intraocular lymphoma

This photo essay shows the transient therapeutic effect of pars plana vitrectomy (PPV) in a patient affected by primary intraocular lymphoma (PIOL). PPV is crucial for the diagnosis of PIOL, but it may also play a role in the therapeutic approach.

Timolol 0.1% Gel versus Timolol 0.5% Eyedrops in the Prophylaxis of Ocular Hypertension after Phacoemulsification Surgery:

Purpose To determine the efficacy of timolol 0.1% gel in preventing increased intraocular pressure (IOP) after uncomplicated cataract surgery. Methods In this prospective, double-blinded, randomized study were enrolled 70 patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation. After cataract surgery, 25 patients received a single instillation of timolol 0.1% gel (group A); 20 a single instillation of timolol 0.5% eyedrops (group B); and 25 no treatment (group C). The IOP was measured before surgery (T0) and 5 minutes (T1), 2 hours ± 30 minutes (T2), 4 hours ± 30 minutes (T3), and 24 hours ± 180 minutes after surgery (T4). Results The patients in groups A and B had lower mean IOP values than those in group C at T2, T3, and T4; IOP was higher at T2 and T3 than at T1 in the control group. The IOP spikes in group C were higher than those observed in groups A and B: at T2, they were observed in 40% of the patients in group A, 30% in group B, and 76% in group C; and at T3, in respectively 20%, 10%, and 68%; and at T4, in respectively 4%, 0%, and 28%. Conclusions Timolol 0.1% gel is as effective as timolol 0.5% eyedrops in reducing IOP and in limiting the occurrence of IOP spikes for up to 24 hours after phacoemulsification.

Optical coherence tomography angiography in age-related macular degeneration: The game changer:

Optical coherence tomography angiography is one of the biggest advances in ophthalmic imaging. It enables a depth-resolved assessment of the retinal and choroidal blood flow, far exceeding the levels of detail commonly obtained with dye angiographies. One of the first applications of optical coherence tomography angiography was in detecting the presence of choroidal neovascularization in age-related macular degeneration and establishing its position in relation to the retinal pigmented epithelium and Bruch’s membrane, and thereby classifying the CNV as type 1, type 2, type 3, or mixed lesions. Optical coherence tomography angiograms, due to the longer wavelength used by optical coherence tomography, showed a more distinct choroidal neovascularization vascular pattern than fluorescein angiography, since there is less suffering from light scattering or is less obscured by overlying subretinal hemorrhages or exudation. Qualitative and quantitative assessments of optical coherence tomography angiography findings in exudative and nonexudative age-related macular degeneration have been largely investigated within the past 3 years both in clinical and experimental settings. This review constitutes an up-to-date of all the potential applications of optical coherence tomography angiography in age-related macular degeneration in order to better understand how to translate its theoretical usefulness into the current clinical practice.

Tear Film Stability in Sjögren Syndrome Patients Treated with Hyaluronic Acid Versus Crosslinked Hyaluronic Acid-Based Eye Drops

PURPOSE To compare the stability of the tear film after instillation of eye drops containing hyaluronic acid (HA) or crosslinked hyaluronic acid (CLHA)-based in patients with Sjögren syndrome-related dry eye (SSDE). METHODS Forty subjects were included in this study and were divided into 2 groups: the first group (control group) consisted of 20 healthy volunteers; the second group (study group) constituted of 20 suffering from SSDE; before and 5, 30, and 60 min after instillation of eye drops the surface regularity index (SRI) and surface asymmetry index (SAI) were registered. RESULTS Comparing HA and CLHA, in the control group, SAI show statistically significant difference in the time 0 and in time 5, whereas there is no a statistically significant difference after 30 and 60 min from instillation. For SRI there is no statistically significant difference at any time. In SSDE group there is no statistically significant difference in the time 0 and 5, whereas there is a statistically significant difference after 60 min for SAI, and after 30 and 60 min for SRI from instillation. Both SRI and SAI in dry eyes were significantly greater than in control eyes (P < 0.05). CONCLUSION Our study showed a better efficacy of CLHA compared with HA in maintaining the stability of the tear film in a patient suffering from SSDE.

New Insights On Ocular Sarcoidosis: An Optical Coherence Tomography Angiography Study

ABSTRACT Purpose: To report optical coherence tomography angiography (OCT-A) findings in eyes with ocular sarcoidosis (OS) and to compare these findings with those of fluorescein angiography (FA). Methods: Observational, cross-sectional, case-control study. Patients presenting with OS involving the posterior segment were evaluated using FA, structural-OCT and OCT-A. OCT-angiograms of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC) were qualitatively and quantitatively analyzed. Results: OCT-A seemed more sensitive than FA in detecting perifoveal capillary arcade disruptions, areas of hypoperfusion/non-perfusion and capillary abnormalities (p<0.05). Capillary hypoperfusion was more frequently detected in the DCP than in SCP, conversely capillary abnormalities were more often observed at the level of the SCP. Capillary vessel density values were significantly lower in eyes with OS than in healthy controls both at the level of DCP and CC (p<0.05). Conclusion: The depth-resolved nature of OCT-A allowed new insights on OS-induced microvascular and perfusion impairments.

Inflammatory Choroidal Neovascularization: Beyond the Intravitreal Approach

ABSTRACT Purpose: To describe the importance of a customized combined systemic and local therapy in the management of inflammatory choroidal neovascularization (iCNV). Methods: Observational retrospective case series. Results: Four iCNV cases, complicating posterior uveitis or panuveitis affecting young patients, are reported. Combination of both intravitreal (IVT) and systemic drugs represented a successful treatment strategy. Conclusions: iCNV is a sight-threatening disease which affects mostly young people. Customized and both systemic and IVT therapies might represent the best therapeutic option in order to obtain disease control and good prognosis.

Depth-Resolved Imaging of Papillary Vitreoretinal Neovascularization: OCT-Angiography Assessment in Ocular Ischemic Syndrome

Ocular ischemic syndrome results from compromised blood flow to the eye and is usually related to proximal large vessel disease. Affected patients may show rubeosis, neovascular glaucoma, arteriolar attenuation, dilated but not tortuous veins, intraretinal hemorrhages, macular edema, neovascularization of the optic disk and retina, and collateral vessels at the optic nerve head.1 A 67-year-old man complained of visual loss in his left eye. Best-corrected visual acuity was 20/200. The optic nerve head showed a fine neovascular network (Figure 1), veins were dilated but not tortuous, and arteriolar attenuation was also visible. Fluorescein angiography (Figure 2) revealed a prolonged arm-to-eye time, a delayed arterial–venous perfusion, and an abnormal vascular network of the optic disk corresponding to a leaking neovascularization radiating toward the nasal periphery in the late phases. Ocular ischemic syndrome diagnosis was confirmed by carotid doppler ultrasonography that showed a decreased blood flow to the eye, as a result of narrowing of the ophthalmic artery.2 Optical coherence tomography angiography (OCT-A) was performed using a Spectralis OCT-A prototype (Heidelberg Engineering, Heidelberg, Germany) with a 15 · 10° volume scan (261 B-scans) centered on the optic disk. The OCT-angiograms were analyzed with multiple 80-mm-thick slabs, manually fine-tuned from the retinal pigment epithelium to the vitreous cavity.3 The multilayered OCT-A assessment separately showed the origin of new vessels from the deep papillary vasculature and the presence of collateral “shunting” Fig. 1. Color fundus photograph of the optic disk of a 67-year-old patient suffering from ocular ischemic syndrome. Papillary and vitreoretinal new vessels radiating in nasal direction are shown. Mild media opacities are responsible of a difficult visualization of the lesion.