Federico Regine

Subjective visual halos after sildenafil (Viagra) administration: Electroretinographic evaluation.

PURPOSE The ophthalmologic and electroretinographic (ERG) findings in one subject with subjective visual disturbances after sildenafil administration are described. DESIGN Interventional case report. METHODS A complete ophthalmologic examination was performed, including best-corrected visual acuity and ERG, repeated 1 and 2 hours after administration of 100 mg of sildenafil. MAIN OUTCOME MEASURES Rod responses were obtained over a range of retinal illuminances from those producing a minimum detectable response to those producing rod saturation. Intensity amplitude function was determined. RESULTS At 2 hours after 100 mg of oral sildenafil, we observed significant variations from baseline in parameters of best-fit Naka-Rushton function; V(max) was notably higher, and K was 0.14 log units lower than baseline. CONCLUSIONS Sildenafil administration resulted in a higher rod response to light stimuli and in a higher rod sensitivity. These findings are consistent with the weak PDE-6 inhibition induced by sildenafil.

Validity and limitations of the Nidek NT-4000 non-contact tonometer: a clinical study

Using Goldmann applanation tonometry (GAT) as a gold standard, we evaluated the accuracy of Nidek NT‐4000 pneumotonometry (NPT) in adults without corneal disease. Bland and Altman analysis of serial intra‐ocular pressures (IOPs) measured with NPT and GAT in 10 healthy subjects revealed that the repeatability coefficients for the two methods were similar. NPT, GAT and ultrasonic pachymetry were then performed in 100 patients. Bland and Altman analysis showed that NPT yielded significantly higher readings than GAT [mean biases for right and left eye measurements were 1.37 mmHg (95% limits of agreement: −3.02–5.76) and 1.17 mmHg (95% limits of agreement: −2.76–5.11) respectively] and was more affected by corneal thickness variations. For detection of IOPs ≥21 mmHg, NPT displayed very high sensitivity (0.90) and good specificity (0.95). NPT may be useful in screening and clinical settings but borderline‐high IOP readings should be confirmed with GAT.

Acute electroretinographic changes during sildenafil (Viagra) treatment for erectile dysfunction.

The authors describe their findings on 12 subjects who were treated with 50 mg of Sildenafil (Viagra) and underwent ERG measurements prior to and 1 hour after ingestion. The Naka–Rushton equation was used to describe the b-wave luminance-response function of the scotopic ERG. Statistically significant differences were noted in the Vmax and K values. Sildenafil ingestion resulted in an increase in Vmax (higher rod response to light stimuli) and a decrease in K (higher sensitivity).

Combined reduced fluence photodynamic therapy and intravitreal ranibizumab for polypoidal choroidal vasculopathy

Purpose: We performed a prospective noncomparative study to report the results of reduced fluence photodynamic therapy (PDT) combined with intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy with active exudation and hemorrhage. Methods: Seventeen polypoidal choroidal vasculopathy eyes were treated, and follow-up for all patients was 12 months. Photodynamic therapy was administered with reduced fluence (exposure time of 70’’) and followed (48 hours later) by intravitreal ranibizumab (0.5 mg in 50 &mgr;L). Intravitreal ranibizumab, with or without reduced fluence PDT, was repeated as indicated by clinical and angiographic findings. Results: During the follow-up, the mean best-corrected visual acuity significantly improved from 0.45 ± 0.29 logarithm of the minimum angle of resolution at baseline to 0.29 ± 0.28 logarithm of the minimum angle of resolution at 12 months. The mean total macular volume (documented by optical coherence tomography retinal map examination) decreased from 7.5 ± 1.18 mm3 to 6.7 ± 0.8 mm3. In 95% of the cases, best-corrected visual acuity remained stable or improved. Conclusion: Reduced fluence PDT limits laser exposure, minimizing the risks of PDT-induced adverse effects. Intravitreal injections of ranibizumab 0.5 mg reduced bleeding and leakage in polypoidal choroidal vasculopathy eyes and interfere with rebound upregulation of vascular endothelial growth factor because of PDT-induced choroidal hypoperfusion. Combined treatment may improve treatment outcomes in polypoidal choroidal vasculopathy while minimizing ocular and systemic complications of treatment.

Excimer laser photorefractive keratectomy for high myopia and myopic astigmatism.

BACKGROUND AND OBJECTIVE To determine the efficacy, safety, and predictability of excimer laser photorefractive keratectomy of high myopia and myopic astigmatism. PATIENTS AND METHODS 76 eyes of 52 patients with myopia from -8.00 to -23.50 diopters (D) with or without astigmatism up to -5.50D were treated with the VISX 20/20 excimer laser (VISK, Santa Clara, CA) and a multi-zone ablation technique. Visual acuity, manifest refraction, corneal haze, and topography were evaluated at 1 week and 1, 3, 6, 12, and 18 months postoperatively. RESULTS Postoperative refractions were generally stable after 12 months. At the last follow-up all patients were within - 1.96 D of the intended correction. Eighteen months postoperatively, 68% of patients undergoing photorefractive keratectomy (PRK), and 65% of patients undergoing photo astigmatic refractive keratectomy (PARK), were within 1 D of planned refraction. Furthermore, 87% of patients after PRK and 80% of patients after PARK had a visual acuity of 20/40 or better. CONCLUSIONS High myopia with or without astigmatism was successfully treated in most of the patients using PRK. The stability of the postoperative refraction during the first 18 months seems to be good. The incidence of adverse effects was low but improvements in the future should further reduce complications, thus increasing the safety of refractive procedures.

Efficacy of 2% ibopamine on the dilation of patients with pseudoexfoliation syndrome

Purpose To compare the mydriatic effects of 2% ibopamine and collyrium containing 10% phenylephrine + 0.5% tropicamide and to study the associated drug in patients with ocular pseudoexfoliation (PEX) syndrome. Methods This was a prospective, comparative, interventional clinical study. The study group consisted of 20 patients with ocular PEX syndrome. Intervention procedures included administration of 10% phenylephrine-0.5% tropicamide versus 2% ibopamine versus 2% ibopamine followed by the combination drug. Main outcome measurement was mydriatic efficacy measured in terms of mean pupil diameter. Adverse effects on intraocular pressure (IOP) were measured with a Goldmann applanation tonometer. Mean premedication pupil diameters in all patients were less than 3.5 mm. Results Instillation of 10% phenylephrine-0.5% tropicamide caused significantly greater mydriasis than 2% ibopamine (pupil diameters: 6.17 mm, SD=1.14 versus 5.33 mm, SD=1.34; p<0.001). Combined use of both collyria significantly increased mydriasis (7.19 mm; SD=0.69) compared with that induced by either of the products alone (p<0.001). Inadequate mydriasis (pupil diameters < 5.5 mm) was observed in 2 patients after administration of 10% phenylephrine-0.5% tropicamide and in 10 following instillation of 2% ibopamine, but the addition of 10% phenylephrine-0.5% tropicamide to ibopamine-treated eyes resulted in adequate dilation in all cases. IOP increases of 4 mmHg over baseline values were observed in 12 (60%) patients after 2% ibopamine. Conclusions In patients with ocular PEX, instillation of 2% ibopamine exerts a significant additive effect on mydriasis induced with 10% phenylephrine-0.5% tropicamide with only minimal increases in IOP

Comparative efficacy of acetazolamide and apraclonidine in the control of intraocular pressure following phacoemulsification.

Purpose: The purpose of our study was to compare the effects of systemically administered acetazolamide and topical apraclonidine 0.5% in the control of intraocular pressure (IOP) following phacoemulsification of senile cataracts. Setting: The study was conducted on patients affected by cataract and followed at the Department of Ophthalmology. Methods: Seventy-eight eyes in 78 patients were selected. Twenty-six eyes were randomly assigned to postoperative treatment with topical apraclonidine 0.5%, 26 received oral acetazolamide and the remaining 26 received no hypotensive treatment (control group). Statistical analyses were performed mainly by means of analyis of variance. Results: IOPs measured 24 h after surgery were significantly (p = 0.01) lower in the apraclonidine group compared to the control group. Conclusions: Our double-blind prospective study conducted on patients randomly assigned to treatment with apraclonidine or acetazolamide shows that the former drug is undoubtedly effective in the prevention of IOP increases following phacoemulsification. IOPs recorded in patients treated with this drug were lower than those observed in the acetazolamide and the control groups. Considering the lower risk of toxicity associated with topical administration, apraclonidine 0.5% seems to be preferable to oral acetazolamide in this postoperative setting.

Work-Related Accidents of Ophthalmologic Interest in Italy During 1986–1991

The authors analysed accidents of ophthalmological interest obtaining information from the database of the INAIL (National Insurance Institute for Professional Casualties) concerning the period of 1986-1991. The INAIL registers all casualties that cause work disabilities exceeding 3 days. The investigation included all job types grouped into two major categories: agriculture (16% of all insured labour) and industry/craftsmanship (84%). Over 78% of the cases examined were in the industry/craftsmanship category. Approximately 22% of the cases were in the agriculture category. Every year in Italy, about 6% of regularly employed workers suffer casualties. The incidence of casualties of ocular interest has been a stable 0.37% in the years examined; 2.88% of these casualties produce permanent consequences (1/10,000 workers per year). The risk in 3 times higher in agriculture.

A cluster of presumed, noninfectious endophthalmitis after intravitreal injection of bevacizumab: long-term follow-up.

PURPOSE To report the outcome of 5 consecutive cases of presumed, noninfectious endopththalmitis following intravitreal injection of bevacizumab (IVB). METHODS Ten pre-loaded syringes of bevacizumab (1.25 mg/50 µL) furnished by a compounding pharmacy were injected intravitreally. Treatments were performed in the operating room by the same surgeon on 2 consecutive days. RESULTS Of 10 eyes, 5 showed moderate to severe ocular inflammation within a few days of injection. All patients were treated in the same surgical session. Vitreous tap performed in the patient presenting with the most severe grade of inflammation was negative for bacteria and fungi. At the time of the vitreous biopsy, this patient was injected with vancomycin 1 mg/100 µL in the vitreous cavity. Other eyes with moderate inflammation received topical and systemic antibiotics and topical steroid treatment. Visual acuity returned to pre-endophthalmitis or better levels in all eyes within 1 month. The other 5 patients treated with IVB from the same batch in the other surgical session did not develop inflammation. CONCLUSIONS IVB can induce noninfectious endophthalmitis. The use of compounded syringes can explain clustering of the inflammation. We were unable to identify the reasons for the variable grade of inflammation we observed in our patients.

Compassionate Use of Intravitreal Pegaptanib in Patients with Age-Related Macular Degeneration

The study aim was to evaluate the short-term safety and efficacy of pegaptanib sodium injections (Macugen, Eyetech Pharmaceuticals, Inc., New York, NY) in the compassionate-use therapy of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Intravitreal pegaptanib was used to treat 41 eyes in 40 patients with CNV. Injections were given every 6 weeks, and a minimum of three injections were planned. The mean change in BCVA for all lesions was a loss of 0.03 Snellen lines. Seven eyes (17.1%) gained more than 3 lines, three (7.31%) lost 6 lines or more, and in 75.6% the BCVA stabilized or improved.