Fulvio Parentin

Safety and efficacy of infliximab and adalimumab for refractory uveitis in juvenile idiopathic arthritis: 1-year followup data from the Italian Registry.

Objective. To evaluate safety and efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of juvenile idiopathic arthritis-related anterior uveitis (JIA-AU). Methods. Starting January 2007, patients with JIA-AU treated with IFX and ADA were managed by a standard protocol and data were entered into the National Italian Registry (NIR). At baseline, all patients were refractory to standard immunosuppressive treatment and/or were corticosteroid-dependent. Data recorded every 3 months included uveitis course, number/type of ocular complications, drug-related adverse events (AE), treatment change or withdrawal, and laboratory measures. Data of patients treated for at least 1 year were retrieved from the NIR and analyzed using descriptive statistics. Treatment efficacy was based on change in uveitis course and in number of ocular complications. Results. Up to December 2009, data for 108 patients with JIA-AU treated with anti-tumor necrosis factor-α agents were recorded in the NIR and data from 91, with at least 12 months’ followup, were included in the study. Forty-eight patients were treated with IFX, 43 with ADA. Forty-seven patients (55.3%) achieved remission of AU, 28 (32.9%) had recurrent AU, and 10 (11.8%) maintained a chronic course. A higher remission rate was observed with ADA (67.4% vs 42.8% with IFX; p = 0.025). Ocular complications decreased from 0.47 to 0.32 per subject. Five patients experienced resolution of structural complications. No patient reported serious AE; 8 (8.8%) experienced 11 minor AE (9 with IFX, 2 with ADA). Conclusion. IFX and ADA appear to be effective and safe for treatment of refractory JIA-related uveitis, with a better performance of ADA in the medium-term period.

Effect of astigmatism on multifocal intraocular lenses

PURPOSE To study the effect of astigmatism on multifocal intraocular lens (MIOL) function. SETTING Laser Laboratory, Department of Electronics, Electrotechnics and Informatics, University of Trieste, Italy. METHODS Using an experimental optical system, this study compared the division of a laser beam in the focal spots of 1 monofocal IOL (Pharmacia 722A), 1 bifocal IOL (Pharmacia 811E), and 2 MIOLs (AMO Array MPC25NB and Domilens Progress 1). The model consists of a helium-neon laser and an optical system: a triangular optical bench with a precision collimator, a micropositionable immersion stage to support the IOL, and a digital image-processing system. Astigmatism was induced by interposing a +1.0 diopter (D) cylinder lens between the IOL and the television camera. Astigmatism was corrected by adding a -1.0 D cylinder lens in front of the IOL on the same axis. RESULTS Astigmatism creates pairs of focal lines, 1 for each focal spot in the IOL. In the multifocal IOL, the posterior focal line of the nearest focus interfered with the anterior line of the next focus. Correcting the astigmatism led to a significant reduction (mean 20%) in light intensity. CONCLUSIONS Astigmatically neutral surgery or surgical correction of pre-existing astigmatism is essential in MIOL implantation to minimize the decrease in contrast sensitivity.

Analysis of light energy distribution by multifocal intraocular lenses through an experimental optical model

Purpose: To analyze and compare the light energy distribution generated by multifocal intraocular lenses (IOLs). Setting: Laser Laboratory of the Department of Electronics, Electrotechnics and Informatics, University of Trieste, Italy. Methods: An optic system to examine the division of a laser beam in the various focal spots of multifocal IOLs was developed. The model consists of a helium‐neon laser and an optical system: a triangular optical bench with a precision collimator, a micropositionable immersion stage supporting the IOL to be measured, and a digital image‐processing system. Four bifocal and three multifocal IOLs were studied. This system is able to expand the distance between foci, leading to a sharper separation of the focal spots. The resolution of the images makes it possible to analyze the distribution of total light energy among the foci. Results: Results showed the variation in light intensity of the focal spots of multifocal and bifocal IOLs, as well as their disposition in the dioptric range. Conclusion: Light distribution among various focal distances corresponded to the foci provided by monofocal, bifocal, and multifocal IOLs. The percentage of light energy distribution was related to the importance of each focus.

Refractive evaluation in children with growth defect.

Purpose. Growth hormone (GH) is considered essential for postnatal somatic growth, exerting its effects on growth by hepatic production of IGF-I. IGF and other growth factors interact with the developing ocular tissues by influencing the synthesis of the extracellular matrix of the sclera and by inducing angiogenesis. The association between optic nerve hypoplasia, reduced retinal vascularization and GH defi- ciency (GHD) is well known. The purpose of this study is to evaluate the possible influence of congenital GHD on the refraction and on the emmetropization process. Methods. Eighty children with congenital GHD had a thorough ophthalmologic examination, including cycloplegic refraction and axial length measurement. As a control group we enrolled 483 healthy children. Results. In accordance with other epidemiological studies, the control group showed a slightly myopic mean defect; on the contrary, in GHD group we found a hyperopic defect, related to a shorter axial length, with statistically significant differences. Conclusions. Our findings emphasise the possible role of growth hormone in ocular development, and its interaction with the physiological process of emmetropization.

Central corneal thickness in children with growth hormone deficiency

Acta Ophthalmol. 2010: 88: 692–694

Granulomatous anterior uveitis associated with bimatoprost: a case report.

Purpose: To describe a previously unreported case of anterior granulomatous uveitis in a patient using bimatoprost. Methods: A 72-year-old woman with a long-standing history of anisometropic amblyopia and pseudoexfoliative glaucoma in the right eye started therapy with bimatoprost 0.03% once a day in the right eye. She had no previous history of ocular inflammation or ocular surgery. Her medical history was negative for systemic diseases associated with ocular inflammation. Results: After one week, the patient developed severe conjunctival injection, cells and flare, and numerous ‘mutton fat’ keratic precipitates in the right eye. Examination of the left eye revealed no evidence of inflammation. Bimatoprost was discontinued; no topical steroid therapy was started. Systemic investigations were normal. The inflammation resolved over two weeks, solely with the discontinuation of bimatoprost. Conclusions: Bimatoprost is a synthetic prostamide, chemically related to prostamide F. Prostamides are naturally occurring substances, biosynthesized from anandamide in a pathway that includes COX2. Even though anandamide has proven suggestive potential pro-inflammatory effects, the mechanism of induction of inflammation by bimatoprost remains uncertain and speculative. In our report, the onset of acute uveitis in a patient using bimatoprost, after a long-term and well-tolerated treatment with a prostaglandin analog, suggests a distinct potential pro-inflammatory action of prostamides. This can indirectly support the concept that the target receptor of bimatoprost is different, and that the mechanism of action of prostamides is pharmacologically unique.

Congenital growth hormone deficiency and eye refraction : A longitudinal study

The aim of this study was to study the influence of growth hormone deficiency (GHD) on emmetropization and to evaluate the effect of growth hormone replacement therapy on eye refraction. Twenty-eight children affected by congenital GHD and undergoing substitutive therapy (group 1), and 28 healthy subjects (group 2), were prospectively studied. All patients had a thorough eye examination, including cycloplegic refraction and axial length measurement (only GHD children). After 2 years, we found in both groups a reduction of the dioptric power of the eye. A t test for paired data showed statistically significant differences in both groups (p < 0.001), but the change of refraction was higher in group 2 (p < 0.01). Axial length showed a statistically significant increase, according to the myopic shift (p < 0.001). The change of the refraction found in GHD children could be related to the somatic growth and partially induced by growth hormone therapy. The difference between the two groups could be explained with the late beginning of the therapy in GHD children. It is possible to form the hypothesis that a correct and well-timed substitutive therapy could permit a normal emmetropization process.

Parinaud's oculoglandular syndrome due to herpes simplex virus type 1.

Purpose: To describe the clinical findings in a patient with Parinauds oculoglandular syndrome as an uncommon manifestation of primary herpes simplex virus type 1 (HSV-1) infection. Methods: The clinical course, the laboratory findings, the therapy, and the outcome regarding a 14-year-old girl are described. Results: The culture and PCR detection of HSV-1 on conjunctiva and skin scrapings, along with seroconversion to HSV, confirmed the etiology. The oral and local acyclovir therapy led to a prompt improvement in the patients symptoms. Conclusion: The solitary ocular-glandular syndrome due to HSV-1 primary infection has never been reported before. Parinauds oculoglandular syndrome is found in 5% of patients with cat-scratch disease and only on rare occasion associated with other conditions. Herpetic infection should be considered in the differential diagnosis of young patients with conjunctivitis, periorbital swelling, and painful preauricular and submandibular lymphadenopathy, combined with systemic symptoms of malaise and fever.

Thalidomide Effectiveness for Bilateral Chronic Idiopathic Anterior Uveitis in a Three-Year-Old Child

The authors report their experience with thalidomide in the treatment of a bilateral chronic idiopathic uveitis, in a 3-year-old female. This case was complicated by the presence of a cataract and an iris neovascularization in the right eye; furthermore it was partially unresponsive to a conventional anti-inflammatory and immunosuppressive therapy. Oral thalidomide induced slow but dramatic regression of the inflammation, and a significant reabsorption of neovascular tufts, both in slitlamp examination and on iris fluorescein angiography. The authors emphasize the efficacy of thalidomide as anti-inflammatory agent and as inhibitor of neoangiogenesis, reporting the recent literature about the use of this drug in ophthalmology.

Polymicrobial keratomycosis in a three-year-old child.

Purpose: To describe a previously unreported case of polymicrobial mycotic keratitis caused by an association between Candida lusitaniae, C. parapsilosis, and Geotrichum candidum. Methods: A three-year-old child with an antecedent trauma with vegetable matter and a prolonged use of corticosteroid eyedrops developed fungal keratitis. Results: The isolates of the corneal scraping using Sabaraud dextrose agar grew C. lusitaniae, C. parapsilosis, and G. candidum. After topical 0.2% and systemic fluconazole treatment, the corneal lesion resolved with no recurrence. Conclusions: Corneal trauma with vegetables and the indiscriminate use of corticosteroids are important risk factors for mycotic keratitis. A combination of topical 0.2% and systemic fluconazole therapy was effective in the treatment of this mycotic association. This is the first report of fungal keratitis caused by C. lusitaniae and G. candidum.