Gianluca Guidi

Macular pucker: To peel or not to peel the internal limiting membrane? a microperimetric response

Background: To compare functional and anatomical outcomes after idiopathic macular pucker removal between eyes that underwent internal limiting membrane (ILM) peeling and eyes that did not. Methods: In this multicentric, randomized clinical trial, 60 eyes of 60 patients affected with idiopathic macular pucker were enrolled. Thirty eyes underwent 23-gauge pars plana vitrectomy associated with ILM peeling (“ILM peeling group”), whereas 30 eyes did not undergo ILM peeling (“ILM not peeling group”). Retinal sensitivity, frequency of microscotomas, and all the other microperimetric parameters were tested by MP1 microperimetry. Best-corrected visual acuity was investigated with the Early Treatment Diabetic Retinopathy Study chart. Anatomical outcomes were analyzed with spectral domain optical coherence tomography. Results: After a 12-month follow-up, the mean retinal sensitivity in the 4° central area showed a greater and faster recovery in the ILM not peeling group than in the ILM peeling group (P = 0.041). The number of absolute microscotomas (0 dB) within the 12° central retinal area was significantly higher in the ILM peeling group than in the ILM not peeling group (P = 0.044). Conclusion: The ILM not peeling group seems to show better outcomes than the ILM peeling group as measured by mean retinal sensitivity and number of microscotomas after a 12-month follow-up.

IL-8 and VEGFR-2 polymorphisms modulate long-term functional response to intravitreal ranibizumab in exudative age-related macular degeneration.

AIM To investigate possible associations between VEGFR-2 and IL-8 gene SNPs and 1-year response to intravitreal ranibizumab for exudative age-related macular degeneration. MATERIALS & METHODS Sixty-four eyes underwent a loading phase of three monthly intravitreal injections of ranibizumab 0.5 mg/0.05 ml followed by Pro Re Nata retreatment. VEGFR-2 rs2071559 (-604 A/G) and IL-8 rs4073 (-251 A/T) were analyzed. RESULTS Ranibizumab was significantly more effective as measured by visual acuity in patients harboring the IL-8 rs4073 TT genotype (p = 0.045), whereas patients carrying the VEGFR-2 rs2071559 CC genotype revealed better functional response as measured by mean retinal sensitivity (p = 0.034). CONCLUSION IL-8 rs4073 and VEGFR-2 rs2071559 genotypes may represent important molecular determinants to modulate final outcomes in neovascular age-related macular degeneration patients.

Bimatoprost 0.01% vs bimatoprost 0.03%: a 12-month prospective trial of clinical and in vivo confocal microscopy in glaucoma patients

PurposeTo evaluate the safety of two commercially available formulations of bimatoprost eye drops: 0.03 and 0.01% ophthalmic solutions.MethodsThis was a randomized, prospective, parallel-group, open-label, cohort study. A total of 60 glaucoma patients (60 eyes) under bimatoprost 0.03% monotherapy since at least 1 year were enrolled. Selected patients were randomized to receive a single drop of bimatoprost 0.01% (n=30) or bimatoprost 0.03% (n=30) ophthalmic solutions for 12 months. Statistical analysis was performed using paired t-test and repeated measures ANOVA test.ResultsGlobal clinical score (the sum of pruritus, stinging/burning, blurred vision, sticky eye sensation, eye dryness sensation, and foreign body sensation) significantly decreased in the bimatoprost 0.01% group from baseline 4.7±3.8 to 2.9±2.3 (P<0.001) and 2.5±2.0 (P<0.001) at 6-month and 12-month follow-ups, respectively. Comparison between groups showed differences at both follow-up visits (P=0.003 and P<0.001, respectively). In vivo confocal microscopy revealed a significant increase in goblet cell density in the bimatoprost 0.01% group compared with the bimatoprost 0.03% group (P<0.001 at both follow-up visits). All functional parameters and conjunctival hyperemia improved in the bimatoprost 0.01% group at each follow-up visit (P<0.05) and in comparison with bimatoprost 0.03% (P<0.05).ConclusionThe results of this trial suggest that bimatoprost 0.01% eye drops seem to decrease the ocular discomfort with respect to bimatoprost 0.03% eye drops.

Analysis of Functional Dissociations between Best Corrected Visual Acuity and Microperimetric Parameters in Neovascular Age-Related Macular Degeneration Patients Underwent to Three Monthly Ranibizumab Injections

Background: To analyze the sensitivity of best corrected visual acuity and microperimetry to detect significant visual changes after 3 intravitreal ranibizumab in exudative age-related macular degeneration. Design: Prospective, open-label study. Participants: 50 eyes of 50 naive patients affected by neovascular age-related macular degeneration were enrolled. Methods: Enrolled patients underwent to a loading phase of 3 monthly intravitreal injections of ranibizumab. Best-corrected visual acuity was investigated with the ETDRS chart at 4 m. Central retinal sensitivity was tested with microperimetry using a Goldmann III stimulus to 33 points over the 12° central of the macula with a 4-2 double staircase strategy. Main outcome measures: Comparison of changes in mean 4° central retinal sensitivity and best-corrected visual acuity in “BCVA relatively stable patients” (defined as change ≤ ± 4 ETDRS letters after treatment). Analysis of a possible relationship between changes in best-corrected visual acuity and 4° central retinal sensitivity in “mean 4° central retinal sensitivity relatively stable patients” (defined as change in mean retinal sensitivity ≤ ± 2dB) Results: Mean best-corrected visual acuity improved of 5.90 ± 11.29 ETDRS letters (P=0.0006). Total mean retinal sensitivity improved +1.59 ± 2.12 dB (P<0.0001), while in the 4° central retinal area the increase was +1.36 ± 3.45 dB (P=0.0078). 38% of patients (19 eyes) were considered as “BCVA relatively stable patients”. In this subgroup, Pearson’s correlation analysis showed a direct correlation between changes observed with both methods (r = 0.71; P = 0.002). 48% of patients (24 eyes) were considered as “Mean 4° central retinal sensitivity relatively stable patients”. In this subgroup, Pearson’s correlation analysis didn’t show a relationship between changes observed with both methods (r = 0.11; P = 0.56). Conclusions: Microperimetry central retinal sensitivity seems to be an important to complete the functional evaluation in patients with wet age-related macular degeneration after 3 intravitreal ranibizumab.

Emerging surgical therapy in the treatment of glaucoma.

There is general consensus that surgery gives a better intraocular pressure (IOP) control than medical therapy, but surgery may be affected by complications and failures, and for this reason nowadays, it is reserved to advanced or clearly progressive glaucoma. In recent years, there have been a lot of efforts to enhance safety and efficacy of conventional surgery as to find new techniques more safer and more effective. Actually, this is a field in rapid evolution, and we have a great number of innovative procedures, often working on complete different basis. These procedures are classified according to their mechanism of action and the type of surgical approach, in order to clearly understand of what we are speaking about. From a general point of view, surgical procedures may be divided in procedures that increase outflow and procedures that reduce aqueous production: most of these procedures can be performed with an ab externo or an ab interno approach. The ab interno approach has great advantages and enormous potential of development; probably, its diffusion will be facilitated by the development of new devices for angle visualization. Nevertheless, it is important to remember that actually none of the new procedures has been validated in large controlled clinical trials and none of the new procedures is indicated when IOP target is very low.