M. Tavolato

Cytokine and chemokine levels in tears and in corneal fibroblast cultures before and after excimer laser treatment

PURPOSE: To measure multiple cytokine and chemokine production in tears of myopic patients before and after laser in situ keratomileusis (LASIK) and in human corneal fibroblast (HCF) cultures before and after excimer laser treatment. SETTING: Department of Neuroscience, Ophthalmology Unit, University of Padua, Italy and Vissum‐Instituto de Oftalmológico de Alicante, Alicante, Spain METHODS: Tear samples were obtained from 15 myopic patients before LASIK and 1 and 24 hours after LASIK. Quiescent HCF cultures were treated using the same laser energy. Culture medium was collected before treatment and after 1 and 24 hours. Cytokine concentrations were determined using multiplexed bead analysis. RESULTS: Compared with baseline values, interleukin (IL)‐12 tear levels were significantly increased 1 hour after surgery and eotaxin levels were significantly increased at 24 hours (both P<.05). Culture medium of HCF contained high levels of IL‐6, IL‐8, and monocyte chemotactic protein (MCP)‐1 and low levels of IL‐1, eotaxin, and regulated on activation, normal T expressed, and secreted (RANTES) cytokine. One hour after treatment, levels of all cytokines were significantly reduced. At 24 hours, IL‐1, IL‐6, IL‐8, and MCP‐1 levels were significantly increased compared with values at baseline and at 1 hour while RANTES cytokine and eotaxin levels had returned to baseline levels. CONCLUSIONS: In vivo and in vitro studies showed that after excimer laser treatment, cytokines are released to modulate the wound‐healing process; however, they can potentially induce inflammation. However, these types of in vitro studies, although useful for evaluating changes in cytokine profiles before and after treatment, only partially reproduce in vivo corneal behavior.

Spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS)

Purpose To report a case of spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS). Methods An Ex-PRESS was implanted under the conjunctiva in a 76-year-old man with primary open-angle glaucoma. Results Two years after implantation, the Ex-PRESS extruded spontaneously. Despite this adverse event, there was no increase in intraocular pressure. Conclusions This is the first report of spontaneous extrusion of an Ex-PRESS device. Implanting the device under a scleral flap should be considered to avoid adverse events such as extrusion or conjunctival erosion.

Tumor necrosis factor-alpha (TNF-α) in seasonal allergic conjunctivitis and vernal keratoconjunctivitis

Purpose To quantify the presence of the proinflammatory cytokine tumor necrosis factor-alpha (TNF-α) in allergic conjunctivitis. Materials and Methods Tears and peripheral blood samples were collected from patients with seasonal allergic conjunctivitis (SAC, n=6), vernal keratoconjunctivitis (VKC, n=12), and normal subjects (CT, n=12). From an additional six nonactive allergic patients, tears were collected before and after specific conjunctival allergen challenge (CAC). Upper tarsal conjunctival biopsies were obtained from five CT and five VKC patients. TNF-α in tears was measured by enzyme-linked immunoassay and identified in tissues by immunohistochemistry. Results Tear TNF-α levels in VKC patients were significantly increased compared to CT (p=0.03), and were significantly correlated with the severity of the disease. No differences were found between SAC and CT tear samples. TNF-α serum levels were higher in VKC than CT; however, this difference was not statistically significant. After CAC, tear TNF-a levels were found increased in only one of six patients. In VKC tissues, TNF-α positive cells were significantly increased compared to CT (p=0.03). Conclusions TNF-α may have a significant role in severe forms of allergic conjunctivitis.

Large-spot subthreshold transpupillary thermotherapy for chronic serous macular detachment

Purpose: To report the effect of subthreshold transpupillary thermotherapy (TTT) in treating serous detachment of the neurosensory retina secondary to chronic central serous chorioretinopathy (CCSC). Methods: Seven eyes from five patients with CCSC, persistent serous detachment of the neurosensory retina and a clinical course of between 12 and 60 months were treated. All eyes received large-spot TTT guided by indocyanine green angiography (ICGA). Subthreshold TTT was performed using an 810 nm diode laser with a spot size of 3.0 mm (power was set at 350 mW). Treatment was applied for 60 seconds to the areas of choroidal hyperfluorescence on ICGA. Results: The mean number of TTT sessions was 1.4 ± 0.5. All eyes were followed up for at least 6 months (mean 9.6 ± 3.2 standard deviation; range 6–12 months). The mean logarithm of the minimum angle of resolution best-corrected visual acuity was significantly better compared with baseline. All TTT-treated eyes had stable or improved vision (P < 0.001). Mean optical coherence tomography (OCT) central foveal thickness was significantly lower in all patients (P < 0.001) compared with pretreatment OCT, with a reduction in subretinal fluid and resolution of serous detachment associated with anatomical fovea restoration. No patient had any treatment-related side effects. Conclusion: Modified subthreshold TTT appears to have a beneficial effect in treating patients with CCSC and persistent neurosensory detachment. The encouraging results and lack of visually significant complications suggest that further investigation is warranted.

Outcomes of 195 consecutive patients undergoing 2-port pars plana vitrectomy with slit-lamp illumination system for posterior segment disease: a retrospective study.

Purpose: The purpose of this study was to evaluate the safety and efficacy of 2-port 20-gauge pars plana vitrectomy with a slit-lamp illumination system in different vitreoretinal pathologies. Design: Retrospective, consecutive, interventional case series. Methods: One hundred and ninety-five consecutive eyes of 195 patients underwent 20-gauge 2-port pars plana vitrectomy with a combination of slit-lamp illumination and a plano-concave contact lens, at the San Paolo Ophthalmology Center, from September 2005 through November 2007. Postoperative visual acuity at baseline and at 1, 3, and 6 months; intraoperative and postoperative complication rate; and surgical time were evaluated. Results: All patients completed 6 months of follow-up. The mean overall visual acuity was 0.74 ± 0.03 (mean ± SD) at baseline, improving to 0.56 ± 0.03 (P < 0.0001), 0.48 ± 0.03 (P < 0.0001), and 0.43 ± 0.03 (P < 0.0001) at 1, 3, and 6 months, respectively. No intraoperative complications occurred. Postoperative complications included retinal detachment in three patients, epiretinal membrane recurrence in three eyes, persistent macular hole in four eyes, and phthisis in one eye. Cataract formation was observed in 25 eyes. The total mean surgical time was 28.3 ± 10.1 minutes. No one had hypotony after the surgical procedure, and no cases of endophthalmitis were observed. Conversion to standard three-port vitrectomy was not necessary in any of the cases. Conclusion: Two-port 20-gauge pars plana vitrectomy with slit-lamp illumination is a safe and effective procedure for posterior segment surgeries.