Michele Reibaldi

Standard-Fluence versus Low-Fluence Photodynamic Therapy in Chronic Central Serous Chorioretinopathy: A Nonrandomized Clinical Trial

PURPOSE To evaluate the efficacy of low-fluence compared with standard-fluence rate photodynamic therapy (PDT) for treating chronic central serous chorioretinopathy. DESIGN Prospective, multicenter, investigator-masked, nonrandomized clinical trial. METHODS Forty-two eyes (42 patients) with chronic central serous chorioretinopathy were enrolled; 19 eyes received indocyanine green angiography-guided standard-fluence PDT (50 J/cm(2)) and 23 eyes received indocyanine green angiography-guided low-fluence PDT (25 J/cm(2)). Primary outcome measures were the changes in mean logarithm of the minimal angle of resolution best-corrected visual acuity and the rate of eyes with complete subretinal fluid reabsorption. Secondary outcomes were the changes in central foveal thickness and choroidal perfusion. RESULTS Mean logarithm of the minimal angle of resolution best-corrected visual acuity improved significantly at all time points (P < .01), in the standard-fluence group from 0.43 to 0.24 at 12 months and in the low-fluence-group from 0.46 to 0.16, without significant difference between the 2 groups. At 12 months, a complete subretinal fluid reabsorption was seen in 15 standard-fluence-treated and 21 low-fluence-treated eyes (79% vs 91%; P = .5). In 1 standard-fluence eye, choroidal neovascularization developed at 3 months, and this eye received further PDT; in the other eyes, at 12 months, a moderate-significant choriocapillaris nonperfusion was seen in 8 standard-fluence-treated and 0 low-fluence-treated eyes (44% vs 0%; P = .002). CONCLUSIONS In most of the eyes, both standard-fluence PDT and low-fluence PDT resulted in complete subretinal fluid reabsorption with visual acuity improvement. Choroidal hypoperfusion related to PDT could be reduced by low-fluence PDT.

Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Idiopathic Macular Hole: A Cross-sectional Prospective Study

PURPOSE To determine the choroidal thickness in the macular area in patients with idiopathic macular hole in one eye and an unaffected fellow eye and in healthy controls. DESIGN Cross-sectional, prospective study. METHODS Twenty-two patients with a full-thickness unilateral idiopathic macular hole and 22 age- and sex-matched controls were recruited. Enhanced depth imaging optical coherence tomography images were obtained by using spectral-domain optical coherence tomography. The choroidal thickness was measured in the subfoveal area and 1000 μm and 2000 μm away from the fovea in the nasal and temporal regions. The diameter of the macular hole and the axial length were determined. RESULTS Choroidal thickness was significantly different across the 3 groups at all locations (P < .001, analysis of variance). The choroid was significantly thinner in eyes with idiopathic macular hole and in unaffected fellow eyes than in the control group (P < .01, Tukey-Kramer test). The mean subfoveal choroidal thickness was 183.2 μm in the idiopathic macular hole group, 196.6 μm in the fellow-eye group, and 245.0 μm in the control group. A negative correlation between subfoveal choroidal thickness and axial length was found in all groups (macular hole, r = -0.53, P = .01; fellow eyes, r = -0.56, P < .01; controls, r = -0.52, P = .01); in control eyes, a negative correlation was found between choroidal thickness and age (r = -0.48, P = .02). CONCLUSIONS Choroidal thickness was reduced in eyes with idiopathic macular hole and also in fellow unaffected eyes. This may suggest a contributing role of the choroid in the pathogenesis of idiopathic macular hole.

Allergic conjunctivitis: a comprehensive review of the literature

Ocular allergy represents one of the most common conditions encountered by allergists and ophthalmologists. Allergic conjunctivitis is often underdiagnosed and consequently undertreated. Basic and clinical research has provided a better understanding of the cells, mediators, and immunologic events, which occur in ocular allergy. New pharmacological agents have improved the efficacy and safety of ocular allergy treatment. An understanding of the immunologic mechanisms, clinical features, differential diagnosis, and treatment of ocular allergy may be useful to all specialists who deal with these patients. The purpose of this review is to systematically review literature underlining all the forms classified as ocular allergy: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratocongiuntivitis, contact allergy, and giant papillary conjunctivitis.

Pharmacological management of ocular hypertension: current approaches and future prospective

Elevated eye pressure is the main risk factor for glaucoma, and intraocular pressure rises when the balance between aqueous humor formation and outflow resistance is compromised. In a normal eye there is a precise tune of aqueous outflow under the fine control of ciliary body and trabecular meshwork. Current pharmacological therapies for lowering the intraocular pressure in glaucoma include increasing aqueous humor outflow and suppression of aqueous humor production. However, most of antiglaucoma drugs currently on the market do not target the trabecular meshwork that represents the site of the pathology. This review focuses on pharmacological management of ocular hypertension with a particular attention to the future pharmacotherapy scenario.

Low-fluence photodynamic therapy in longstanding chronic central serous chorioretinopathy with foveal and gravitational atrophy.

Purpose To describe anatomic and functional outcomes in two patients with long-standing severe chronic central serous chorioretinopathy (CSC) with foveal and gravitational atrophy treated with low-fluence photodynamic therapy (PDT). Methods Two patients with a history of over 10 years of chronic CSC and development of gravitational tracts, with best-corrected visual acuity <20/200, were treated with PDT guided by indocyanine green angiography (ICGA) with a fluence of 25 J/cm2 at an irradiance of 300 mW. Follow-up examinations 1 and 9 months after therapy included measurement of near and far best-corrected visual acuity, fundus biomicroscopy, fluorescein angiography and ICGA, optical coherence tomography, and microperimetry. Results At 1 and 9 months after low-fluence PDT, complete resolution of subretinal, intraretinal, and under retinal pigment epithelium fluid was observed in both patients. Far and near visual acuity improved in both eyes. Improvement of sensitivity and fixation stability were demonstrated by microperimetry. No treatment-related side effects were seen. Conclusions ICGA-guided low-fluence PDT seems effective and safe for treating long-standing chronic CSC.

miRNA profiling in vitreous humor, vitreal exosomes and serum from uveal melanoma patients: Pathological and diagnostic implications.

Uveal melanoma (UM) represents approximately 5–6% of all melanoma diagnoses and up to 50% of patients succumb to their disease. Although several methods are available, accurate diagnosis is not always easily feasible because of potential accidents (e.g., intraocular hemorrhage). Based on the assumption that the profile of circulating miRNAs is often altered in human cancers, we verified whether UM patients showed different vitreous humor (VH) or serum miRNA profiles with respect to healthy controls. By using TaqMan Low Density Arrays, we analyzed 754 miRNAs from VH, vitreal exosomes, and serum of 6 UM patients and 6 healthy donors: our data demonstrated that the UM VH profile was unique and only partially overlapping with that from serum of the same patients. Whereas, 90% of miRNAs were shared between VH and vitreal exosomes, and their alterations in UM were statistically overlapped with those of VH and vitreal exosomes, suggesting that VH alterations could result from exosomal dysregulation. We report 32 miRNAs differentially expressed in UM patients in at least 2 different types of samples analyzed. We validated these data on an independent cohort of 12 UM patients. Most alterations were common to VH and vitreal exosomes (e.g., upregulation of miR-21,-34 a,-146a). Interestingly, miR-146a was upregulated in the serum of UM patients, as well as in serum exosomes. Upregulation of miR-21 and miR-146a was also detected in formalin-fixed, paraffin-embedded UM, suggesting that VH or serum alterations in UM could be the consequence of disregulation arising from tumoral cells. Our findings suggest the possibility to detect in VH and serum of UM patients “diagnostic” miRNAs released by the affected eye: based on this, miR-146a could be considered a potential circulating marker of UM.

Cellular stress response, redox status, and vitagenes in glaucoma: a systemic oxidant disorder linked to Alzheimer’s disease

Amyloid deposits, constituted of amyloid beta (Aβ) aggregates, are a characteristic feature of several neurodegenerative diseases, such as Alzheimer’s, mild cognitive impairment and Parkinson’s disease. They also have been recently implicated in the pathogenesis of retinal damage, as well as age-related macular degeneration and glaucoma. Glaucoma is a progressive optic neuropathy characterized by gradual degeneration of neuronal tissue due to retinal ganglion cell loss, associated to visual field loss over time resulting in irreversible blindness. Accumulation of Aβ characterizes glaucoma as a protein misfolding disease, suggesting a pathogenic role for oxidative stress in the pathogenesis of retinal degenerative damage associated to glaucoma. There is a growing body of evidence demonstrating a link between Alzheimer’s disease and glaucoma. Further, several heat shock proteins (HSPs) members have been implicated both in neurodegenerative diseases and glaucomatous apoptosis. To maintain redox homeostasis vitagenes, as integrated mechanisms, operate actively to preserve cell survival under condition of stress. Vitagenes encode for sirtuin, thioredoxin and HSPs. The present study was designed to investigate cellular stress response mechanisms in the blood of patients with glaucoma, compared to control subjects. Levels of vitagenes HSP-72, heme oxygenase-1, as well as F2-isoprostanes were significantly higher in the blood of patients with glaucoma than in controls. Furthermore, in the same experimental group increased expression of Trx and sirtuin 1 were measured. Our results sustain the importance of redox homeostasis disruption in the pathogenesis of glaucoma and highlights the opportunity that new therapies that prevents neurodegeneration through non-immunomodulatory mechanisms might be synergistically associated with current glaucoma therapies, thus unraveling important targets for novel cytoprotective strategies.

Intraocular pressure and central corneal thickness in premature and full-term newborns.

PURPOSE To evaluate the intraocular pressure (IOP) and central corneal thickness (CCT) in premature and full-term newborns. METHODS IOP and CCT were determined in 33 premature (mean [± SD] gestational age 31 ± 3 weeks, mean birth weight 1474 ± 354 g) and in 33 full-term white newborns (mean gestational age 39 ± 1 weeks, mean birth weight 2763 ± 574 g). The mean age after birth at measurement was respectively 3 ± 1 weeks and 1 ± 1 weeks. Infants with any ocular abnormalities, such as corneal and iris alterations, congenital cataract, retinopathy, glaucomatous corneal and optic disk changes (horizontal corneal diameter >10 mm Hg, C/D >0.4), or familial congenital glaucoma were excluded. IOP was determined with the use of only topical anesthesia with a Tono-Pen XL tonometer and a wire lid retractor, and then CCT was determined by means of a portable pachymeter. RESULTS Mean IOP was 18.9 ± 3.7 mm Hg (range, 13-25) in premature and 17 ± 2.6 mm Hg (range, 12-22) in full-term newborns (P = 0.018 after correction by age after birth). Mean CCT was 599 ± 36 μm (range, 524-720 μm) in premature infants and 576 ± 26 μm (range, 489-650 μm) in the full-term group (P < 0.001 after correction by age after birth). Multivariate analysis showed that IOP increased with increasing CCT (P = 0.025) and that CCT declined with increasing birth weight (P = 0.026). CONCLUSIONS In premature newborns, IOP measurements were slightly greater than in full-term newborns because of an increased CCT.

Heavy versus standard silicone oil in the management of retinal detachment with macular hole in myopic eyes.

Purpose: The purpose of this study was to compare pars plana vitrectomy (PPV) with 1000 cSt silicone oil endotamponade and PPV with densiron endotamponade for retinal detachment with macular hole and posterior staphyloma in highly myopic eyes. Patients and Methods: In a prospective study, 30 eyes of 30 patients were randomly assigned to PPV and densiron (n = 15) or PPV with silicone oil (n = 15). All eyes had laser photocoagulation of the macular hole rim after PPV. Silicone oil or densiron was removed 12 weeks after surgery. Patients were followed-up for 6 months after oil removal. Results: In the densiron group, the retinal reattachment rate was 100% with densiron in situ and 87% after its removal, and in the silicone oil group, the retinal reattachment rate was 67% with silicone oil in situ and 53.4% after oil removal. Thus, PPV with densiron had a better anatomical success rate than silicone oil (P = 0.04 with endotamponade and P = 0.05 after endotamponade removal). In both groups, paired comparison of preoperative and postoperative best-corrected visual acuity was not statistically significant (P = 0.08). Conclusion: Pars plana vitrectomy with densiron is a preferred surgical procedure for the repair of macular hole retinal detachment in highly myopic eyes with posterior staphyloma.

Low levels of 17-β-oestradiol, oestrone and testosterone correlate with severe evaporative dysfunctional tear syndrome in postmenopausal women: a case-control study.

Aims To evaluate the role of 17-β-oestradiol, oestrone and total testosterone (TT) deficiency in the pathogenesis of severe evaporative dry eye syndrome (DES), investigating the relationship between tear osmolarity, tear film break-up time (TF-BUT), Schirmer test and serum sex hormones in postmenopausal women. Methods 44 postmenopausal women were recruited for a case–control study: 22 women with severe evaporative DES (Group A) and 22 without DES (Group B). The tests performed included laboratory blood analysis: fasting plasma profile (17-β-oestradiol, oestrone and TT), glucose level and lipid profile. Detailed eye examinations, including corneal and conjunctival staining, tear osmolarity measurement, tear volume and TF-BUT, were performed. The Ocular Surface Disease Index Questionnaire was also administered. Results Values of Schirmer test and TF-BUT in Group A were significantly lower in comparison with Group B (p<0.001). Serum levels of 17-β-oestradiol, oestrone and TT were significantly lower in Group A compared with Group B (p<0.05). In women with severe evaporative DES, the levels of 17-β-oestradiol, oestrone and TT were inversely correlated with the tear film osmolarity (r=−0.7, −0.88, −0.81, respectively). Conclusions In postmenopausal women with severe evaporative DES, sex hormone levels are lower than control and that tear osmolarity is negatively correlated with sex hormone levels.