P. Chelazzi

Parnaparin versus aspirin in the treatment of retinal vein occlusion. A randomized, double blind, controlled study

INTRODUCTION Retinal vein occlusion (RVO) is a common cause of unilateral visual loss. Evidence based treatment recommendations for patients with RVO cannot be made because of the lack of adequate clinical trials. To compare the efficacy and safety of aspirin and of a low molecular weight heparin, parnaparin, in the treatment of RVO. MATERIALS AND METHODS In a multicenter, randomized, double blind, controlled trial eligible patients with a delay between symptoms onset and objective diagnosis of less than 15 days were randomized to aspirin 100 mg/day for 3 months or to a fixed daily dose of parnaparin, 12.800 IU for 7 days followed by 6.400 IU for a total of 3 months. Primary end-point of the study was the incidence of functional worsening of the eye with RVO at 6 months, as assessed by fluorescein angiography, visual acuity, and visual field. Study end-points were adjudicated by an independent committee. RESULTS Sixty-seven patients were enrolled in the study and 58 of them (28 treated with parnaparin, 30 with aspirin) were evaluable for the analysis. Baseline characteristics were well balanced between groups. Functional worsening was adjudicated in 20.7% of patients treated with parnaparin and in 59.4% of patients treated with ASA (p=0.002). Recurrent RVO was diagnosed in 3 patients, all treated with ASA (p=n.s.). Bleeding rates were similar between the two groups. CONCLUSIONS Parnaparin appears to be more effective than aspirin in preventing functional worsening in patients with RVO. The results of this study need to be confirmed in a larger clinical trial.

Eyelid myiasis caused by Cordylobia anthropophaga

Myiasis is an infection of tissue and organ of animals or man by fly larvae. The common site of infestation is the skin wound. Less common sites are eyes, nose, paranasal sinuses, throat, and urogenital tract. Ocular involvement occurs in about 55% of all cases of human myiasis. Ophthalmomyiasis, infestation of the eye with insect larvae, is known to occur in parts of Asia and North Africa. Cutaneous myiasis caused by Cordylobia Anthropophaga occurs sporadically in Europe. We report a case in which disease was imported in Italy from Central Africa. A 59 year-old man presented with a 1-week history of a slowly enlarging mass of the right upper lid. He returned 4 days before from a holiday in Kenya (Malindi). During the trip back to Italy the furuncular lesion started developing on his right upper lid. Ocular examination revealed a mild cellulitis with oedema and erythema (Figure 1A). Slit lamp examination showed a discrete, movable mass under the right eyebrow, with a small fistula that intermittently revealed a little white mass, moving inside the lesion, compatible with the diagnosis of cutaneous myiasis of the upper lid (Figure 1B). B-scan echography was performed, revealing the presence of the larva within the thickness of the eyelid. The day after, surgical exploration was performed: through an incision in the upper eyelid, the larva was extracted with forceps (Figure 1C and D), placed in 70% alcohol to preserve and sent to the Department of Biology, entomology laboratory, University of Pavia for evaluation. The wound was cleaned with povidone and closed. The patient was treated with ampicillin/sulbactam and amoxicillin for 5 days. During the following week, the patient eyelid edema and erythema completely resolved. The parasite was later identified as Cordylobia Anthropophaga by its morphological characteristics.