Mario Fruschelli

Coagulative, Fibrinolytic and Metabolic Pattern in Patients with Central Retinal Vein Occlusion

Central retinal vein occlusion (CRVO) is an important cause of visual loss. Many risk factors have been associated with CRVO onset at various ages. Among them diabetes mellitus, hypertension, immunologic disorders, increase in blood viscosity and coagulation, decrease of fibrinolysis have been reported in many subjects. The aim of our study was to detect the metabolic, coagulative and fibrinolytic pattern in 54 patients (26 men, 28 women, mean age 50.4 ± 12.3) affected by CRVO. We excluded from the study patients with other ocular disorders. A fibrinolytic impairment is the most common feature in our population. It occurs either in dysmetabolic or in nonmetabolic subjects. Such data suggest a prominent role of the fibrinolytic system in the pathogenesis of CRVO.

Ocular manifestations of chronic graft-versus-host disease in patients treated with extracorporeal photochemotherapy

Purpose Eye involvement has long been appreciated in patients with chronic graft versus host disease (cGVHD). In particular, ocular complications are frequent and can be potentially severe in patients with steroid-refractory cGVHD, and therefore necessitate close monitoring. This prospective study was designed to describe eye manifestations of cGVHD in a large series of patients monitoring them before and after 1 year of extracorporeal photochemotherapy (ECP). ECP is a relatively new therapeutic approach based on the biological effects of psoralen 8-methoxypsoralen (8-MOP) and ultraviolet A light (UVA) on mononuclear cells collected by apheresis, and reinfused into the patient. Methods Only patients with steroid-refractory cGVHD under treatment with ECP, who developed cGVHD-related eye symptoms, were selected for the study. Ophthalmologic examination was repeated every 3 months. Only patients with complete recovery of the ocular manifestations and symptoms were considered responsive. Results In our study we observed eye alterations in 24 out of 140 patients (17%) with cGVHD. After 12 months of ECP, 10 out of 21 patients (48%) completely responded to the therapy. In all these cases the contribution of ECP was also essential in all the other organs subject to cGVHD. Conclusions Further studies are necessary to clarify the role of ECP in patients with cGVHD, especially in associated eye manifestations. Although our experience is limited, it suggests that ECP could be a safe and effective therapy for steroid-refractory eye manifestations of cGVHD.

Phacoemulsificator and sterile drapes contamination during cataract surgery: a microbiological study.

Purpose To determine the microbial contamination of the irrigating fluids at the time of phacoemulsification after the use of topical povidone-iodine and antibiotics prophylaxis. Methods A total of 119 patients undergoing cataract surgery were enrolled in this prospective study. All patients received 5 mg/mL levofloxacin starting from the day prior to surgery and topical and 5% povidone-iodine drops starting from 30 minutes before the surgery. At the end of each surgery, 2 samples of drainage liquids were sterilely collected from the drainage bags (DBL) and from the peristaltic pump single-cassettes (PCL) of the phacoemulsification machine. Search for aerobic and anaerobic bacteria and fungi was performed. Results Seventy-five patients (31.5%) revealed a growth of at least one microbial species (53 DBL and 22 PCL, 44.5% vs 18.5%; p<0.001). Sixty-six patients (55.5%) had at least one positive intraoperative solution. Overall, 111 microbial strains were collected: 82 (74%) Gram-positive bacteria, 20 (18%) fungi, and 9 (8%) Gram-negative bacteria. Thirteen staphylococcal isolates from PCL, compared with 52 out of DBL (11% vs 43.7%, p<0.001), fungi were essentially isolated from PCL. No significant correlation was found between microbial isolation and risk factors. No postsurgical infective complication occurred in the follow-up. Conclusions Evaluation of intraoperative fluids can provide evidence on sources or vehicles of postsurgical infections. Antibiotic prophylaxis and topical povidone-iodine can significantly contribute to minimize the risk of endophthalmitis.

Spindle cell lipoma of the orbit: a case report of an unusual orbital pathology

Spindle cell lipoma is a rare and distinct variant of soft tissue tumour characterised by spindle cells in which the fat content may be scarce or absent. Most spindle cell lipomas arise as a subcutaneous mass of the neck, shoulders or back. Rarely, they can also be found in unusual sites, such as the oral cavity, larynx, bronchus, breast, and extremities. Localisation of spindle cell lipoma in the orbit has been described in a few cases. We report here on a case of an orbital mass surgically excised in an adult male and discuss the differential diagnosis with other soft tissue tumours with a lipomatous component, such as lipomatous haemangiopericytoma, a rare variant of haemangiopericytoma.

Evaluation of Chronic Central Serous Chorioretinopathy after Subthreshold Yellow Micropulse Diode Laser Photostimulation at a Wavelength of 577 nm

Objective: This study evaluated the efficacy and safety of subthreshold yellow diode-laser micropulse 577 nm (SDM) in the treatment of chronic central serous chorioretinopathy (CSCR). Methods: 40 eyes of 40 patients with non-resolving CSCR of >12 months duration were treated with SDM yellow laser (577 nm). Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured. Amsler grid screening, ophthalmoscopy, fundus autofluorescence (FAF) and SD-OCT were performed. Follow up measurements were recorded from 3 to 12 months. Results: Restoration of normal macular anatomy was obtained in 85.7% of cases with a significant reduction in mean central foveal thickness (CFT). Mean visual acuity gain was 14.95 ETDRS letters, subjective or objective deterioration after treatment was not recorded in any case. Conclusion: The possibility of favouring reabsorption of subretinal liquid by stimulating the retinal pigment epithelium, even at the fovea, without damaging retinal tissue, opens up new frontiers for the therapy of chronic CSCR.

Epithelial Cyst of the Superior Oblique Muscle Trochlea

Abstract Most of the congenital orbital cysts are choristomas such as dermoid or epidermoid and only in a few cases they are epithelial. Clinically, they manifest as cystic movable formations mostly localized in the upper temporal quadrant of the orbit. We describe here the case of a 49-year-old man with an orbital cyst localized in the upper-nasal quadrant of the orbit and which was showing signs of a gradual enlargement and progression over the past weeks. Computed tomography revealed a cyst of 1.9 × 1.6 cm in size and located within the trochlea of the upper oblique muscle. The cyst was completely extirpated after orbitotomy performed by superciliary approach. Histopathology revealed a cyst with nonkeratinized cuboidal epithelium. Postoperative course was uneventful, without inflammation signs, and after 5 weeks excellent functional and aesthetic effects were achieved with no iatrogenic alteration of the ocular motility.

Use of hypo-osmolar riboflavin for corneal cross-linking in thin keratoconic corneas

Purpose To evaluate the efficacy of UVA collagen cross linking (CXL) on thin keratoconic corneas with previous application of hypoosmolar riboflavin solution.

I-LASIK retreatment of residual refractive errors after microkeratome and femtosecond assisted LASIK

Purpose To evaluate the efficacy and safety of femtosecond‐assisted sub‐bowman keratomileusis (I‐LASIK) retreatment for residual refractive errors after either I‐LASIK or microkeratome assisted LASIK.

Pseudophakic eye globe disruption.

Purpose Scleral rupture due to bulb bursting can result from a heavy contusion. Owing to refined surgical techniques and the use of antibiotics and cortisone-based medication, more conservative concepts have followed. In major ruptures, the results were almost always very poor, with atrophy or subatrophy of the eyes. Methods A 63-year-old man with major left ocular trauma and intraocular lens dislocation in the subconjunctival area was referred to the authors for clinical and surgical evaluation. Results Surgery was performed 3 weeks after the trauma to allow for improvement in the patients condition. The reabsorption of a palpebral-frontal hematoma, which made bulb exploration almost impossible, was fundamental in order to proceed. After 1 year, the best-corrected visual acuity was 0.9. In fact, great improvements in surgical techniques in recent years have allowed us to consider the problem of major rupture in a new way, both technically and from an organizational point of view. Conclusions In terms of organization, the concept of urgent surgical procedures must be reevaluated, because besides traumatic damage, incomplete surgical measures may result. This makes all treatment useless, in both barely equipped and highly specialized centers.

Optical coherence tomography and biomicroscopical analysis in macular holes

Purpose To assess the usefulness of optical coherence tomography (OCT) for better differential diagnosis of macular holes in comparison with biomicroscopical fundus analysis. Methods We reviewed the files of 25 eyes of 24 patients who were diagnosed as having a macular hole on OCT examination and biomicroscopical fundus analysis. Each eye underwent six radial 3-mm OCT scans centered on the macula, one 6-mm vertical and one 6-mm horizontal scan. Retinal thickness was measured at the foveal center and 750 μm from the center, vertically, and horizontally. The diameter of the macular contour was also measured on vertical and horizontal scans. Results On biomicroscopy only 8 eyes (32%) were diagnosed as having macular hole, while in the remaining 17 eyes (68%) diagnosis of macular hole was possible only performing an OCT examination. Conclusion Optical coherence tomography is very useful in the diagnosis of macular holes compared with classic biomicroscopical analysis.