Ettore Ferrari

Indocyanine green angiography in central serous chorioretinopathy

Purpose. To analyse images obtained by indocyanine green angiography in central serous chorioretinopathy (CSC). Methods. Ninety patients affected with CSC were examined using indocyanine green angiography. Results. CSC was detected in 127 of the 180 eyes examined. Leakage points were detected in 99 eyes with fluorescein angiography; in 85 of these eyes, they corresponded o hyperfluorescence with indocyanine green angiography, while a hyperfluorescence of the neuroepithelial detachment was seen in 21 eyes. Areas of choriodal hyperpermeability were seen in all 127 eyes with CSC and in 9 fellow eyes. With ICG angiography, the appearance of pigment epithelial detachments was similar to that previously described (early hyperfluorescence and later hypofluorescence), and was seen in 47 eyes. In 103 eyes, hypofluorescence lesions of various sizes, were detected which became more marked in the later stages. These lesions corresponded to retinal pigment epithelium lesions in fluorescein angiography, mainly hyperfluorescence caused by window defect. We were also able to observe RPE atrophic tracts in 31 eyes. These tracts appeared hyperfluorescent in 11 eyes where a minimal amount of RPE atrophy was present and hypofluorescent in 20 eyes in which the tract had marked RPE atrophy. Conclusion. The results obtained confirm the finding of choriodal hyperpermeability and subretinal diffusion of ICG, which indicate involvement of the choroid in CSC. The observation of progressively hypofluorescent lesions corresponding to retinal pigment epithelium alterations suggests that there may be as yet unknown interactions of pigment epithelium and ICG.

Light panretinal photocoagulation (LPRP) versus classic panretinal photocoagulation (CPRP) in proliferative diabetic retinopathy.

Purpose. We misled to verify whether a panretinal photocoagulation (PRP) performed using low levels of ARGON laser energy (light PRP) has the same efficacy as a PRP performed in a conventional fashion using argon green wavelengths (classic PRP) in eyes with high-risk proliferative diabetic retinopathy (HRPDR). Furthermore, we misled to compare the session number performed and the side effects produced by the two techniques. Methods. Sixty-five eyes with HRPDR of 50 consecutive patients were enrolled in a prospective randomized controlled trial. In eyes selected for light PRP, a very light biomicroscopic effect on the retina was obtained for each spot. In eyes assigned to classic PRP, each spot produced a white-yellow biomicroscopic effect. Mean follow-up was 22.4 months ±9.7 in the light PRP and 21.6 months ±9.3 in the classic PRP group (p = 0.727). Results. The initial mean logMAR visual acuity (VA) in the light PRP group was 0.12 ± 0.13 and in the classic PRP group 0.14 ± 0.15 (p = 0.493). The final mean VA in the former was 0.18 ± 0.25, and in the latter 0.27 ± 0.30 (p = 0.231). Median power was 235 mW (100–540 mW) for light and 420 mW (200–950 mW) for classic PRP (p < 0.001). Regression of HRPDR at the end of the follow-up was obtained in 30/31 eyes (97%) treated with classic PRP and in 31/34 eyes (91%) treated with light PRP (p = 0.615). The total mean session number was 7.4 ± 2.4 for light and 9.9 ± 2.2 for the classic PRP group (p < 0.001). Complications were more frequent in the classic PRP group. Conclusions. The efficacy of Light PRP is similar to that of classic Light PRP in eyes with HRPDR. Light PRP is associated with fewer complications and allows the reduction of the number of treatment sessions.

Diode laser photocoagulation of choroidal hemangioma

Background: The argon laser photocoagulation has recently become the treatment of choice in choroidal hemangioma. We evaluated the efficacy of the near infrared wavelength diode laser in the treatment of such tumours. This wavelength is not highly absorbed by the retinal pigment epithelium and penetrates deep into the choroid. Methods: Two cases of choroidal haemangioma with a serous detachment of the neural retina were diagnosed with ophthalmoscopy, fluorescein and indocyanine green angiography, A-scan and B-scan ultrasonography and treated with a surface photocoagulation with a diode laser. The efficacy of photocoagulation was evaluated three, six, twelve and fifteen months after laser treatment. Results: The resorption of the subretinal fluid and a reduction in thickness of the tumour followed laser photocoagulation. Conclusions: Diode lasers might be effective in the treatment of choroidal haemangioma.

Retinal pigment epithelium tear following toxemia of pregnancy

A 28-year-old woman with toxemia during the 34th week of pregnancy complained of visual loss in one eye. Two weeks after abruptio placentae and delivery a retinal pigment epithelium (RPE) tear which presumably followed a RPE detachment (PED) was found in the macular region of the right eye. Visual acuity was 0.8 at the time of diagnosis but was 1.0 in both eyes one year after the delivery. Some authors have described peculiar choroidal lesions associated with central serous chorioretinopathy (CSC) in pregnancy and ischemic exudative choroidal lesions during severe toxemia. However the findings we describe are highly unusual, indicating that the mechanisms of choroidal and RPE pathology are still poorly understood. We also demonstrate that a pathological tear following toxemia of pregnancy is compatible with good acuity in spite of the anatomical damage.

Levofloxacin disposition over time in aqueous humor of patients undergoing cataract surgery

ABSTRACT The ocular disposition of levofloxacin in patients receiving two 500-mg oral doses 10 h apart before cataract surgery was assessed with the intent of defining drug ocular exposure over time. The mean aqueous humor concentrations persisted above 1.5 mg/liter between 1.5 and 6.0 h after the second dose, with average aqueous-to-plasma ratios ranging between 0.33 and 0.57. This favorable ocular disposition provides support for trials of systemic levofloxacin for prophylaxis of postoperative endophthalmitis in selected patients or as adjunctive therapy for the treatment of this potentially devastating infective complication.

Continuous wave Nd:YAG laser photocoagulation in proliferative diabetic retinopathy.

AIMS--The therapeutic efficacy of the continuous wave (CW) Nd:YAG laser (working in the free running mode) was investigated in proliferative diabetic retinopathy (PDR) comparing it with a conventional laser source such as the krypton laser. METHODS--Twenty four eyes of 12 patients affected with bilateral PDR were included and divided in two groups. The right eyes were treated with a red krypton laser and the left eyes with a CW Nd:YAG laser. RESULTS--Three months after krypton photocoagulation 10 eyes showed a reduction or a complete regression of PDR and two eyes were unchanged. In the CW Nd:YAG laser group no eyes showed any regression of new vessels, in seven eyes the angiographic features were unchanged, and in five eyes they worsened. All the eyes of the second group underwent retreatment with the krypton laser after 3 or 6 months. After a mean follow up of 13 months all eyes in the krypton group showed a reduction or complete regression of PDR; in the retreated group 10 eyes improved and two were unchanged. CONCLUSIONS--The statistical analysis showed a highly significant difference (p = 0.001) between krypton and CW Nd:YAG laser which indicated the lack of efficacy of the latter in the treatment of PDR. In the krypton laser group no significant difference (p = 0.05) after the retreatment was found confirming the efficacy of this treatment.

Efficacy of collagen shields after extracapsular cataract extraction.

The efficacy of presoaked porcine collagen shields was compared with subconjunctivally injected corticosteroids and antibiotics in reducing ocular inflammation after ECCE with IOL implantation, and signs of reduced oxygen delivery to the cornea were assessed. Fifty eyes of fifty patients were recruited. At the end of surgery 25 eyes (group 1) received a 24-h shield presoaked with 0.1% betamethasone disodium phosphate and 0.5% netilmycin. The other 25 eyes (group 2) received 1 mg betamethasone disodium phosphate and 250 mg piperacillin as a subconjunctival injection. The eyes were then taped closed. Inflammatory parameters (anterior chamber flare, fibrin, folds of Descemets membrane, corneal edema) and tolerability of the delivery system (pain, itching) were evaluated 24 h after surgery. None of the patients lost the shield and the collagen devices were well tolerated. Groups 1 and 2 showed no significant differences in the parameters considered. There was, however, transient, slight diffuse superficial corneal edema in 24% of group 1 and 4% of group 2, raising the question of inadequate oxygen transmission through collagen shields under closed lids. The results suggest that collagen shields used with the right drug solution have no significant adverse effect and may be a less invasive alternative to subconjunctival injection.

Retinal vein occlusion: late complication of a congenital arteriovenous anomaly.

Accessible online at: www.karger.com/journals/oph Congenital arteriovenous anomalies (CAVA) are heterogeneous in dimension and localization. They are often associated with arteriovenous malformations of the ipsilateral visual pathways including the optic nerve, chiasm, midbrain, and cerebral cortex [1]. In 1973, Archer et al. [1] proposed a classification of congenital arteriovenous anastomosis in three groups based both on dimensions and on the presence of an interposed capillary bed. Until some years ago these CAVA were believed to be stable and unchanging lesions; Yanoff and Fine [2] described ‘non-progressive arteriovenous aneurysms’; Spencer [3] underlined the lack of progression in these malformations; however, a review of the literature has considered thrombosis of the central and branch retinal vein as a complication of the anastomosis without capillary bed [4, 5]. We report one eye with CAVA at the optic disc, which was complicated by a venous occlusive thrombosis.

Ab interno trabeculectomy: Ultrastructural evidence and early tissue response in a human eye

PURPOSE: To report the results of ultrastructural analysis of the postoperative effects of ab interno trabeculectomy in a human eye. SETTING: Department of Ophthalmology, Palmanova Hospital, Palmanova, Udine, Italy. METHODS: A 60‐year‐old woman with cataract and glaucoma had enucleation for a choroidal melanoma 10 days after ab interno trabeculectomy combined with phacoemulsification. A second ab interno trabeculectomy was performed after enucleation to evaluate the outcomes of the previous trabeculectomy. Light and transmission electron microscopy analyses were performed on samples excised from areas (1) not subjected to a procedure (control samples), (2) that had ab interno trabeculectomy before enucleation, and (3) that had ab interno trabeculectomy immediately after enucleation. RESULTS: Control samples showed normal trabecular features. Semithin sections of all ab interno trabeculectomy samples showed full‐thickness removal of trabeculum segments, with Schlemms canal lumen opening into the anterior chamber and apparent preservation of the adjacent structures. On ultrathin sections of samples that had ab interno trabeculectomy before enucleation, the endothelium lining the outer wall of Schlemms canal and other angle components showed intact ultrastructural features. In trabecular beams that were not removed, the extracellular matrix appeared to have maintained its fine texture and was free of activated fibroblasts or leucocyte infiltrates. CONCLUSIONS: Observations confirm that ab interno trabeculectomy causes direct communication between Schlemms canal lumen and the anterior chamber in vivo and immediately after enucleation during the early postoperative period. The absence of an evident inflammatory reaction in the examined case should be considered with caution because of possible tumor‐induced immune suppression.

Ab-interno trabeculo-canalectomy: surgical approach and histological examination

Purpose To evaluate, on eye bank eyes, a new surgical approach aimed at removing a quadrant of the trabecular meshwork (TM), with an ab interno approach. Methods Gonioscopically controlled ab interno removal of the TM was done with a sub-retinal forcep on six human bank eyes. Serial histological sections were obtained from the treated and untreated part of each globe to assess the effect of the technique on intraocular tissues. Results Under the gonioscope, the TM was easily removed in strings of varying length. Histological examination showed, unexpectedly, that this resulted in a well-defined deep furrow in the middle of the trabecular region involving both the TM and the inner wall of Schlemms canal. The operation created a direct communication between the anterior chamber and Schlemms canal lumen without any evident damage to the outer canal wall and adjacent ocular structures such as the iris base and corneal endothelium. Conclusions Our small series on human bank eyes showed that the procedure involves both the TM and the inner wall of Schlemms canal and is therefore called ab interno trabeculocanalectomy (AITC). The intraoperative findings and the histological evidence are encouraging, and suggest that the procecedure could have potential clinical application.