Giancarlo Sborgia

Three-port lens-sparing vitrectomy for aggressive posterior retinopathy of prematurity : Early surgery before tractional retinal detachment appearance

Purpose Aggressive posterior retinopathy of prematurity (APROP) may suddenly develop into tractional retinal detachment (TRD), often resulting in poor vision if untreated. The aim of the current study is to examine the anatomic results and complications of lens-sparing vitrectomy (LSV) for stage 3 APROP, before TRD appearance. Methods A retrospective, noncomparative, consecutive case series of 13 eyes of 9 patients (mean gestational age 24.1±0.9 weeks [range: 23–25 weeks], mean birthweight of 725.8±107.9 grams [range: 598–897 grams]) with stage 3 APROP was carried out. The eyes did not respond to at least one session of retinal laser photocoagulation, showing signs of disease progression. All eyes underwent 20-gauge LSV before retinal detachment appearance. Results All eyes underwent 20-gauge three-port LSV and intraoperative additional laser photocoagulation. At the end of the surgery, five eyes were tamponaded with air; in eight eyes, a balanced salt solution was left in the vitreous cavity. After 13.5±5.3 months of follow-up (range: 4–22), the retina was completely attached in all eyes, without any signs of progression. The authors did not observe any intraoperative or postoperative complications. Conclusions Surgical approach to stage 3 APROP refractory to laser photocoagulation could be effective and safe in order to avoid the progression of the disease.

THE INFLUENCE OF LOW TO MODERATE MYOPIA ON RETINAL NERVE FIBER LAYER AS ASSESSED BY SCANNING LASER POLARIMETRY WITH VARIABLE CORNEAL COMPENSATOR

Purpose: To evaluate the influence of different degrees of myopia on retinal nerve fiber layer (RNFL) as measured by scanning laser polarimetry (SLP) with variable corneal compensator (VCC) in healthy eyes. Methods: One hundred and seventy-four healthy age-matched subjects with low to high myopic and emmetropic eyes underwent RNFL measurement by means of GDxVCC. The GDx parameters included in the analysis were: Temporal-superior-nasal-inferior thickness (TSNIT) average, Superior average, Inferior average, TSNIT standard deviation, Inter-eye symmetry, NFI, Symmetry, Superior ratio, Inferior ratio, Superior/nasal, Maximum modulation, Superior maximum, Inferior maximum, Ellipse modulation, Normalized superior area, Normalized inferior area, Ellipse standard deviation, Ellipse average. The mean value of each SLP parameter of myopic eyes was compared with the mean value of the same parameter of emmetropic eyes. Results: Mean myopia was 3.9 ± 1.5 dpt (range: –2 to –8.25 dpt). TNSIT average was higher in myopic group (p = 0.0111), together with Superior average (p = 0.0244), Symmetry (p < 0.0001) and Ellipse average (p = 0.0111). Two ratio parameters, Superior ratio and Inferior ratio, were higher in emmetropic eyes (p = 0.0179 in both cases). In both the myopic and the emmetropic group, all the SLP assessments of the RNFL fell within the normal range, according to the GDx database. Conclusions: Low to high myopia is not related to clinically relevant variations of SLP parameters, as assessed with GDx-VCC.

Is There Still a Clinical Use for Scanning Laser Polarimetry with Fixed Corneal Compensator

Purpose: To compare the scanning laser polarimetry device with a fixed corneal compensator (GDx FCC) with the new version with a variable corneal compensator (GDx VCC) in healthy subjects. Methods: A prospective, nonrandomized, comparative trial was carried out with both the FCC and the VCC systems on 130 healthy volunteers. The FCC measurements were divided into 2 subgroups, in accordance with the appearance of the macula. Subjects with a uniform aspect of the macula were included in the macula-‘negative’ group (macula–), whereas subjects with an irregular macular appearance with FCC were included in the macula-‘positive’ group (macula+). Data relative to all the GDx parameters were examined. For each parameter, we compared the data obtained by the FCC to the VCC models. Subsequently we compared each FCC subgroup (macula+ and macula–) to VCC. Results: A total of 67 subjects entered the macula– group and 63 the macula+ group. FCC significantly overestimated the average parameters and underestimated the number, the modulation and also the ratio parameters. The only parameter showing no difference was symmetry. Similar trends were also evident when the subjects were divided into the macula+ and – subgroups. Conclusion: Individual variations of corneal birefringence, which are not completely corrected by FCC, result in over- or underestimation of retinal nerve fiber layer parameters. This measurement error cannot be eliminated, not even by only selecting patients with a uniform aspect of macular scan. For this reason GDx FCC does not seem to be an acceptable tool in the early diagnosis of glaucoma, and modern versions of this device should be preferred.

Combined aniridia ring implantation and cataract surgery in an Axenfeld-Rieger syndrome: a UBM report.

Purpose: To describe ultrasound biomicroscopy (UBM) features in a patient with Axenfeld-Rieger syndrome (ARS) and cataract before and after anterior segment surgery using intraocular lens (IOL) and aniridic ring implantation (Morcher Aniridia rings 50 D). Methods: Visual acuity, subjective glare disability, intraocular pressure, endothelial cell density, and UBM imaging were reviewed over a period of 1 year. Results: One month after surgery, the operated eye showed improved visual acuity and visual comfort, and UBM examination showed a well-centered IOL and well-aligned aniridic ring fins. After 8 months, UBM examination showed contraction of the capsular bag, which appeared wrinkled, fibrous, and thickened. The capsular bag comprised the aniridic ring fins, causing misalignment. The glare disability had dropped from grade 0 to 3. The same outcome was present at 1 year. Conclusion: Ultrasound biomicroscopy is a useful noninvasive diagnostic means to picture anatomic details before and after surgery; it suggested that capsular bag shrinking caused migration of the aniridic rings, 8 months after surgery.

25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body

Purpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate.

Analysis of Morphologic and Functional Outcomes in Macular Edema due to Central Retinal Vein Occlusion Treated with Intravitreal Dexamethasone Implant

Purpose To analyze anatomic and functional retinal changes and their correlation after intravitreal dexamethasone implant (DEX implant) in patients with central retinal vein occlusion- (CRVO-) related macular edema (ME) using optical coherence tomography and microperimetry. Methods Fifteen treatment-naïve patients with functional impairment due to CRVO-related ME were enrolled in this prospective interventional case series. Main outcomes were best-corrected visual acuity (BCVA), retinal sensitivity (RS), and central retinal thickness (CRT). Secondary outcomes were ellipsoid zone (EZ) status and fixation behaviour. All patients underwent DEX implant and were retreated according to predefined criteria. Data were prospectively recorded at baseline and at month 1, 3, 6, 9, and 12. Correlation between main outcomes was analyzed. Results Fifteen eyes of 15 patients (9 men, 6 women; mean age 61.8 ± 10.9 years) were included. BCVA and CRT significantly improved at all follow-up visits, while RS significantly improved at 3, 6, 9, and 12 months. EZ status and fixation behaviour did not change significantly. Baseline CRT had a significant negative correlation with BCVA and RS at different follow-up visits (r=−0.52  to −0.63, p ≤ 0.04; r=−0.52, p=0.04; resp.). At all time points, there was not a significant correlation between CRT and BCVA and RS, while RS and BCVA showed a significant correlation, increasing over time (r=−0.72  to −0.89; p < 0.001). Conclusion DEX implant led to a significant morphofunctional improvement. Baseline CRT is predictive of changes of functional outcomes whose correlation increases over time after treatment.

Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: A case report

BackgroundThe incidence of anterior ischemic optic neuropathy after coronary artery bypass graft procedures ranges from 1.3 to 0.25%. The mechanisms of anterior ischemic optic neuropathy after cardiovascular procedures remain undefined but many systemic and related-to-surgery risk factors could underlie anterior ischemic optic neuropathy. In this case, we report a rare presentation of a bilateral anterior ischemic optic neuropathy after coronary artery bypass graft and speculate on the preoperative hyperhomocysteinemia as an independent risk factor for anterior ischemic optic neuropathy.Case presentationA 56-year-old white man, a tobacco smoker with type 2 diabetes and coronary artery disease, underwent a conventional coronary artery bypass graft with extracorporeal circulation. In spite of ongoing anti-aggregation, antithrombotic, and vasodilator therapy, 10 days after the surgery he complained of severe bilateral visual loss. Funduscopy and fluorescein angiography revealed a bilateral anterior ischemic optic neuropathy. Analysis of preoperative laboratory tests revealed hyperhomocysteinemia.ConclusionHyperhomocysteinemia could increase the risk of ocular vascular damage and bilateral ocular involvement in patients who have undergone conventional coronary artery bypass graft.

Gentle endodiathermy of retinal vessels to mark paravascular posterior retinal breaks in highly myopic eyes

Purpose: To show a new method to highlight posterior paravascular retinal breaks, responsible for posterior retinal detachment in highly myopic eyes, by gentle endodiathermy on the nearby retinal vessel, in areas of patchy chorioretinal atrophy. Methods: A standard 25-gauge (25-G) 3-port pars plana vitrectomy with internal limiting membrane (ILM) peeling was performed. A gentle endodiathermy was applied on the vessel close to the retinal break until a clear withe spot became visible. This spot was used as a landmark to identify the retinal break after fluid-air exchange. Results: The retina was attached after a single operation and no retinal redetachment was reported. A complete blood flow restoration in the treated vessel was documented with fluorescein angiography after 5 days. Conclusions: This simple technique may help the vitreoretinal surgeon to identify paravascular retinal breaks after fluid-air exchange. No damage to the retinal vessels undergoing endodiathermy was observed.

Sd-oct And Microperimetric Correlated Changes In Progressive X-linked Retinoschisis After Vitrectomy: A Case Report

Purpose: To report optical coherence tomography and microperimetric correlated changes in a case of bilateral foveal schisis in progressive X-linked retinoschisis (XLRS) treated with vitrectomy, inner limiting membrane (ILM) peeling, and air tamponade. Methods: One case report. Results: An 18-year-old boy with bilateral foveal schisis in progressive XLRS underwent vitrectomy, ILM peeling and air tamponade in both eyes. At baseline and follow-up (1 month in right eye, 6 months in left eye), visual acuity test, optical coherence tomography, retinal sensitivity map, and fixation stability study were performed. At the end of follow-up, in both eyes, the largest foveal schisis cavities resolved, central macular thickness and volume on optical coherence tomography decreased, and visual acuity improved. In right eye, the mean retinal sensitivity is worsened after 1 month from surgery and conversely central macular sensitivity improved; in left eye, retinal sensitivity improved overall after 6 months from surgery; fixation became more stable in both eyes. There were no adverse events. Conclusion: Retinal sensitivity and fixation behavior analysis could be a complementary tool respect in addition to visual acuity test and optical coherence tomography to investigate the efficacy of vitrectomy with ILM in progressive X-linked foveal schisis to prevent functional impairment before it happens.