Lucia Scorolli

Pseudoexfoliation Syndrome: A Cohort Study on Intraoperative Complications in Cataract Surgery

Our aim was to determine the rate of intraoperative complications induced by pseudoexfoliation syndrome (PSX) in cataract surgery. We report our experience regarding 1,052 consecutive patients who underwent phacoemulsification. Exact logistic regression was used to examine the role of PSX in intraoperative complications. Odds ratio for intraoperative complications (vitreous loss, capsular break, zonular break) was estimated to be 5.1 for PSX present as compared to when it is absent. PSX was associated with a statistically significant increase in intraoperative complications during cataract surgery (p < 0.0001).

Tamoxifen retinopathy: does it really exist?

Abstract · Background: Tamoxifen retinopathy is known to be an adverse effect of high-dose tamoxifen treatment. Evidence of ocular toxicity at lower doses is less convincing: the aim of this study was to assess the prevalence of the above-mentioned retinopathy in a population treated with low-dose tamoxifen. · Methods: One hundred and twenty-nine women treated with low-dose tamoxifen (20 mg/day) were examined. Visual acuity measurement, slit-lamp biomicroscopy and fundus examination were performed. Patients were reexamined after 6–12 months. · Results: Refractile retinal opacities, similar to those previously described as tamoxifen retinopathy, were observed in four patients (prevalence 3.1%; mean duration of therapy 806 days). None of them revealed corneal opacities, papillary and/or macular edema, or visual impairment. The ophthalmoscopic aspect did not change after a mean follow-up of 215 days, although one of these patients had interrupted tamoxifen intake. Statistical analysis (Student’s t-test) did not reveal any difference between patients with and those without refractile retinal opacities as far as age, treatment duration and ERG values were concerned. An early hyperfluorescence, reminescent of cuticular drusen, was demonstrated by fluorescein angiography in all four cases. · Conclusions: The present study would seem to confirm that low-dose tamoxifen may induce retinal toxicity in a low proportion of patients, but we cannot be certain that the refractile retinal opacities observed are really caused by tamoxifen, as differentiation from age-related macular degeneration with cuticular drusen appears nearly impossible.

Potential role of intravitreal human placental stem cell implants in inhibiting progression of diabetic retinopathy in type 2 diabetes: neuroprotective growth factors in the vitreous

Background: Intravitreal injection of human mesenchymal stem cells has been shown to be effective in slowing the progression of diabetic retinopathy in an animal model of chemically induced diabetes mellitus. We studied changes in growth factor levels released from human mesenchymal stem cells in the vitreous cavity as well as changes in growth factor levels in host retinal neurons following intravitreal injection. Methods: Twenty-two Lewis rats were treated with an intravitreal human mesenchymal stem cell microinjection. Determination of neurotrophic factors released by human mesenchymal stem cells in the vitreous was carried out using real-time polymerase chain reaction. Results: Detectable levels of neurotrophic factors were identified postoperatively in the vitreous of all rats. Conclusion: Increased intravitreal and retinal concentrations of neuroprotective growth factors in rats confirm the neuroprotective activity of human mesenchymal stem cells in diabetic retinopathy.

Argon laser vs. subthreshold infrared (810-nm) diode laser macular grid photocoagulation in nonexudative age-related macular degeneration

BACKGROUND A diode laser can be used to create a subthreshold (invisible end point) lesion in patients with age-related macular degeneration (AMD). This has the potential benefit of localizing the treatment effect to the retinal pigment epithelium and sparing more of the overlying sensory retina. We performed a study to compare the safety and efficacy of argon laser and subthreshold infrared (810-nm) diode laser macular grid photocoagulation in reducing the number of drusen in patients with AMD. METHODS We reviewed the charts of 144 patients with bilateral early-stage nonexudative AMD, characterized by soft drusen. One eye of each patient was treated, and the other eye served as a control. Seventy-eight eyes of 78 patients with a mean age of 67.5 (standard deviation [SD] 8.3) years underwent argon laser macular grid photocoagulation at a university-affiliated hospital in Bologna, Italy, and 66 eyes of 66 patients with a mean age of 66.4 (SD 6.3) years underwent subthreshold infrared (810-nm) diode laser macular grid photocoagulation at a private clinic in Bologna. Each group was classified into three subgroups based on the number of drusen (more than 20, 10 to 20, or less than 10). The patients underwent fluorescein angiography, fundus examination, measurement of far (Snellen chart) and near (Jaeger chart) best corrected visual acuity, and visual field and contrast sensitivity testing. The mean length of follow-up was 18 (SD 0.5) months. RESULTS At 18 months, far and near best corrected visual acuity were statistically significantly improved in the treatment groups compared with the untreated group (p < 0.001, Mann-Whitney U test). There was no significant difference in visual acuity between the treatment groups. Compared with baseline, the number of drusen was significantly reduced in both treatment groups (p < 0.001). Evolution of the disease was observed in the untreated group. The visual field was slightly but significantly reduced after argon laser treatment (p < 0.001) but not diode laser treatment; the difference in visual field between the two groups was not significant. There was a slight reduction in contrast sensitivity, particularly with night vision, after argon laser treatment but not diode laser treatment. The difference between the two treatment groups was significant (p < 0.01). INTERPRETATION Subthreshold infrared diode macular grid photocoagulation may be a safe and viable method for preventing progression of nonexudative AMD.

Efficacy of transfer factor in treating patients with recurrent ocular herpes infections

Recurrent ocular herpes is an insoluble problem for the clinician. As cellular immunity plays an important role in controlling herpes relapses, and other studies have shown the efficacy of HSV-specific transfer factor (TF) for the treatment of herpes patients, an open clinical trial was undertaken in 134 patients (71 keratitis, 29 kerato-uveitis, 34 uveitis) suffering from recurrent ocular herpetic infections. The mean duration of the treatment was 358 days, and the entire follow-up period 189121 before, and 64062 days after TF treatment. The cell-mediated immune response to the viral antigens, evaluated by the lymphocyte stimulation test (LST) and the leucocyte migration test (LMT) (P<0.001), was significantly increased by the TF treatment. The total number of relapses was decreased significantly during/after TF treatment, dropping from 832 before, to 89 after treatment, whereas the cumulative relapse index (RI) dropped, during the same period, from 13.2 to 4.17 (P<0.0001). No side effects were observed. It is concluded that patients with relapsing ocular herpes can benefit from treatment with HSV-specific TF.

Bilateral serous retinal detachments following organ transplantation.

Purpose The authors report the physiopathogenetic features of bilateral serous neurosensory retinal detachments occurring in patients who have undergone organ transplantation. Methods The clinical and photographic findings of four patients who have undergone renal (3 cases) and liver (1 case) transplantation in whom bilateral serous retinal detachment developed early after surgery were reviewed. The patients were processed for clinical symptoms, visual acuity evaluation, slitlamp and fundus examinations, tonometry and fluorescein angiography. Results Ocular examination, in patients complaining of blurred vision and metamorphopsia, revealed loss of visual acuity, bullous serous neurosensory retinal detachment with retinal pigment epithelial detachments in fundus examination and areas of dye leakage in fluorescein angiography, despite tonometry and slitlamp examination were unremarkable. These alterations were spontaneously resolved with the normalization of renal function. Conclusion The only common factor in each of the four patients resulted in alterations of the kidney function. This finding provides further evidence that renal failure may cause alterations in electrolytes extracellular distribution, leading to the formation of serous neurosensory retinal detachments.

Effect of basic fibroblast growth factor and cytochrome c peroxidase combination in transgenic mice corneal epithelial healing process after excimer laser photoablation

Purpose: To evaluate the role of prepared basic fibroblast growth factor (bFGF) and cytochrome c peroxidase (CCP) combination eyedrops in corneal epithelial healing of transgenic mice (B6(A)-Rperd12/J) after excimer laser photoablation. Materials and methods: In this prospective study, 216 eyes of 108 mice underwent bilateral photorefractive keratectomy. We considered 4 groups: A, B, C, and D. Group A received standard topical postoperative therapy with tobramycin, diclofenac, and dexamethasone eyedrops plus CCP at 3 drops per day for a week or until corneal re-epithelialization was achieved. Group B received standard topical postoperative therapy plus bFGF eyedrops and phosphate-buffered saline (PBS) 3 drops per day for a week or until corneal re-epithelialization was complete. In group C, 1 eye received standard topical postoperative therapy plus CCP eyedrops, bFGF eyedrops, and PBS 3 drops per day for a week or until corneal re-epithelialization was complete. Control eyes (group D) received a standard topical postoperative therapy plus placebo eyedrops. Mice were followed-up for a week from the day after the surgery to evaluate the rate of corneal re-epithelialization. Results: Data were analyzed by ANOVA using the XLSTAT 2010 software. Eyes in group A, B, and C healed completely before the fifth postoperative day, achieving, respectively, a re-epithelialization time of 92 hours ± 10 SD, 90 hours ± 12 SD, and 86 hours ± 12 SD. Group D had a re-epithelialization time of 121 hours ± 8 SD (P < 0.05). No side effects or toxic effects were documented. Conclusions: Results suggest that re-epithelialization after phototherapeutic keratectomy can benefit from topical therapy with CCP/bFGF combination eyedrops. Further clinical studies are needed to evaluate the long-term effectiveness of these eyedrops to prevent corneal haze.

Effect of Basic Fibroblast Growth Factor in Transgenic Mice: Corneal Epithelial Healing Process after Excimer Laser Photoablation

Purpose: To evaluate the role of preparedbasic fibroblast growth factor (bFGF) eyedrops in corneal epithelial healing of transgenic mice after excimer laser photoablation. Materials and Methods: In our prospective case series, 60 eyes of 30 mice had uneventful bilateral excimer laser photoablation. In each mouse, 1 eye received the standard topical postoperative therapy with tobramicin, diclofenac and dexamethasone eyedrops, plusbFGF eyedrops 5 μg/10 μl PBS 3 times a day for 1 week, or until corneal reepithelialization was complete. The fellow eye served as the control and received the standard postoperative therapy plus placebo. The mice were monitored daily, commencing the day after surgery and for 7 days, in order to evaluate the corneal reepithelialization rate by using a video slitlamp camera with a cobalt blue light. The mean diameter of the corneal wounds was measured. Videotaped images were recorded and analyzed by computer planimetry. Results: All the eyes treated withbFGF eyedrops healed completely before day 5 after surgery, with a mean reepithelialization time of 90 ± 12 h (standard deviation); the mean reepithelialization time was 124 ± 10 h in those eyes receiving placebo. There were no statistically significant differences between the 2 groups in corneal haze presentation during the follow-up, perhaps because the time period was too brief (7 days). However, corneal clarity on slitlamp biomicroscopy was greater in the study group than in the control group. No side effects or toxic effects were documented. Conclusions: These data suggest that the bFGF significantly accelerates epithelial healing after excimer photoablation. A further clinical study should be performed to prove the results obtained in this study as well as the long-term efficacy of bFGF to prevent corneal haze.

Role of cysteine in corneal wound healing after photorefractive keratectomy.

Aims: To evaluate the efficacy of cysteine oral supplements in corneal wound healing after photorefractive keratectomy (PRK). Methods: A total of 200 eyes (100 patients) underwent PRK. We divided patients into 2 groups; each group was composed of 50 patients (100 eyes). Group 1 patients were assigned to use oral L-cysteine, with a daily dose of 200 mg (100-mg pills to be taken twice a day) for a duration of 14 days, starting from the week preceding the operation; the patients in group 2 were used as a control, and received the oral supplementation of 40-mg placebo pills to be taken twice a day for a duration of 14 days, starting from the week preceding the operation. Results: All the eyes of patients treated with cysteine oral supplements showed shorter times to re-epithelization than the eyes of the control group. The mean time of corneal wound healing observed in group 1 was 102 ± 15 h, compared to an average of 159 ± 9 h in group 2. Conclusion: Our research showed that oral cysteine supplementation, in a daily dose of 200 mg, reduces mean corneal wound healing time in patients after PRK.

Effect of cytochrome c peroxidase on corneal epithelial healing process after photorefractive keratectomy

PURPOSE: To evaluate the role of commercially prepared cytochrome c peroxidase eyedrops in corneal epithelial healing after photorefractive keratectomy (PRK). SETTING: Department of Pathophysiological Optics, Faculty of Medicine, University of Bologna, Bologna, Italy. METHODS: Seventy‐two eyes of 36 patients affected by low to moderate refractive error (myopia and myopic astigmatism) had uneventful bilateral photorefractive keratectomy (PRK). In each patient, 1 eye (32 eyes) received standard postoperative therapy plus cytochrome c peroxidase eyedrops (3 times a day for 1 week or until corneal reepithelialization was completed, corresponding to 15 000). The fellow eye served as the control and received standard postoperative therapy plus placebo. Patients were monitored daily starting the day after surgery for 7 days to evaluate the corneal reepithelialization rate using a video slitlamp camera with a cobalt blue light. Mean diameter of corneal wounds was measured. Videotaped images were recorded and analyzed by computer planimetry. RESULTS: All the eyes treated with cytochrome c peroxidase eyedrops healed completely before day 5 postsurgery, with a mean reepithelialization time of 91 hours ± 14 (SD); the mean reepithelialization time was 154 ± 9 in eyes receiving placebo (P<.05); the mean reepithelialization rate was 0.066 ± 0.007 mm/hour in the cytochrome c peroxidase group and 0.039 ± 0.006 mm/hour in the control group (P<.05). There were no statistically significant differences between groups in corneal haze presentation during follow‐up (P =.70), perhaps because the time period was too brief (7 days). However, corneal clarity, on slitlamp biomicroscopy in the study group was greater than in the control group. No side effects or toxic effects were documented. CONCLUSIONS: These data suggest that cytochrome c peroxidase significantly accelerates epithelial healing after PRK. Further clinical study should be performed to prove the results obtained in this pilot study and the long‐term efficacy of cytochrome c peroxidase to prevent corneal haze.