Michele Vetrugno

Anterior chamber depth measured by two methods in myopic and hyperopic phakic IOL implant

AIM To evaluate the accuracy and reliability of the optical versus ultrasonic measurement of anterior chamber depth (ACD) in a group of patients affected by high myopia or hyperopia, before phakic IOL implant. METHODS 18 consecutive patients (34 eyes) were enrolled in this study, and asked to undergo phakic IOL implant to correct high myopia or hyperopia. The mean age was 29.5 (SD 3.4) years, the male/female ratio was 10/8. 13 patients (24 eyes) were myopic (mean myopia −16.17 (4.39) D, range −9 to −24 D), whereas five patients (10 eyes) were hyperopic (mean hyperopia 7.4 (2.01) D, range 5.5–11 D). For each patient, ACD was evaluated comparing an optical system (Orbscan topograph system) with a standard A-scan ultrasound system. To evaluate the reliability of the two methods, the average of three optical and 10 ultrasonic consecutive measurements were considered. Statistical analysis was performed by means linear regression. RESULTS The average difference between optical and ultrasound values was 0.17 (0.1) mm (4.68% (2.52%)). There was a constant underestimation of the ACD with the optical system compared with the ultrasound measurement, more evident in the hyperopic eyes (5.20% (1.95%)) than in myopic ones (4.46% (2.72%)). The reliability of measurements, as showed by the standard deviation values, was higher in the optical system (0.03 (0.02)) than in the ultrasound (0.1 (0.05)), with a statistical difference (p<0.001). The linear regression analysis between optical and ultrasound measurements was 0.8992 (p<0.0001). CONCLUSIONS The optical measurement of ACD is an accurate and reliable technique in high myopic and hyperopic eyes. It gives a small underestimation of the ACD values, but it could be preferable to the ultrasound technique, because it demonstrates more repeatability and has the advantages of a non-contact technique.

A randomized, double-masked, clinical study of the efficacy of four nonsteroidal anti-inflammatory drugs in pain control after excimer laser photorefractive keratectomy.

OBJECTIVE This study assessed the efficacy of 4 nonsteroidal anti-inflammatory drugs (NSAIDs) after excimer laser photorefractive keratectomy (PRK). BACKGROUND Inadequate control of pain after PRK surgery can be a severe source of distress to patients and can interfere with their willingness to undergo a second PRK procedure. METHODS This randomized, double-masked, placebo-controlled clinical study was conducted in 125 patients. Four NSAIDs (diclofenac, flurbiprofen, ketorolac, and indomethacin) were tested against a placebo group (artificial tears). Pain levels after PRK were quantified using Present Pain Intensity (PPI) and Pain Rating Indices based on rank values (PRI[R]) scores, both of which were calculated using patient responses to a modified McGill Pain Questionnaire. The PRI(R) consisted of 4 subscales-sensory (S), affective (A), evaluative (E), and miscellaneous (M)-as well as a total score (T). RESULTS Three hours after PRK, no differences in PPI scores were found between the ketorolac, diclofenac, and indomethacin groups, whereas placebo was significantly less effective than the NSAIDs. Patients who received flurbiprofen reported PPI scores that were significantly lower (P < 0.001) than those of patients who received diclofenac and indomethacin, but PPI scores in the flurbiprofen and the ketorolac groups did not differ significantly. Twenty-four hours after surgery, patients treated with flurbiprofen, ketorolac, and diclofenac reported the lowest PPI scores compared with those treated with indomethacin and placebo (P < 0.001). Moreover, flurbiprofen-treated patients also had the lowest PRI(R)T scores (P < 0.001). When the pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the flurbiprofen group at 24 hours (P < 0.001). The PRI(R)A score was significantly higher in the placebo and indomethacin groups compared with the other groups (P < 0.001). At the 48- and 72-hour time points, flurbiprofen-treated patients again reported significantly lower PPI and PRI(R)T scores (P < 0.001 for both) in pair-wise comparisons with the other treatment groups. The number of patients who self-administered additional oral analgesics did not differ significantly between the groups. However, the mean number of analgesic tablets used was significantly higher in the placebo group than in any NSAID group (P < 0.001). The ketorolac group had the largest number of patients complaining of itching (P < 0.043). No other subjective symptoms were significantly different across groups. Finally, all NSAIDs, except flurbiprofen, prolonged the mean reepithelialization period slightly (P < 0.001). CONCLUSIONS Flurbiprofen appeared to be the most effective NSAID for the treatment of pain, even at 24 hours after surgery when pain was at a maximum.

Efficacy of the fixed combinations of bimatoprost or latanoprost plus timolol in patients uncontrolled with prostaglandin monotherapy: A multicenter, randomized, investigator-masked, clinical study

Purpose To compare the efficacy and tolerability of a once-daily evening dose of bimatoprost/timolol fixed combination (BTFC) with that of a once-daily evening dose of latanoprost/timolol fixed combination (LTFC) in patients not controlled with prostaglandins analogues monotherapy. Methods A total of 82 patients on prostaglandin analogues monotherapy were enrolled in this prospective, multicenter, investigator masked, clinical study and were randomized to either BTFC (n=47) or LTFC (n=35) topical therapy once at night for 12 weeks. The primary endpoint of the study was to compare the mean daily intraocular pressure (IOP) reduction from baseline between the two treatment arms. Secondary endpoints included the mean daily IOP at 1 and 3 months compared to baseline and the percentage of patients showing a mean IOP reduction from baseline greater than or equal to 15% or 20%. Results Mean IOP at baseline was 22.7±2.0 and 22.1±2.6 mmHg in the BTFC and LTFC groups, respectively (p=0.23). Both treatments were effective in reducing the IOP from baseline. The mean IOP reduction was significantly greater in the BTFC group than in the LTFC group (–21.4% vs −13.7%, p<0.001). A higher percentage of patients in the BTFC group showed a mean IOP reduction from baseline ≥ 15% (72.3% vs 40.0%) and ≥ 20% (61.7% vs 17.1%) compared to patients in the LTFC group. Conclusions Both BTFC and LTFC were more effective versus the monotherapy with prostaglandin analogues. BTFC demonstrated higher performance than LTFC in terms of relative IOP reduction.

A randomised, double masked, clinical trial of high dose vitamin A and vitamin E supplementation after photorefractive keratectomy

AIM To evaluate the effect of a high dose vitamin A and E supplementation on corneal re-epithelialisation time, visual acuity and haze following photorefractive keratectomy (PRK). METHODS Two groups of 20 patients who underwent myopic PRK were supplemented with either 25 000 IU retinol palmitate and 230 mg α tocopheryl nicotinate or a placebo. Clinical outcomes were evaluated up to 360 days. RESULTS In the vitamin treated group, re-epithelialisation time was significantly faster (p=0.029) and haze incidence was reduced (p=0.035), especially for high myopic corrections (p=0.043). This group also reported a significantly better uncorrected visual acuity (p=0.043). CONCLUSIONS High dose vitamin A and E oral supplementation may accelerate re-epithelialisation time and may reduce corneal haze formation after PRK.

Contrast sensitivity measured by 2 methods after photorefractive keratectomy.

Purpose: To study contrast sensitivity in eyes that had flying‐spot excimer laser photorefractive keratectomy (PRK) and to compare a subjective method (Vision Contrast Test System [VCTS] 6500) and an objective method (visual evoked potential [VEP]) of measuring contrast sensitivity. Setting: Istituto Clinica Oculistica, Università degli Studi, Bari, Italy. Methods: Contrast sensitivity changes over time were evaluated in 26 eyes. The baseline values were compared with measurements 3, 6, and 12 months after PRK using the VCTS 6500 and VEP. Contrast threshold and VEP amplitude were classified by myopic correction. Results: Contrast threshold values changed significantly over time (P < .001). Significant differences were found between mean contrast threshold preoperatively and 12 months postoperatively (P < .001) at all spatial frequencies. A significant relationship was established between baseline and 12 month measurements at 18 cycles per degree. Mean VEP amplitude measurements also changed significantly over time (P < .001) and showed a significant relationship between baseline and 12 month measurements (P < .001). A significant relationship was also established between baseline and 12 month VEP amplitude values at 100% of grating contrast. Patients with high myopia complained significantly more at a lower contrast threshold and at lower VEP amplitude values than patients with low myopia. Conclusions: Three months after PRK, contrast threshold and VEP amplitude values were reduced. Partial recovery was established at 6 months, although patients reported permanent impairment under low‐contrast conditions, especially if the myopia correction was more than 6.0 diopters.

Learning effect of short-wavelength automated perimetry in patients with ocular hypertension.

AimTo evaluate the learning effect of short-wavelength automated perimetry (SWAP) on a group of patients with ocular hypertension experienced with standard automated perimetry (SAP). MethodsThirty patients with ocular hypertension underwent 5 full-threshold SWAP tests at intervals of 7±2 days. The parameters investigated to detect a learning effect were duration, the perimetric indices, and the number of points with a P of <5% and 1% in the total and pattern deviation maps. Differences in learning effect were also evaluated by comparing the sensitivities of central, paracentral, and peripheral areas, hemifields and quadrants. ResultsLearning effects were demonstrated for mean defect (P<0.0001, analysis of variance), duration (P=0.0001), the number of points with P<5% in the pattern deviation map (P=0.003), and short fluctuations (P=0.03). The effect was greater in the peripheral than in central areas (P=0.04). Mean defect was the most sensitive parameter, for which the learning effect was statistically significant between the first and the fifth test. ConclusionsThe results of this study demonstrate a significant learning effect at full-threshold SWAP. This may limit the efficacy of this kind of perimetry in detecting early glaucoma, and should therefore be carefully considered when creating normative databases for new SWAP strategies.

Learning effect of humphrey matrix frequency doubling technology perimetry in patients with ocular hypertension

AimTo evaluate the learning effect of Frequency Doubling Technology (FDT) perimetry using the Humphrey Matrix-FDT perimetry (Matrix) 24-2 full-threshold program on patients with ocular hypertension experienced with standard automated perimetry. MethodsTwenty-four patients with ocular hypertension underwent 5 full-threshold Matrix tests at intervals of 5±2 days. Learning effect was defined as an improvement at results for duration, perimetric indices, foveal sensitivity, Glaucoma Hemifield Test, and the number of points with a P<5% and <1% in the total and pattern deviation maps. Eccentricity, hemifield, and quadrant sensitivities were also addressed as sources of differences in learning effect. Test-retest variability was also calculated for each repetition as the mean of the point-to-point interindividual standard deviations. ResultsA learning effect was demonstrated for mean defect (P=0.031, analysis of variance) and foveal sensitivity (P=0.009) and it only affected the first test for both parameters. All the other parameters did not show any significant learning effect. The effect was independent from eccentricity and quadrant or hemifield sensitivities. ConclusionsThe results of this study demonstrate that the learning effect for Matrix-FDT is mild and it may affect only the first test. Caution is needed in the analysis of the first Matrix-FDT examination and retest may be advisable in the presence of low mean defect.

Effects of Coenzyme Q10 in Conjunction With Vitamin E on Retinal-evoked and Cortical-evoked Responses in Patients With Open-angle Glaucoma

Purpose:To evaluate pattern-evoked retinal and cortical responses [pattern electroretinogram (PERG) and visual-evoked potential (VEP), respectively] after treatment with coenzyme Q10 in conjunction with vitamin E in open-angle glaucoma (OAG) patients. Methods:Forty-three OAG patients (mean age, 52.5±5.29 y; intraocular pressure <18 mm Hg with &bgr;-blocker monoterapy only) were enrolled. At baseline and after 6 and 12 months, simultaneous recordings of PERG and VEPs were obtained from 22 OAG patients who underwent treatment consisting of coenzyme Q10 and vitamin E (Coqun, 2 drops/d) in addition to &bgr;-blocker monoterapy (GC group), and from 21 OAG patients who were only treated with &bgr;-blockers (GP group). Results:At baseline, intraocular pressure, PERG, and VEP parameters were similar in both GC and GP groups (analysis of variance, P>0.05). After 6 and 12 months, PERG and VEP response parameters of GP patients were unchanged when compared to baseline. In GC patients, PERG P50 and VEP P100 implicit times were decreased, whereas PERG P50-N95 and VEP N75-P100 amplitudes were increased (P<0.01) when compared to baseline. In the GC group, the differences in implicit times and amplitudes with respect to baseline were significantly larger (P<0.01) than those recorded in the GP group. The improvement (12 mo minus baseline) of VEP implicit time was significantly correlated with the changes of PERG P50-N95 amplitude (r=−0.66171, P=0.0008) and P50 implicit time (r=0.68364, P=0.00045) over a period of 12 months. Conclusions:Coenzyme Q10 associated with vitamin E administration in OAG shows a beneficial effect on the inner retinal function (PERG improvement) with consequent enhancement of the visual cortical responses (VEP improvement).

Acute and Chronic Effects of Brimonidine 0.2% on Intraocular Pressure and Pulsatile Ocular Blood Flow in Patients with Primary Open-Angle Glaucoma: An Open-Label, Uncontrolled, Prospective Study

BACKGROUND Brimonidine has been reported to decrease aqueous production and increase uveoscleral outflow; however, the hemodynamic effects of brimonidine are still under investigation. OBJECTIVE The purpose of this study was to report the acute and chronic effects of brimonidine 0.2% on intraocular pressure (IOP) and pulsatile ocular blood flow (pOBF) in patients with primary open-angle glaucoma (POAG). METHODS Nonsmoking patients aged 45 to 67 years with POAG and normal blood pressure, heart rate, body mass index, and hemorheologic parameters were enrolled in the study. Brimonidine 0.2% was self-administered twice daily for 180 days. IOP and pOBF were determined using Goldmann applanation tonometry and the Langham system. All measurements were taken at baseline and 4, 8, and 12 hours after treatment and were repeated on days 7, 15, 30, 60, 90, 120, 150, and 180 of treatment. RESULTS Of the 18 eligible patients, 10 (6 men and 4 women) were enrolled (mean age, 51.5 +/- 4.39; range, 47-64 years). When measured 12 hours after instillation, mean IOP was significantly reduced by 21.5% (P < 0.001) compared with the baseline value. The greatest decrease in IOP (-23.5%) was observed at 8 hours. After 12 hours, a significant increase (P < 0.001) in pOBF was measured. A stable IOP reduction (P < 0.001 vs baseline), as well as an increase in pOBF (P = 0.015), was recorded at the subsequent time points. The pOBF increases ranged from 22.5% at day 30 to 9.2% at day 180 of treatment. No evidence of adverse events was found at any time point. CONCLUSIONS In this sample of patients with open-angle glaucoma, brimonidine induced a rapid reduction in IOP that was significant even after 6 months. Moreover, an increase in pOBF was observed from the first day of treatment, and remained consistent throughout the study.

A randomized, comparative study of fluorometholone 0.2% and fluorometholone 0.1% acetate after photorefractive keratectomy.

Purpose To compare the efficacy and tolerance of fluorometholone 0.1% acetate and fluorometholone 0.2% eyedrops in the postoperative management of photorefractive keratectomy (PRK). Methods A randomised single-blind comparative study was performed on two groups of 30 patients who underwent myopic PRK. The first group was given fluorometholone 0.1% acetate and the second fluorometholone 0.2%. Uncorrected and best corrected visual acuity, haze, IOP and local tolerance were evaluated. Statistical analysis was done using parametric and non-parametric tests. Results Visual acuity did not differ in the two groups; both were homogeneous as far as refractive error and haze were concerned. Three patients (10%) treated with fluorometholone 0.2% and two patients (6.6%) with fluorometholone 0.1% acetate developed ocular hypertension, but this was not statistically significant. Conclusions Fluorometholone 0.1% acetate was effective on inflammation after PRK, with the same efficacy as fluorometholone 0.2%.