Carlo Capoferri

Conservative management of congenital nasolacrimal duct obstruction

Fifty-nine children 1 to 24 months of age with congenital nasolacrimal duct obstruction (CNDO) were treated with local hydrostatic massage and antibiotic eye drops. Children 1 to 12 months of age showed a cure rate of 93.3%; only two of them underwent nasolacrimal probing. Children 13 to 24 months of age had a cure rate of 79.3%, and six underwent probing. The initial probings were successful in both age groups. Fifty-one children (86.4%) were thus spared nasolacrimal probing.

Laser Treatment of Macular Subretinal Neovascularizations in Angioid Streaks

A serous hemorrhagic maculopathy with a subretinal neovascular membrane appears in about 70% of cases of angioid streaks. In this study a series of 60 eyes (31 patients) was reviewed. In 13 eyes macular subretinal neovascularizations were photocoagulated with blue-green argon laser, green argon laser, dye laser (rhodamine 6G) at 590 nm and red krypton laser. The authors present and discuss the results obtained and suggest that photocoagulation of subretinal new vessels not involving the fovea can be worth performing.

Dye laser photocoagulation of macular subretinal neovascularization in pathological myopia

The authors present a randomized study of 27 eyes affected by pathological myopia with macular subretinal neovascularization which were treated with a tunable dye laser. The effectiveness of three different wavelengths (577, 590 and 620 nm) in the direct treatment of subretinal neovascularizations was evaluated in 3 groups of 9 patients each.Statistical analysis of both visual and anatomical results did not show significant differences among the three wavelengths used.

Prenatal Detection and Early Diagnosis of Hereditary Retinoblastoma in a Family

A couple asked for prenatal testing, the husband being a retinoblastoma survivor. Family history suggested that the tumor predisposing mutation came from his paternal side. DNA analysis indicated that the foetus had not inherited that mutation. Detection of a regressed retinoblastoma in the husbands mother changed the interpretation of the haplotypes obtained, and it was concluded that the foetus had inherited the mutation. Ultrasonography on the 3rd day of extra-uterine life showed a retinal mass in the newborns left eye. Two years later, the couple asked for a new prenatal diagnosis. DNA analysis showed that the foetus had inherited the mutant retinoblastoma haplotype from the father. Fundus examination on the 2nd day of extra-uterine life showed a retinal lesion in the newborns left eye at the posterior pole. This case indicates the necessity of a thorough check on history and an ophthalmological examination of family members.

Herpes zoster ophthalmoplegia in two hemodialysis patients

Two uremic patients undergoing hemodialysis developed ophthalmic herpes zoster (OHZ), rapidly complicated by external ocular motor palsies. A total third nerve palsy was present in one case, a third with pupil sparing and fourth nerve palsy in the other. The palsies fully recovered within eight and nine weeks, respectively. Relative lymphopenia and absence of vascular brain lesions suggest a viral origin in these immunosup-pressed cases.

Different echographic aspects of retinoblastoma in two members of a family

A 52-year-old woman presented in her right eye a whitish translucent mass, expanding from the retinal surface into the vitreous. Echography showed a hyperreflective lesion with a corresponding posterior shadowing. Fluorescein angiography confirmed the diagnosis of retinoma. Her grandson had been identified before birth as a carrier of the mutation of hereditary retinoblastoma. On his third day of life, the retinal surface was entirely covered with hemorrhages, echography showed a 1.2 mm thick, highly reflective membranous-like lesion in his left eye. A similar mass was detected three weeks later in his right eye. The lesions were successfully photo-coagulated. In the present study the authors report and discuss the echogaphic pictures obtained and the role of ultrasonographic examination in the diagnosis of different forms of retinoblastoma, considering clinical and genetic implications.

Delayed diagnosis of homocystinuria in a myopic

Sir: We observed a case in which ocular manifestations led to the diagnosis of homocystinuria after vascular symptoms had been present for over 3 years. A 19-yearold man was referred to one of us (C.B.) because of the suspicion of generalized vasculitis. His history was significant for a sudden lung embolism at age 16. In the ensuing 3 years, the patient experienced two episodes of cerebral hemorrhage, with epilepsy and coma, and an obstruction at the bifurcation of the aorta. He had undergone an aorto-bifemoral bypass and the amputation of the first two right toes. Previous ophthalmic examinations had detected only severe myopia, with normal fundus appearance. No diagnosis had been made. Visual acuity was 0.8 in both eyes (RE, 1 1 ; LE, 11 1 x 170°). Ophthalmoscopy and retinal fluorescein angiography were normal. Slit-lamp examination revealed microspherophakia, iridodonesis, and phakodonesis in both eyes. No lens displacement was observed. A-scan ultrasonography showed practically normal axial lengths and increased lens thickness (RE, 23.6 and 4.7 mm; LE, 23.8 and 4.7 mm, respectively). The clinical diagnosis of homocystinuria was confirmed by the finding of homocystine in plasma and urine, a distinctive feature of cystathionine-fl-synthase deficiency. In the next 24 months, the patient was treated successfully with pyridoxine hydrochloride (600rag/day) and folate (15 mg/day), resulting in disappearance of the metabolic abnormalities and of the relapsing thromboembolic episodes.