Nicola Delle Noci

Bevacizumab compared with macular laser grid photocoagulation for cystoid macular edema in branch retinal vein occlusion.

Introduction: To evaluate the outcome of cystoid macular edema treated with intravitreal injections of bevacizumab and macular grid laser photocoagulation (GLP), in patients with perfused branch retinal vein occlusion. Methods: Thirty eyes of 30 consecutive patients with cystoid macular edema secondary to nonischemic branch retinal vein occlusion were assigned to either GLP group or to intravitreal bevacizumab (IB) group. Complete ophthalmologic examinations were performed just before GLP and IB injection at 1, 3, 6, and 12 months after treatment. Changes in logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), central macular thickness (CMT) shown by optical coherence tomography-3 were evaluated. Results: Baseline BCVA (logMAR) and CMT were, respectively, 0.89 ± 0.13 and 650 ± 140 &mgr;m for the GLP group, 0.87 ± 0.16 and 690 ± 120 &mgr;m for the IB group. After the treatment, at 1, 3, 6, and 12 months in the GLP group, BCVA had improved by 0.19, 0.22, 0.21, and 0.20 logMAR, CMT had decreased by 40%, 41.3%, 40.5%, and 42%. In the IB group, BCVA had improved by 0.31, 0.32, 0.30, and 0.31 logMAR and CMT had decreased by 59.5%, 59%, 60%, and 60.3%. The group receiving bevacizumab had better BCVA and lower CMT values at all time points (P < 0.05). Conclusion: Intravitreal bevacizumab injection improves BCVA and reduces CMT more than GLP. Intravitreal bevacizumab injection was well tolerated and could be used as primary treatment in patients with cystoid macular edema secondary to perfused branch retinal vein occlusion.

Linkage analysis in keratoconus: replication of locus 5q21.2 and identification of other suggestive loci.

PURPOSE Keratoconus (KC) is the most common indication for corneal transplantation in the Western world, with etiologic mechanisms still poorly understood. The disease prevalence in the general population is approximately 1:2000, and familial aggregation, together with increased familial risk, suggests important genetic influences on its pathogenesis. To date, several loci for familial keratoconus have been described, without the identification of any responsible gene in the respective mapped intervals. The aim of this study was to identify causative/susceptibility genes for keratoconus. METHODS A total of 133 individuals (77 affected and 59 unaffected) of 25 families from southern Italy were genotyped using microsatellite markers and included in a genome-wide scan. Nonparametric and parametric analysis using an affected-only strategy were calculated by using genetic algorithm software. RESULTS The chromosomal regions 5q32-q33, 5q21.2, 14q11.2, 15q2.32 exhibited the strongest evidence of linkage by nonparametric analysis (NPL = 3.22, 2.73, 2.62, and 2.32, respectively). The regions 5q32-q33 and 14q11.2 were also supported by multipoint parametric analysis, for which heterogeneity LOD (HLOD) scores of 2.45 (alpha = 0.54) and 2.09 (alpha = 0.46), respectively, were obtained under an affected-only dominant model. CONCLUSIONS This study represents the first KC linkage replication study on the chromosomal region 5q21.2 and reports evidence of suggestive linkage in several regions for which suggestive or significant linkage has been previously detected in different populations.

Intravitreal pegaptanib sodium (Macugen®) for diabetic macular oedema

Purpose:  To report the functional and anatomical outcomes resulting from the use of intravitreal pegaptanib sodium (Macugen®) in patients with diabetic macular oedema (DMO).

Correlation of Visual Function Impairment and Optical Coherence Tomography Findings in Patients with Adult-Onset Foveomacular Vitelliform Macular Dystrophy

PURPOSE To investigate the relationship between morphologic and functional abnormalities in patients affected with adult-onset foveomacular vitelliform macular dystrophy (AFVD). DESIGN Prospective, noncomparative observational study. METHODS A complete ophthalmologic examination, including best-corrected visual acuity (BCVA), fundus examination, fundus-related perimetry, and optical coherence tomography (OCT), was performed in 20 consecutive AFVD patients. The stage of the disease and the thickness of the neuroepithelium at the foveola (neurosensory retina) were compared with the BCVA as well as with the type of scotoma, the average retinal sensitivity, and the location and stability of fixation. RESULTS Thirty-five eyes of 20 consecutive patients (10 men and 10 women; mean age, 58.2 years) were graded as follows: 10 had vitelliform stage (stage 1), nine had pseudohypopyon stage (stage 2), 10 had vitelliruptive (stage 3), and six had atrophic stage (stage 4) disease. Reduced thickness of the neuroepithelium at the foveola and BCVA were statistically correlated to an advanced stage of the disease (P = .001 and P = .0062, respectively). Moreover, worse BCVA was correlated statistically to reduced thickness of the neuroepithelium at the foveola (r = 0.14; P = .02). Reduced thickness of the neuroepithelium at the foveola was correlated statistically to the development of absolute scotoma (P = .03), eccentric fixation (P = .01), and unstable fixation (P = .03). CONCLUSIONS OCT and fundus-related perimetry allow a correlation to be defined between foveal thickness and visual function and are useful tools to define better the degree of anatomic and functional impairment in AFVD patients.

Short-term safety and efficacy of intravitreal bevacizumab for pseudophakic cystoid macular edema.

Purpose: To determine the feasibility, safety, and clinical effect of intravitreal bevacizumab (Avastin) in patients with refractory cystoid macular edema after uncomplicated cataract surgery. Methods: Ten eyes of 10 patients affected by pseudophakic cystoid macular edema refractory to medical treatment treated with at least one intravitreal injection of 1.25 mg of bevacizumab were enrolled in the study. Follow-up visits included Early Treatment Diabetic Retinopathy Study visual acuity testing, optical coherence tomography imaging, and ophthalmoscopic examination. Results: The follow-up was 6 months. All eyes had improved best corrected visual acuity, and no eye had worse visual acuity (≥2 Early Treatment Diabetic Retinopathy Study lines). The mean baseline best corrected visual acuity was 20/80 and the mean final best corrected visual acuity 20/32, the difference was statistically significant (P < 0.0001). The mean central macular thickness at baseline (546.8 mm; range, 359–720 mm) decreased significantly (228.7 mm; range, 190–280 mm) by the end of follow-up (P < 0.0001). No ocular or systemic adverse events were observed. Conclusions: Short-term results suggest that intravitreal bevacizumab is safe and well tolerated in patients with pseudophakic cystoid macular edema. Treated eyes had a significant improvement in best corrected visual acuity and decrease in macular thickness by optical coherence tomography.

High-Definition Optical Coherence Tomographic Visualization of Photoreceptor Layer and Retinal Flecks in Fundus Albipunctatus Associated With Cone Dystrophy

T he frequency of unintended vein or peripheral nerve biopsy with temporal artery biopsy has not been addressed specifically in the literature. The results of an inadvertent biopsy of a temporal vein or branch of the facial or auriculotemporal nerve are not inconsequential. Depending on the precise location in the temporal region and the type of peripheral nerve (motor or sensory), inadvertent peripheral nerve biopsy can result in considerable morbidity. It also requires that the procedure be repeated to obtain the correct tissue and, in some institutions, triggers a tissue committee review and clarification from the surgeon for the discrepancy between the intended and submitted tissue.

Incidence and treatment of diplopia after three-wall orbital decompression in Graves' ophthalmopathy.

PURPOSE To describe our experience treating diplopia after orbital decompression in patients with thyroid orbitopathy. PATIENTS AND METHODS From May 1997 to July 2001, we performed orbital decompression on 102 patients (34 men and 68 women) with severe proptosis. In 10 (9.8%) of these patients who had no diplopia preoperatively, diplopia in primary gaze occurred after decompression. In 19 (18.6%) of the patients with diplopia in primary gaze before surgery, there was no modification of diplopia after decompression. In 24 (23.5%) of the patients with diplopia in primary gaze before surgery, a more severe imbalance occurred after decompression. Forty-four (83%) of these 53 patients underwent adjustable extraocular muscle surgery with the use of viscoelastic substances to gain single vision in primary position. In 9 (17%) of the patients, diplopia was resolved with the use of prismatic lenses. RESULTS In 31 (70.4%) of 44 patients, we obtained a stable resolution of diplopia in primary position (minimum follow-up, 6 months). In 10 (22.7%) of these patients, a second surgery on the oblique muscles was necessary 6 months after the first surgery to resolve torsional diplopia. In 3 (6.8%) of the patients, diplopia has been resolved with prismatic lenses. CONCLUSION Orbital decompression reduces proptosis, but may cause diplopia or worsen it.

Short-term fluctuation of diabetic macular edema after intravitreal ranibizumab injection.

Purpose: To examine the short-term fluctuation of diabetic macular edema (DME) after one intravitreal ranibizumab injection. Methods: Twenty consecutive patients with DME received an intravitreal injection of ranibizumab (0.05 mL/0.5 mg). Assessment of best-corrected visual acuity (BCVA), fundus biomicroscopy, MP-1 fundus-related perimetry using follow-up strategy (pattern macula 8° 0 dB with threshold strategy 4–2), and optical coherence tomography central macular thickness (CMT),were performed at baseline and 1 hour, 24 hours, 14 days, 28 days, and 56 days after intravitreal injection of ranibizumab. Results: A total of 18 eyes of 18 patients (9 male, 9 female; mean age, 62.28 ± 8.08 years; range, 48–75 years) who completed the 56-day follow-up were included for analysis. Intravitreal ranibizumab was found to produce significant improvements in mean BCVA and MP-1 sensitivity, as well as reduction in mean CMT, after one injection. This anatomical and functional improvement, which compared with baseline was evident as soon as the 1-hour follow-up (mean CMT reduction: t = 1.7899, P = 0.045; mean MP-1 sensitivity improvement: t = −1.9891, P = 0.0315), and lasted until the 56-day follow-up (mean BCVA improvement: t = 2.26, P < 0.05; mean CMT reduction: t = 3.61, P < 0.05; MP-1 sensitivity improvement: t = −5.21, P < 0.05). Conclusion: These short-term observations give insights into the physiopathology of DME treated with a intravitreal ranibizumab injection.

Isolated foveal hypoplasia.

Purpose To describe a patient with isolated foveal hypoplasia. Methods A 55-year-old man with the clinical suspicion of foveal hypoplasia was given a complete ophthalmological examination, including optical coherence tomography (OCT), fluorescein angiography (FA) and fundus-related perimetry (FRP). Mutation screening for oculocutaneous albinism and aniridia was also performed, but the results were negative for both. Results Following a complete ophthalmological examination and genetic studies, we were able to confirm the clinical suspicion of isolated foveal hypoplasia in this otherwise healthy patient. Conclusions With this report we want to highlight the roles of OCT, FA and FRP in the diagnosis of such a singular condition as isolated foveal hypoplasia.

Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab

A 67-year-old woman developed refractory pseudophakic cystoid macular edema (CME) after uneventful phacoemulsification. Three months after an intravitreal injection of bevacizumab (1.25 mg), the CME was completely resolved, with resultant improvement in visual acuity.