Francesca Verboschi

Diagnostic Aspects and Retinal Imaging in Ocular Toxocariasis: A Case Report from Italy

Toxocara canis is a nematode parasite, commonly found in dogs. This roundworm parasite can invade the eye, causing visual impairment. Toxocara should be considered as a possible causative agent of posterior and diffuse uveitis, and it could be considered in the differential diagnosis of retinoblastoma. Ocular manifestations vary from severe endophthalmitis to silent incidental findings on a routine examination. We report a case of ocular toxocariasis in a 24-year-old Asiatic female that presented to us complaining of visual impairment. Fundoscopic examination revealed a posterior pole granuloma and exudative retinal detachment along with exudates. Presentation, clinical findings, morphological changes, and treatment are discussed. The enzyme-linked immunosorbent assay serology for Toxocara canis was performed, demonstrating the positivity for IgG and IgE. Treatment with the antihelminthic albendazole was initiated. Fluorescein angiography (FA; HRA 2, Heidelberg engineering) and optical coherence tomography (OCT; Spectralis, Heidelberg tomography) were performed, and results have been reported.

Fixation Improvement through Biofeedback Rehabilitation in Stargardt Disease

Stargardt disease is the most common hereditary macular degeneration in juveniles. It is characterized by macular dystrophy associated with loss of central vision in the first or second decade of life, a “beaten-metal” appearance in the fovea or parafoveal region, yellowish flecks around the macula or in posterior area of the retina, progressive atrophy of the bilateral foveal retinal pigment epithelium, and the “dark choroid” sign on fundus fluorescein angiography in most cases. We report a case of Stargardt disease in a 26-year-old Caucasian female submitted to rehabilitative training with microperimetry MP-1 to find a new preferred retinal locus (PRL) and to train her to better her quality of life. Best corrected visual acuity, mean retinal sensitivity, fixation, bivariate contour ellipse area, and speed reading were evaluated before and after the training and results were discussed.

Cystoid Macular Edema Induced by Low Doses of Nicotinic Acid

Cystoid macular edema (CME) is a condition that involves the macula, causing painless vision loss. In this paper, we report a case of niacin-induced bilateral cystoid macular edema (CME) in a middle-age woman taking low dose of niacin (18 mg of nicotinic acid). Optical coherence tomography (OCT) showed retinal thickening and cystoid spaces in both eyes, whereas fluorescein angiography (FA; HRA 2, Heidelberg Engineering) revealed the absence of fluorescein leakage also in later phases. Four weeks after discontinuation of therapy there were a complete disappearance of macular edema at funduscopic examination and an improvement of visual acuity in both eyes. Furthermore OCT showed a normal retinal profile in both eyes. In our opinion considering the wide availability of niacin, medical monitoring and periodical examination should be considered during niacin administration. To our knowledge, this is the first report in the literature that described the very low-dose niacin-induced bilateral niacin maculopathy.

Effect of corneal light scatter on vision: a review of the literature.

The cornea is the transparent connective tissue window at the front of the eye. The physiological role of the cornea is to conduct external light into the eye, focus it, together with the lens, onto the retina, and to provide rigidity to the entire eyeball. Therefore, good vision requires maintenance of the transparency and proper refractive shape of the cornea. The surface structures irregularities can be associated with wavefront aberrations and scattering errors. Light scattering in the human cornea causes a reduction of visual quality. In fact, the cornea must be transparent and maintain a smooth and stable curvature since it contributes to the major part of the focusing power of the eye. In most cases, a simple examination of visual acuity cannot demonstrate the reduction of visual quality secondary light scattering. In fact, clinical techniques for examining the human cornea in vivo have greatly expanded over the last few decades. The measurement of corneal back scattering qualifies the degree of corneal transparency. The measurement of corneal forward-scattering quantifies the amount of visual impairment that is produced by the alteration of transparency. The aim of this study was to review scattering in the human cornea and methods of measuring it.

Long term results of no-alcohol laser epithelial keratomileusis and photorefractive keratectomy for myopia

AIM To evaluate the long term clinical results of mechanical no-alcohol-assisted laser epithelial keratomileusis (LASEK) versus standard photorefractive keratectomy (PRK) for low-moderate myopia. METHODS Twenty-five eyes treated with LASEK and twenty-five eyes treated with PRK were evaluated with a mean follow-up duration of 60mo. Mechanical separation of the epithelium was performed with blunt spatula and without application of alcohol. Laser ablation was performed with the MEL-70 excimer laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12mo, and every year subsequently. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, haze, efficacy and safety indexes. RESULTS Twenty-one eyes and 22 eyes completed follow-up of 60mo in LASEK and PRK group respectively. Manifest refraction at 60mo follow-up was -0.01 and 0.26 in LASEK and PRK group respectively. In the LASEK group mean UDVA and mean CDVA after 60mo were 20/22 and 20/20 respectively (P>0.01). In the PRK group mean UDVA and mean CDVA at 60mo follow-up were 20/20 and 20/20 after 60mo (P>0.01). The efficacy indexes were 0.87 and 0.95, and the safety indexes were 1.25 and 1.4 respectively for LASEK group and PRK group. CONCLUSION Both standard PRK and no-alcohol LASEK offer safe and effective correction of low-moderate myopia in the long term without any statistically significant difference between the two groups.

Efficacy of Microperimetric Biofeedback after Retinal Detachment

Background: To evaluate visual recovery after rehabilitation with microperimetric biofeedback in patients submitted to surgery for retinal detachment. Methods: We have randomly divided 44 eyes of 44 patients after surgery for retinal detachment into two group: group A, 23 eyes, submitted to biofeedback training with microperimetry MP-1, 10 training sessions, once a week, ten minutes for each eye; group B (control group), 21 eyes, treated with common care strategy. We have compared best correct visual acuity (BCVA) of two groups at baseline, 6, 12 and 18 weeks with Student’s t test. Results: At baseline the mean BCVA was 0.6 ± 0.43 logMAR in group A and 0.66 ± 0.67 logMAR in group B (p=0.74). At 6 weeks after training the mean BCVA of group A was 0.27 ± 0.29 logMAR significantly better (p=0.02) than group B (0.67 ± 0.67 logMAR). At 12 weeks the mean BCVA was 0.18 ± 0.25 logMAR in group A better than the control group in which the mean BCVA was 0.60 ± 0.66 logMAR (p=0.01). At 18 weeks visual performances were still better in biofeedback group than in group B (p=0.01) in which the mean BCVA was 0.58 ± 0.68 logMAR. Conclusions: Microperimetric biofeedback allowed a better and faster visual recovery after surgery for retinal detachment than normal condition.