Giacomo Abbruzzese

Computer assisted evaluation of retinal vessels tortuosity in Fabry disease.

Purpose:  Fabry Disease (FD) is a rare X‐linked metabolic disorder characterized by diffuse deposition of sphingolipids in many tissues. Retinal vessel tortuosity is a common ocular manifestation in FD and may represent a useful marker for the disease. Unfortunately its clinical evaluation is poorly reproducibile and alternative means of evaluation may be of interest. We tested a new semi‐automatic software measuring retinal vessel tortuosity from eye fundus digital images in a group of FD patients.

Long-term results of photodynamic therapy for subfoveal choroidal neovascularization with pathologic myopia.

Purpose: The purpose of our study was to determine the long-term visual and anatomic outcomes of photodynamic therapy in patients affected with choroidal neovascularization secondary to pathologic myopia. Methods: We retrospectively evaluated 43 eyes of 43 patients. Patients with pathologic myopia were included if they had received photodynamic therapy for choroidal neovascularization involving the center of the avascular foveal zone and if they had a follow-up of at least 5 years. We included only the cases for which both of the examiners of the FAs were in agreement concerning the subfoveal localization of choroidal neovascularization. Patients treated with other therapies such as anti–vascular endothelial growth factor or steroids in the study eye were excluded. Visual acuity was measured using Early Treatment Diabetic Retinopathy Study charts. Anatomic outcome measures were the lesion size expressed as the greatest linear diameter and the chorioretinal atrophy that developed around the regressed choroidal neovascularization. Results: Average visual acuity was stable during the first year, tended to be worse at 2 years, whereas it was significantly worse at 3 years and afterward, reaching a loss of nearly 3 lines at 7 years. We found that neither the number of photodynamic therapy treatments nor baseline photodynamic therapy spot size influenced change of visual acuity during follow-up. Chorioretinal atrophy around choroidal neovascularization was detected in 83% of patients at the 5-year follow-up visit. Conclusion: The results showed that visual acuity decreased significantly after a long follow-up period mainly because of the development of chorioretinal atrophy.

Treatment of macular serous neuroretinal detachment in tilted disk syndrome: report of 3 cases.

Purpose. To describe functional and anatomic results obtained by treatment with photodynamic therapy (PDT) or intravitreal bevacizumab (Avastin, Roche) in macular serous retinal detachment associated with tilted disk syndrome. Methods. Three eyes of 3 patients with symptomatic macular serous detachment associated with tilted disc syndrome (optic disc with an oblique axis, inferonasal crescent, and inferior staphyloma) were treated. In all patients, best-corrected visual acuity (BCVA) was tested and fluorescein angiography (FA) and optical coherence tomography (OCT) were performed before and about 45 days after treatment. All patients underwent a complete ophthalmologic examination including OCT at least 6 months after treatment. The first patient was treated with one low fluence (300 mW/cm2 for 83 seconds) PDT (6 months follow-up). The second patient was treated with 3 intravitreal injections of bevacizumab 1.25 mg (33 months follow-up) and the third patient was treated with 2 low fluence PDTs at 4 months and, after 1 year, 3 intravitreal injections of bevacizumab 1.25 mg (37 months follow-up). Results. Before treatment, all patients complained of visual loss and metamorphopsia. The OCT showed in the macular area a focal neurosensory detachment with foveal involvement. The FA showed in the macular area multiple focal areas of hyperfluorescence due to pigment epithelium atrophy and in the second and third patient also a hyperfluorescent pinpoint with minimal leakage. After treatment in all eyes, symptoms did not change, BCVA remained stable, and in OCT the foveal neuroretinal detachment was changeless. In FA, no noticeable variation of the hyperfluorescence areas was appreciated. In the second patient, the hyperfluorescent point remained unvaried, and the same occurred in the third patient after the first PDT, while after the second PDT a new leaking dot disappeared. Conclusions. Macular serous retinal detachment was first described in 1998 as an uncommon complication of tilted disc syndrome showing angiographic and OCT features similar to a chronic central serous chorioretinopathy. In contrast to this pathology, in our patients treatment with PDT or intravitreal bevacizumab did not succeed, probably because of a different pathogenesis of macular serous detachment. Further investigations are needed to clarify the proper therapy of this disease.

Crystalline Corneal Deposits in Monoclonal Gammopathy: In-Vivo Confocal Microscopy

Purpose: To describe the in-vivo confocal microscopy corneal findings in a patient with bilateral corneal deposits caused by an underlying monoclonal gammopathy. Methods: A 68-year-old man came to our center for an ophthalmologic examination. Besides visual acuity, the examination included slit-lamp biomicroscopy, intraocular pressure, and fundoscopy. Confocal microscopy was performed using Confoscan 4 (Nidek Technologies Padova, Italy) with a 40× lens because of the presence of bilateral crystalline corneal deposits. Serological tests were also performed. Results: Every layer of the cornea is interested by deposits with high reflectivity,especially the epithelium and anterior stroma. The emathological tests evidenced a monoclonal gammopathy of undetermined significance with high levels of Immunoglobulin M. Conclusion: Crystalline corneal deposits in monoclonal gammopathycan be usefully evaluated by confocal microscopy. These manifestations may be evaluated long before systemic signs of the pathology appear, so the early diagnosis is mandatory.

Acquired retinoschisis with giant outer layer break and retinal detachment.

Purpose To evaluate the natural history of a case of retinoschisis with giant outer layer break and retinal detachment. Methods A 42-year-old patient with a sudden paracentral scotoma in the visual field of the right eye underwent the following examinations: best-corrected visual acuity, slit-lamp biomicroscopy, optical coherence tomography, ocular echography, and fundus photography. Results The eye examination revealed inferotemporal retinoschisis-detachment with a giant outer retinal layer break and absence of foveal involvement. No breaks in the internal retinal layer were noted. No treatment was advised in the right eye. During the 3-year follow-up, a progressive reabsorption of subretinal fluid was detected and visual acuity remained unchanged. Conclusions Deliberate nontreatment of a case of nonprogressive retinoschisis-detachment carries less risk of serious complications or loss of vision than does either surgical or prophylactic treatment.

Evaluation of macular thickness after uncomplicated cataract surgery using optical coherence tomography.

Purpose To evaluate central macular thickness (CMT) after cataract surgery in selected groups of patients. Methods The study comprised 4 groups—patients with epiretinal membrane, patients with high myopia, patients with diabetes without retinopathy, and healthy subjects—who underwent phacoemulsification and intraocular lens implantation. Central macular thickness was measured with spectral domain optical coherence tomography (OCT) using the 3D macular cube scan. The OCT evaluation was performed preoperatively and 1, 6, 15, 30, 60, 90, and 360 days after surgery. Visual acuity was measured preoperatively and after 6 and 360 days after surgery. Results The study included 258 patients, 164 women and 94 men, with a mean age of 74 (SD 7.6) years. A statistically significant increase in CMT was observed from day 30 in patients with epiretinal membrane (p = 0.010) and diabetic patients (p = 0.026), reaching its maximum thickness at day 60 (p = 0.001 and p = 0.001), while it was observed only on day 360 in healthy subjects (p = 0.018) and those with high myopia (p = 0.003). The correlation between CMT and visual acuity was statistically significant only in the diabetic group (r = 0.61, p<0.01). Conclusions Following cataract surgery, CMT changes according to characteristic patterns in the different groups studied. These changes did not prevent an optimal recovery of visual function.

3D SURGICAL VIEWING SYSTEM IN OPHTHALMOLOGY: Perceptions of the Surgical Team

Technology is continuously evolving in the ophthalmology world in many spheres. There is a huge innovation in ways to perform ocular surgery with the introduction of three-dimensional (3D) visualization systems (3D describes an image that provides the perception of depth), technology that makes images and movies appear more lifelike in print, on the computer, in the cinema, or on TV. Known as “stereoscopic imaging” and “3D stereo,” people sense a greater depth than with 2D and feel that they could reach out and touch the objects. However, the effects are not just for entertainment; the more realistic a 3D training session, the greater the test of a person’s reactions. The creation of 3D prints, images, and movies is accomplished by capturing the scene at two different angles corresponding to the distance between a person’s left and right eyes (roughly 64 mm). When the left image is directed to the left eye and the right image to the right eye, the brain perceives the illusion of greater depth. The stereo (left and right) frames are separated by colors, by polarization, or by rapidly alternating the left and right images. A corresponding pair of 3D glasses directs the images to the appropriate eye. In fact, 3D surgical microscopes are the frontiers that many pharmaceutical companies are looking at; in particular, a lot of research has been performed in the endoscopic surgery sphere.1–3 From an ophthalmologic point of view, this way of operating is called “heads-up” surgery, when the surgeon no longer looks through the microscope oculars as in a conventional microsurgical procedure. In fact, although wearing lightweight 3D glasses and watching the surgical field on a large flat screen that displays a high-definition 3D image from a camera mounted on the microscope, the surgeon is capable of performing surgery. Alcon recently launched the NGENUITY system, which consists of a 3D stereoscopic, high-definition digital video camera and workstation, which operates as an adjunct to the surgical microscope during surgery. The system displays images real time or from recordings on a flat-panel, high-definition, digital 3D display. There is no additional light (or energy) delivered by the system for visualization or image capture. In this study, we wanted to investigate surgical team satisfaction when using this system. In a survey conducted at the end of each surgery, the primary surgeon, assistant surgeon, anesthetists, and theater nurse were asked about their own experience and comfort during the 3D surgery.

Aflibercept in Serous Foveal Detachment in Dome-Shaped Macula: Short-Term Results in a Retrospective Study

BACKGROUND AND OBJECTIVE To evaluate short-term efficacy of intravitreal aflibercept (Eylea; Regeneron, Tarrytown, NY) in serous foveal detachment (SFD) in dome-shaped macula (DSM). PATIENTS AND METHODS A retrospective, noncomparative case series. Three monthly aflibercept injections were administered. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), optical coherence tomography central subfield thickness (CST), and subretinal fluid (SRF) at baseline and at 2 months and 4 months after the last injection were considered for statistical analysis. RESULTS The authors reviewed nine eyes affected by SFD in DSM. Mean BCVA improved from 0.42 LogMAR at baseline to 0.33 LogMAR at final follow-up (P = .06), and mean CST and SRF reduced from 347 μm to 295 μm (P = .09) and from 146 μm to 99 μm (P < .01), respectively. None of the considered eyes had resolution of the SRF. CONCLUSIONS Three monthly aflibercept injections may improve BCVA and reduce CST and SRF in SFD of DSM. Further prospective studies are necessary to state the real efficacy of this approach. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:822-828.].

Treatment of vitreomacular traction with intravitreal ocriplasmin preceded by anterior chamber paracentesis: case reports.

Purpose To evaluate the efficacy of an intravitreal ocriplasmin injection using anterior chamber paracentesis to release symptomatic vitreomacular traction (VMT). Methods Five patients with symptomatic VMT were enrolled. All patients underwent a complete ophthalmologic examination including acquisition of spectral-domain optical coherence tomography. Before intravitreal injection of ocriplasmin, anterior chamber paracentesis was performed in the study eye to induce mild ocular hypotonia. Control visits were performed the day after the injection, at 1 week, and after 1, 2, and 3 months. Results In 4 patients, we had complete release of VMT and visual improvement after the intravitreal ocriplasmin injection preceded by anterior chamber paracentesis. No adverse events were observed. Conclusions In our small case series, anterior chamber paracentesis performed before intravitreal ocriplasmin seemed to increase the efficacy of the drug in the resolution of symptomatic VMT. Our success estimate is imprecise due to small sample size (95% confidence interval 0.28 to 0.99) and no definitive conclusion can be reached. Further research is worth being conducted to assess the potential usefulness of paracentesis before ocriplasmin injection to increase vitreoretinal traction release rate.