Pier Luigi Grenga

Fourier-Domain Optical Coherence Tomography and Microperimetry Findings in Retinitis Pigmentosa

PURPOSE To investigate the relation between the optical coherence tomography (OCT) findings and retinal sensitivity in patients with retinitis pigmentosa (RP) by assessing the retinal thickness and retinal function using Fourier-domain OCT (FD-OCT) and microperimetry, respectively. DESIGN Observational case series. METHODS Fifty-nine patients (118 eyes) were enrolled, mean age 47 ± 14.8 years. Thirty-two healthy subjects (HS) were enrolled as a control group. Patients were assessed by means of FD-OCT and microperimetry. We analyzed the average foveal thickness (diameter of 1 mm centered on the point of fixation), the value of the retinal sensitivities corresponding to the 4 degrees centered on the fixation point, and logMAR visual acuity for regression analysis converted from Snellen chart. RESULTS We distinguished 4 groups of RP patients according to the macular pattern seen on OCT images. The first group of 36 eyes, mean age of 33.5 ± 7.4 years, had no macular changes, mean best-corrected visual acuity (BCVA) of 0.95 ± 0.07, mean foveal thickness of 256.3 ± 9.14 μm, and mean retinal sensitivities inside the central 4 degrees of 19.27 ± 0.87 dB (P > .05 for all the values). The second group of 28 eyes, mean age 35.4 ± 6.3 years, showed clinical macular edema (CME) on OCT images with mean BCVA of 0.72 ± 0.22, mean foveal thickness of 363.5 ± 93.45 μm, and mean retinal sensitivity inside the central 4 degrees of 15.94 ± 3.6 dB (P < .01 for all the values). The third group of 26 eyes, mean age 50.8 ± 8.7 years, showed macular vitreoretinal traction on OCT images with a mean BCVA of 0.5 ± 0.2, mean foveal thickness of 337.1 ± 71.7 μm, and mean retinal sensitivity inside the central 4 degrees of 11.78 ± 3.09 dB (P < .01 for all the values). The last group of 28 eyes, mean age 52.1 ± 13.6 years, showed macular retinal thinning on OCT images with mean BCVA of 0.36 ± 0.15, mean foveal thickness of 174.2 ± 24.40 μm, and mean retinal sensitivity inside the central 4 degrees of 10.22 ± 3.82 dB (P < .01 for all the values). CONCLUSIONS MP-1 and FD-OCT showed high sensitivity for identifying functional and structural macular abnormalities, respectively. Future studies should investigate the relationships among photoreceptor cell loss, retinal sensitivity, and fixation in patients with RP.

Effect of basic fibroblast growth factor on corneal epithelial healing after photorefractive keratectomy.

PURPOSE To evaluate the effect of basic fibroblast growth factor (bFGF) eye drops on corneal epithelial healing after photorefractive keratectomy (PRK). METHODS One hundred patients treated with PRK for myopia were enrolled in this prospective, randomized study. Fifty patients were treated postoperatively with standard topical therapy and bFGF eye drops and 50 patients, used as controls, received standard postoperative therapy plus placebo (saline drops). Postoperatively, patients were examined daily until the epithelium healed. The velocity of resurfacing was recorded. Corneal clarity, visual acuity, and refraction were evaluated during the 3-month postoperative period. RESULTS Complete epithelial healing was observed starting at postoperative day 3 in 46% of eyes in the bFGF group and 14% of eyes in the control group. At day 4, 98% and 72% of eyes in the bFGF and control groups, respectively, had healed. Five days after PRK, 100% of eyes treated with bFGF and 92% of control eyes achieved complete epithelial healing. In the control group, 98% of eyes healed at day 6 and all eyes completed healing at day 7. The difference in healing time was statistically significant (P<.001). No statistically significant differences were noted for haze prevalence, uncorrected distance visual acuity, and spherical equivalent refraction after treatment between groups (P>.05). No side or toxic effects were reported during the study. CONCLUSIONS Basic fibroblast growth factor accelerates epithelial healing after PRK and could be used as additional treatment in circumstances of delayed healing.

High-resolution spectral domain optical coherence tomography images of alstrom syndrome.

Alström syndrome is a multisystemic disorder characterized by cone-rod dystrophy, hearing loss, obesity, insulin resistance and hyperinsulinemia, type 2 diabetes mellitus, dilated cardiomyopathy, and progressive hepatic and renal dysfunction. The cone-rod retinal dystrophy usually develops within a few weeks after birth. The authors examined a young boy with Alström syndrome by means of microperimetry and spectral domain optical coherence tomography (OCT). Instead of the typical alterations observed in cone-rod dystrophies, the characteristics of the central foveal tissue suggest signs of retinal immaturity, with only a single layer of short, thick cones and rods and immature short outer segments. High-speed and high-resolution spectral domain OCT allowed a detailed analysis of retinal layers in a young patient with Alström syndrome for the first time.

Fixation stability measurements in patients with neovascular age-related macular degeneration treated with ranibizumab

OBJECTIVE To evaluate which of 2 measuring units (bivariate contour ellipse area [BCEA] vs Fujii) yields more accurate measurements of fixation stability, obtained using the MP-1 device, in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal injections of ranibizumab, during a 12-month follow-up period. DESIGN Small retrospective, noncomparative, interventional case series. PARTICIPANTS A total of 25 eyes in 25 patients (13 males, 12 females; mean age 71.72 ± 7.98 years). METHODS All participants were older than 50 years, diagnosed with active subfoveal choroidal neovascularization, had best corrected visual acuity (BCVA) values above 20/100, and all lesion types were included. All patients underwent a loading phase with 3 consecutive intravitreal injections of 0.05 mg ranibizumab at monthly intervals. Patients were retreated after the third injection if they exhibited a 100-μm increase in macular thickness or evidence of intraretinal and/or subretinal fluid and new subretinal hemorrhage, observed with spectral-domain optical coherence tomography and fluorescein angiography. The data collected included BCVA and mean macular sensitivities, BCEA, and fixation patterns, performed at baseline and at months 4 and 12, using the MP-1 device. RESULTS The mean total injection number was 5.92 ± 1.18 (minimum 3, maximum 8). Mean BCVA at baseline was 0.55 ± 0.28 logMAR and increased significantly to 0.50 ± 0.33 logMAR. Mean macular sensitivity at baseline was 7.06 ± 4.59 dB and increased significantly to 8.40 ± 4.82. Mean BCEA was 2.19 ± 1.38 deg(2) and decreased significantly to 1.68 ± 1.43 deg(2). Fixation stability patterns, according to the protocol set out by Fujii, did not change significantly during follow-up. CONCLUSIONS Compared with Fujii fixation stability patterns, BCEA correlated better with variations in macular sensitivity and BCVA. BCEA can be added to the traditional parameters used to evaluate the efficacy of intravitreal injections in patients with nAMD.

Effect of basic fibroblast growth factor and cytochrome c peroxidase combination in transgenic mice corneal epithelial healing process after excimer laser photoablation

Purpose: To evaluate the role of prepared basic fibroblast growth factor (bFGF) and cytochrome c peroxidase (CCP) combination eyedrops in corneal epithelial healing of transgenic mice (B6(A)-Rperd12/J) after excimer laser photoablation. Materials and methods: In this prospective study, 216 eyes of 108 mice underwent bilateral photorefractive keratectomy. We considered 4 groups: A, B, C, and D. Group A received standard topical postoperative therapy with tobramycin, diclofenac, and dexamethasone eyedrops plus CCP at 3 drops per day for a week or until corneal re-epithelialization was achieved. Group B received standard topical postoperative therapy plus bFGF eyedrops and phosphate-buffered saline (PBS) 3 drops per day for a week or until corneal re-epithelialization was complete. In group C, 1 eye received standard topical postoperative therapy plus CCP eyedrops, bFGF eyedrops, and PBS 3 drops per day for a week or until corneal re-epithelialization was complete. Control eyes (group D) received a standard topical postoperative therapy plus placebo eyedrops. Mice were followed-up for a week from the day after the surgery to evaluate the rate of corneal re-epithelialization. Results: Data were analyzed by ANOVA using the XLSTAT 2010 software. Eyes in group A, B, and C healed completely before the fifth postoperative day, achieving, respectively, a re-epithelialization time of 92 hours ± 10 SD, 90 hours ± 12 SD, and 86 hours ± 12 SD. Group D had a re-epithelialization time of 121 hours ± 8 SD (P < 0.05). No side effects or toxic effects were documented. Conclusions: Results suggest that re-epithelialization after phototherapeutic keratectomy can benefit from topical therapy with CCP/bFGF combination eyedrops. Further clinical studies are needed to evaluate the long-term effectiveness of these eyedrops to prevent corneal haze.

Effect of Basic Fibroblast Growth Factor in Transgenic Mice: Corneal Epithelial Healing Process after Excimer Laser Photoablation

Purpose: To evaluate the role of preparedbasic fibroblast growth factor (bFGF) eyedrops in corneal epithelial healing of transgenic mice after excimer laser photoablation. Materials and Methods: In our prospective case series, 60 eyes of 30 mice had uneventful bilateral excimer laser photoablation. In each mouse, 1 eye received the standard topical postoperative therapy with tobramicin, diclofenac and dexamethasone eyedrops, plusbFGF eyedrops 5 μg/10 μl PBS 3 times a day for 1 week, or until corneal reepithelialization was complete. The fellow eye served as the control and received the standard postoperative therapy plus placebo. The mice were monitored daily, commencing the day after surgery and for 7 days, in order to evaluate the corneal reepithelialization rate by using a video slitlamp camera with a cobalt blue light. The mean diameter of the corneal wounds was measured. Videotaped images were recorded and analyzed by computer planimetry. Results: All the eyes treated withbFGF eyedrops healed completely before day 5 after surgery, with a mean reepithelialization time of 90 ± 12 h (standard deviation); the mean reepithelialization time was 124 ± 10 h in those eyes receiving placebo. There were no statistically significant differences between the 2 groups in corneal haze presentation during the follow-up, perhaps because the time period was too brief (7 days). However, corneal clarity on slitlamp biomicroscopy was greater in the study group than in the control group. No side effects or toxic effects were documented. Conclusions: These data suggest that the bFGF significantly accelerates epithelial healing after excimer photoablation. A further clinical study should be performed to prove the results obtained in this study as well as the long-term efficacy of bFGF to prevent corneal haze.

Role of cysteine in corneal wound healing after photorefractive keratectomy.

Aims: To evaluate the efficacy of cysteine oral supplements in corneal wound healing after photorefractive keratectomy (PRK). Methods: A total of 200 eyes (100 patients) underwent PRK. We divided patients into 2 groups; each group was composed of 50 patients (100 eyes). Group 1 patients were assigned to use oral L-cysteine, with a daily dose of 200 mg (100-mg pills to be taken twice a day) for a duration of 14 days, starting from the week preceding the operation; the patients in group 2 were used as a control, and received the oral supplementation of 40-mg placebo pills to be taken twice a day for a duration of 14 days, starting from the week preceding the operation. Results: All the eyes of patients treated with cysteine oral supplements showed shorter times to re-epithelization than the eyes of the control group. The mean time of corneal wound healing observed in group 1 was 102 ± 15 h, compared to an average of 159 ± 9 h in group 2. Conclusion: Our research showed that oral cysteine supplementation, in a daily dose of 200 mg, reduces mean corneal wound healing time in patients after PRK.

Predictive Factors For Development Of Neovascular Age-related Macular Degeneration: A Spectral-domain Optical Coherence Tomography Study.

Purpose: To investigate the risk factors predictive for the development of neovascular age-related macular degeneration (NVAMD) by means of spectral-domain optical coherence tomography. Methods: Retrospective study of 73 eyes graded Stage 2 and Stage 3 according to the AMD International Grading System with minimum follow-up of 24 months. Drusenoid pigment epithelial detachment, hyperreflective foci, external limiting membrane, inner ellipsoid band, and retinal pigment epithelium integrity were analyzed at baseline and last follow-up. Binary logistic regression model analyzed significant predictors of neovascular conversion. Results: The discontinuity of external limiting membrane, inner ellipsoid band, and retinal pigment epithelium bands were significantly more prevalent in the NVAMD group at baseline and last follow-up (P < 0.001). Hyperreflective foci represented the single most important predictor of neovascular conversion (Exp [B], 15.15; P = 0.005) as confirmed by Kaplan–Meier curve (P = 0.002). Drusenoid pigment epithelial detachment width was significantly greater in NVAMD group than control subjects at baseline and last follow-up (P < 0.001), and its delta value also resulted a significant neovascular predictor (Exp [B], 0.99; P = 0.04). Conclusion: Hyperreflective foci significantly increase the risk of NVAMD progression. The delta width of drusenoid pigment epithelial detachment also predicts disease progression, integrating the stratification of NVAMD progression risk.

Microperimetric biofeedback in a patient with oculocutaneous albinism

mechanical cross talk, or normal or abnormal extraocularmuscle dynamics. This case report is the first evidence reported to date of the potential applicability and utility of MP in nystagmus. Based on the retinal projection of the fixation pattern, MAIA MP may be useful to quantify the pattern of fixation in nystagmus and to recognize the dominant eye attending to the higher fixation stability value and the comparison of the extent of the ellipse of fixation between eyes. Future studies should evaluate this potential applicability of MP in case series of nystagmus, as well as the agreement with the measurements obtained with video-oculography.

Hess Area Ratio and Diplopia: Evaluation of 30 Patients Undergoing Surgical Repair for Orbital Blow-Out Fracture

Purpose: To determine if the Hess area ratio is effective in predicting postoperative diplopia in patients undergoing surgery for orbital blow-out fracture. Methods: Our retrospective, interventional case series study involved 30 consecutive cases affected by orbital fractures and diplopia undergoing surgical correction within 7 days after injury. To evaluate ocular motility disturbance, we measured the involved ocular motility range by use of a manual Hess screen test before and 4 months after surgery. The percentage of Hess area ratio % was used to express the range of ocular motility in a numerical value. Results: All patients with preoperative Hess area ratio >85% had no postoperative diplopia, and most patients (57%) having a preoperative Hess area ratio <65% had postoperative diplopia. When the Hess area ratio was between 65% and 85%, surgical outcomes were variable and most patients (55%) described no problematic diplopia in the peripheral visual field. Conclusions: The Hess area ratio is a useful procedure to convert Hess graphic representation in a numerical value so that Hess chart data can be compared among clinicians and used to predict surgical outcomes in patients undergoing surgery for orbital blow-out fractures.