Ignazio Alberto Zucca

Photodynamic therapy of corneal neovascularization with verteporfin

Purpose. To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne®) on corneal neovascularization (CNV) in two patients. Methods. Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months. Results. Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases. Conclusions. PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required.

Qualitative and quantitative analysis of filtering blebs with optical coherence tomography

OBJECTIVE To provide a qualitative and quantitative analysis of filtering blebs with optical coherence tomography (OCT) in patients after primary trabeculectomy. DESIGN Evaluation of diagnostic technology. PARTICIPANTS We retrospectively studied 20 eyes of 20 patients who had a fornix-based flap in primary trabeculectomy: 14 with mitomycin C (MMC) and 6 without MMC. METHODS Filtering blebs were examined using 2 types of OCTs working at a wavelength of 840 and 1310 nm. In this study, we analyzed both the OCT morphologic pattern and the internal structures of blebs, including bleb wall thickness, scleral flap thickness, and the route under the scleral flap, and quantified the reflectivity of the intrableb area. RESULTS Blebs were classified according to the Hirooka scheme in 3 OCT morphologic patterns: cystoid, diffuse, and layer type. The MMC was associated with the surgical success (100%). A significant association was found between good functionality and cystoid type with both devices: 840-nm OCT (p = 0.02) and 1310-nm OCT (p = 0.04). A significant difference in morphologic patterns was found using the 2 OCTs. There were no significant differences between successful and unsuccessful filtering surgery for intrableb structures. The reflectivity of filtering blebs correlated very well to the postoperative intraocular pressure (IOP; R(2) = 0.90; p < 0.001) and to the reduction of IOP (R(2) = 0.58; p = 0.001). Our method to quantify the reflectivity showed a significant degree of intergrader consensus (intraclass correlation coefficient = 0.99; p < 0.001). CONCLUSIONS Although 840-nm OCT was not developed to assess the anterior segment, it may be considered a useful tool to evaluate the functionality of blebs in the postoperative period.

Photodynamic therapy of pterygium with verteporfin: a preliminary report.

Objective: To assess the efficacy and safety of treating pterygia by photodynamic therapy (PDT) with verteporfin (Visudyne®). Materials and Methods: Ten consecutive patients with primary, recurrent, or secondary pterygium, refusing excisional surgery, were treated with a 689-nm laser delivered directly onto the pterygium after verteporfin infusion. Postoperative outcome was followed clinically and photographically for a minimum of 3 months. Results: Successful photothrombosis of pterygium vascularization was obtained immediately after treatment in all cases. After 1 month, revascularization of pterygia was observed in 70% of cases, and treatment was repeated after a 3-month interval. Regression or stabilization of pterygia was manifested by a scarring reaction of the corneal apex with complete or partial disappearance of vascularity. No relevant side effects were observed in our series. Conclusion: PDT with verteporfin is a safe procedure to arrest the growth of pterygia. It is indicated for patients with a low- or medium-grade pterygium that refuse a surgical approach; however, multiple sessions may be required.

Finding of conjunctival melanocytic pigmented lesions within pterygium

Aims : Conjunctival pigmented lesions have characteristic clinical and histopathological appearances. Melanocytic pigmented lesions commonly occur in the conjunctiva, although they have not been previously reported in pterygium, a common lesion which originates from conjunctiva. Our aim was to evaluate the possibility of an association between pterygium and conjunctival melanocytic pigmented lesions.

Unfavorable effect of photodynamic therapy for late subretinal neovascularization with chorioretinal anastomoses associated with idiopathic multiple serous detachments of the retinal pigment epithelium

Purpose To describe a case of a 46-year-old woman with an asymptomatic history of unilateral multiple serous detachments of the retinal pigment epithelium (PED) in the right eye, treated with photodynamic therapy (PDT) with verteporfin for recent onset of subfoveal choroidal neovascularization (CNV) with chorioretinal anastomoses (CRA). Methods Case report. Results Fluorescein and indocyanine green (ICG) angiography, performed with a Heidelberg scanning laser ophthalmoscope (SLO), demonstrated a predominantly classic foveal choroidal neovascular membrane associated with a PED and 1 one retinal and 2 two venous chorioretinal anastomoses. The left fundus was normal. PDT therapy was performed according to standard techniques. Three PDT treatments were performed at an interval of 3 months. Three months after the second PDT, visual acuity dropped to 20/200, with an enlargement of the neovascular network. One month after the third treatment, visual acuity deteriorated further and the CRA appeared enlarged, associated with a dense fibrotic reaction in the centere of the lesion. Conclusions This clinical observation demonstrates that idiopathic serous detachments of the retinal pigment epithelium may represent predisposing changes to CNV development, and in the case CNV is associated with CRA, PDT may be unsuccessful.

Genetic mapping of autosomal dominant primary open-angle glaucoma (POAG) in Sardinia

Primary open-angle glaucoma (POAG) can be subdivided into two groups according to age of onset: (1) the more prevalent middle to late-age-onset chronic open-angle glaucoma (COAG) diagnosed after age 40, and (2) the less common form, juvenile open-angle glaucoma (JOAG), which occurs between 3 years of age and early adulthood. Susceptibility to either COAG or JOAG has been found to be inherited. The discovery of several genetic markers spanning the region 1q21-q24 in genetic linkage with autosomal dominant juvenile open-angle glaucoma (adJOAG) represents a major breakthrough towards the localisation of gene(s) responsible for the disease. Linkage analysis is a powerful means of distinguishing disease loci in large families with dominant disease. However the size of the group of families may represent a crucial factor for the linkage analysis. Sardinia is an island with a relatively isolated ethnic group showing a relatively high frequency of ad JOAG and COAG (Fossarello et al., 1994) and it is genetically more homogeneous than most Western populations. Therefore it represents an ideal ethnic group to search for linkage. We identified 18 families affected by POAG in which the disease appears to be inherited as autosomic dominant trait. In all families but two, occurrence of both JOAG and COAG in the same kindred was observed. Identification of adPOAG locus was performed by linkage analysis using 9 microsatellite markers spanning the region 1q21-q24. No significant linkage was observed. Our findings provide further evidence for genetic heterogeneity in autosomal dominant primary open angle glaucoma, even in a geographic area where a relatively homogeneous genetic background exists.

Association between the ACE insertion/deletion polymorphism and pterygium in Sardinian patients: a population based case–control study

Objective The purpose of the study was to examine whether the insertion (I) and/or deletion (D) polymorphism of ACE confers susceptibility to primary pterygium in Sardinian patients in a case–control study. Methods and results Polymorphism genotyping was performed by nested PCR using genomic DNA extracted from the whole peripheral blood of participants with (n=251) and without (n=260) pterygium. DD, ID and II genotype frequencies were: 48%, 39% and 13%, respectively, for patients with pterygium, and 15%, 40% and 44%, respectively, for the control group. A statistically significant difference was found between the pterygium and control groups for the ACE I/D polymorphism (p<0.001). Moreover, a statistically significant difference was found between the DD and II groups (p<0.01; OR=10.49; 95% CI 6.18 to 17.79), DD+ID versus II group (p<0.01; OR=5.23; 95% CI 3.37 to 8.13) and DD versus ID groups (p<0.01; OR=3.21; 95% CI 2.04 to 5.04). Conclusions Statistical analysis showed that the DD genotype is associated with an increased risk of developing pterygium, and with a good chance that the D allele may play an important role in the development of disease.

Successful ustekinumab treatment of noninfectious uveitis and concomitant severe psoriatic arthritis and plaque psoriasis

We report the first successful treatment of noninfectious uveitis with ustekinumab in a patient with severe concomitant psoriasis and psoriatic arthritis who failed to respond to conventional immune suppressants and with contraindications to tumor necrosis factor alpha inhibitors.

Angiotensin II: immunohistochemical study in Sardinian pterygium

The Angiotensin II (Ang II) is the principal effector peptide of the RAS system. It has a pleiotropic effect and, beside its physiological role, it has the property to stimulate angiogenesis and activate multiple signalling pathways related to cell proliferation. The purpose of the study was to determinate the Ang II expression and localization in Sardinian pterygium and normal conjunctiva by immunohistochemistry, and its possible involvement in the development and progression of the disease. Twenty-three pterygiums and eleven normal conjunctiva specimens obtained from Sardinian patients, were processed for paraffin embedding and assessed for the immunohistochemi-cal revelation of Ang II. Significant Ang II expression was identified in pterygium and conjunctiva. Particularly, thirteen pterygium specimens (n=13) displayed exclusively moderate to strong nuclear staining; some specimens (n=5) showed exclusively a moderate cytoplasmic immunoreactivity, and few specimens (n=2) displayed moderate to strong immunoreactivity in both cytoplasm and nucleus. Only 3 specimens were negative. Statistical significance difference in respect of nuclear and cytoplasmic localization was observed between normal conjunctiva and pterygium (P=0.020). The results showed a predominant intranuclear localization of Ang II in pterygium epithelial cells, in spite of conjunctiva that mainly showed cytoplasmic localization. These findings suggest a possible role for Ang II in the development and/or progression of pterygium mediated by the activation of local RAS system.

Color Discrimination in Long-Term Idiopathic Central Serous Choroidopathy

The color vision of six patients already examined in 1968 during a study on idiopathic central serous choroidopathy was tested again to analyze the possible changes that occurred in the meantime. The tests used were the City University Color Vision Test, the Farnsworth-Munsell 100-hue and the Lanthony desaturated 15-hue. The results show an improvement of the FM 100-hue total score values and a trend towards a scoptopic axis.