R. Meduri

Pseudoexfoliation Syndrome: A Cohort Study on Intraoperative Complications in Cataract Surgery

Our aim was to determine the rate of intraoperative complications induced by pseudoexfoliation syndrome (PSX) in cataract surgery. We report our experience regarding 1,052 consecutive patients who underwent phacoemulsification. Exact logistic regression was used to examine the role of PSX in intraoperative complications. Odds ratio for intraoperative complications (vitreous loss, capsular break, zonular break) was estimated to be 5.1 for PSX present as compared to when it is absent. PSX was associated with a statistically significant increase in intraoperative complications during cataract surgery (p < 0.0001).

Tamoxifen retinopathy: does it really exist?

Abstract · Background: Tamoxifen retinopathy is known to be an adverse effect of high-dose tamoxifen treatment. Evidence of ocular toxicity at lower doses is less convincing: the aim of this study was to assess the prevalence of the above-mentioned retinopathy in a population treated with low-dose tamoxifen. · Methods: One hundred and twenty-nine women treated with low-dose tamoxifen (20 mg/day) were examined. Visual acuity measurement, slit-lamp biomicroscopy and fundus examination were performed. Patients were reexamined after 6–12 months. · Results: Refractile retinal opacities, similar to those previously described as tamoxifen retinopathy, were observed in four patients (prevalence 3.1%; mean duration of therapy 806 days). None of them revealed corneal opacities, papillary and/or macular edema, or visual impairment. The ophthalmoscopic aspect did not change after a mean follow-up of 215 days, although one of these patients had interrupted tamoxifen intake. Statistical analysis (Student’s t-test) did not reveal any difference between patients with and those without refractile retinal opacities as far as age, treatment duration and ERG values were concerned. An early hyperfluorescence, reminescent of cuticular drusen, was demonstrated by fluorescein angiography in all four cases. · Conclusions: The present study would seem to confirm that low-dose tamoxifen may induce retinal toxicity in a low proportion of patients, but we cannot be certain that the refractile retinal opacities observed are really caused by tamoxifen, as differentiation from age-related macular degeneration with cuticular drusen appears nearly impossible.

Capsule contraction after continuous curvilinear capsulorhexis

Abstract We report two cases of capsular bag contraction that occurred within 1 month after continuous curvilinear capsulorhexis, phacoemulsification, and intraocular lens implantation. Neither patient had a known risk for this complication. Both patients had a neodymium:YAG laser anterior capsulotomy, which disrupted the capsulorhexis margin and led to prompt capsular bag distension.

Argon laser vs. subthreshold infrared (810-nm) diode laser macular grid photocoagulation in nonexudative age-related macular degeneration

BACKGROUND A diode laser can be used to create a subthreshold (invisible end point) lesion in patients with age-related macular degeneration (AMD). This has the potential benefit of localizing the treatment effect to the retinal pigment epithelium and sparing more of the overlying sensory retina. We performed a study to compare the safety and efficacy of argon laser and subthreshold infrared (810-nm) diode laser macular grid photocoagulation in reducing the number of drusen in patients with AMD. METHODS We reviewed the charts of 144 patients with bilateral early-stage nonexudative AMD, characterized by soft drusen. One eye of each patient was treated, and the other eye served as a control. Seventy-eight eyes of 78 patients with a mean age of 67.5 (standard deviation [SD] 8.3) years underwent argon laser macular grid photocoagulation at a university-affiliated hospital in Bologna, Italy, and 66 eyes of 66 patients with a mean age of 66.4 (SD 6.3) years underwent subthreshold infrared (810-nm) diode laser macular grid photocoagulation at a private clinic in Bologna. Each group was classified into three subgroups based on the number of drusen (more than 20, 10 to 20, or less than 10). The patients underwent fluorescein angiography, fundus examination, measurement of far (Snellen chart) and near (Jaeger chart) best corrected visual acuity, and visual field and contrast sensitivity testing. The mean length of follow-up was 18 (SD 0.5) months. RESULTS At 18 months, far and near best corrected visual acuity were statistically significantly improved in the treatment groups compared with the untreated group (p < 0.001, Mann-Whitney U test). There was no significant difference in visual acuity between the treatment groups. Compared with baseline, the number of drusen was significantly reduced in both treatment groups (p < 0.001). Evolution of the disease was observed in the untreated group. The visual field was slightly but significantly reduced after argon laser treatment (p < 0.001) but not diode laser treatment; the difference in visual field between the two groups was not significant. There was a slight reduction in contrast sensitivity, particularly with night vision, after argon laser treatment but not diode laser treatment. The difference between the two treatment groups was significant (p < 0.01). INTERPRETATION Subthreshold infrared diode macular grid photocoagulation may be a safe and viable method for preventing progression of nonexudative AMD.

Efficacy of transfer factor in treating patients with recurrent ocular herpes infections

Recurrent ocular herpes is an insoluble problem for the clinician. As cellular immunity plays an important role in controlling herpes relapses, and other studies have shown the efficacy of HSV-specific transfer factor (TF) for the treatment of herpes patients, an open clinical trial was undertaken in 134 patients (71 keratitis, 29 kerato-uveitis, 34 uveitis) suffering from recurrent ocular herpetic infections. The mean duration of the treatment was 358 days, and the entire follow-up period 189121 before, and 64062 days after TF treatment. The cell-mediated immune response to the viral antigens, evaluated by the lymphocyte stimulation test (LST) and the leucocyte migration test (LMT) (P<0.001), was significantly increased by the TF treatment. The total number of relapses was decreased significantly during/after TF treatment, dropping from 832 before, to 89 after treatment, whereas the cumulative relapse index (RI) dropped, during the same period, from 13.2 to 4.17 (P<0.0001). No side effects were observed. It is concluded that patients with relapsing ocular herpes can benefit from treatment with HSV-specific TF.

Bilateral serous retinal detachments following organ transplantation.

Purpose The authors report the physiopathogenetic features of bilateral serous neurosensory retinal detachments occurring in patients who have undergone organ transplantation. Methods The clinical and photographic findings of four patients who have undergone renal (3 cases) and liver (1 case) transplantation in whom bilateral serous retinal detachment developed early after surgery were reviewed. The patients were processed for clinical symptoms, visual acuity evaluation, slitlamp and fundus examinations, tonometry and fluorescein angiography. Results Ocular examination, in patients complaining of blurred vision and metamorphopsia, revealed loss of visual acuity, bullous serous neurosensory retinal detachment with retinal pigment epithelial detachments in fundus examination and areas of dye leakage in fluorescein angiography, despite tonometry and slitlamp examination were unremarkable. These alterations were spontaneously resolved with the normalization of renal function. Conclusion The only common factor in each of the four patients resulted in alterations of the kidney function. This finding provides further evidence that renal failure may cause alterations in electrolytes extracellular distribution, leading to the formation of serous neurosensory retinal detachments.

A new method for determining the blood quantity in the eye in a unit of time

A new method for semiquantitatively determining the blood flow in the eye, in a unit of time is described. The principles of rheography with “infinite time constant” are utilized. After applying a suction cup electrode mechanism, by gradual increases of the vacuum, ocular pressure rises above venous pressure, and without modification of arterial inflow, the venous outflow is blocked; in consequence an increase of blood accumulation in the interior of the eye occurs. The electrical impedance variation, as a result of the latter, gives the recorded tracing a “slow” rising curve, that maintains the same pulse morphology. After being analyzed and elaborated on with certain mathematical formulae, this curve makes it possible to calculate the blood flow in the eye in a unit of time. Statistics on normal patients of various ages are reported. Es wird eine neue Methode für die quantitative Bestimmung der in der Zeiteinheit das Auge durchströmenden Blutmenge beschrieben. Zu diesem Zweck wurden die Prinzipien der Rheographie mit „unendlicher Zeitkonstante“ angewandt. Nach dem Aufsetzen einer mit Elektroden ausgestatteten Saugschale und allmählicher Vergrößerung des Vakuums wurde der Augendruck so erhöht, daß er den des venösen Blutdrucks überstieg. Damit blockierte man den venösen Abfluß, während der arterielle Zufluß unverändert blieb, was ein Anwachsen der Blutdicke im Inneren des Auges zur Folge hatte. Die Veränderung der elektrischen Impedanz, als Folge der größeren Blutdicke, war in der graphischen Darstellung von einer „langsam“ ansteigenden Kurve gekennzeichnet. Diese Kurve wurde mittels einer besonderen mathematischen Formel analysiert und ausgewertet und gestattete es, quantitative Daten über die in der Zeiteinheit in das Auge einfließenden Blutmenge zu ermitteln. Darstellung der ersten Untersuchungen an normalen Augen bei normalen Individuen verschiedener Altersklassen.

Effect of cytochrome c peroxidase on corneal epithelial healing process after photorefractive keratectomy

PURPOSE: To evaluate the role of commercially prepared cytochrome c peroxidase eyedrops in corneal epithelial healing after photorefractive keratectomy (PRK). SETTING: Department of Pathophysiological Optics, Faculty of Medicine, University of Bologna, Bologna, Italy. METHODS: Seventy‐two eyes of 36 patients affected by low to moderate refractive error (myopia and myopic astigmatism) had uneventful bilateral photorefractive keratectomy (PRK). In each patient, 1 eye (32 eyes) received standard postoperative therapy plus cytochrome c peroxidase eyedrops (3 times a day for 1 week or until corneal reepithelialization was completed, corresponding to 15 000). The fellow eye served as the control and received standard postoperative therapy plus placebo. Patients were monitored daily starting the day after surgery for 7 days to evaluate the corneal reepithelialization rate using a video slitlamp camera with a cobalt blue light. Mean diameter of corneal wounds was measured. Videotaped images were recorded and analyzed by computer planimetry. RESULTS: All the eyes treated with cytochrome c peroxidase eyedrops healed completely before day 5 postsurgery, with a mean reepithelialization time of 91 hours ± 14 (SD); the mean reepithelialization time was 154 ± 9 in eyes receiving placebo (P<.05); the mean reepithelialization rate was 0.066 ± 0.007 mm/hour in the cytochrome c peroxidase group and 0.039 ± 0.006 mm/hour in the control group (P<.05). There were no statistically significant differences between groups in corneal haze presentation during follow‐up (P =.70), perhaps because the time period was too brief (7 days). However, corneal clarity, on slitlamp biomicroscopy in the study group was greater than in the control group. No side effects or toxic effects were documented. CONCLUSIONS: These data suggest that cytochrome c peroxidase significantly accelerates epithelial healing after PRK. Further clinical study should be performed to prove the results obtained in this pilot study and the long‐term efficacy of cytochrome c peroxidase to prevent corneal haze.

Implantation and capsular bag stability of single-piece, foldable easacryl 1 intraocular lenses

Purpose: To assess the folding and implantation of the single‐piece EasAcryl 1 intraocular lens (IOL) and the maintenance of the tunnel structure and capsular bag stability after implantation. Setting: S. Orsola Hospital Department of Pathophysiologic Optics, University of Bologna, Bologna, Italy. Methods: This study comprised 300 cases of EasAcryl 1 IOL implantation. First, a 3.2 mm corneal incision was made according to preoperative astigmatism followed by a 5.5 mm ± 0.3 (SD) capsulorhexis. After sutureless phacoemulsification using a venturi pump, the 6.0 mm optic, 11.0 mm diameter IOL was implanted using a hexagonal cartridge. The IOLs were implanted using a 2‐step maneuver when the superior haptic was grasped with the forceps (first case) or a 1‐step maneuver when only the Microsert injector was used. The cartridge was never pushed beyond the tunnel. The preoperative and postoperative incision size and the corneal surgically induced astigmatism were recorded. The IOL rotation was measured 30 ± 5 days and 8 ± 1 months postoperatively. Results: No intraoperative complications occurred after the learning curve. No alteration in astigmatism was observed. The mean IOL rotation was 1.04 ± 0.5 degrees at 30 ± 5 days and 1.02 ± 0.2 degrees at 8 ± 1 months. Conclusions: The EasAcryl 1 was easily implantation through a 3.2 mm tunnel without altering the natural architecture. The unfolding of the IOL was well controlled, and the IOL remained well centered. A short learning curve is required.

Effect of Cysteine in Transgenic Mice on Healing of Corneal Epithelium after Excimer Laser Photoablation

Purpose: To evaluate the role of prepared cysteine per os in corneal epithelial healing in transgenic mice (B6(A)-Rpe65rd12/J) after excimer laser photoablation. Materials and Methods: In our prospective case series, 60 eyes of 30 mice had uneventful bilateral excimer laser photoablation. A first group, composed of 15 mice, received standard topical post-operative therapy with tobramycin, diclofenac and dexamethasone eyedrops, pluscysteine 5 mg 5 μg/10 μl phosphate-buffered saline (3 times a day for 1 week) per os or until corneal re-epithelialization was complete. The control group of 15 mice received standard post-operative therapy plus placebos. The mice were monitored daily, commencing the day after surgery, for 7 days to evaluate the corneal re-epithelialization rate using a video slit-lamp camera with a cobalt blue light. The mean diameters of corneal wounds were measured. Videotaped images were recorded and analysed by computer planimetry. Results: All the eyes of the mice treated withcysteine healed completely by day 5 after surgery, with a mean re-epithelialization time of 92 ± 10 h (SD); the mean re-epithelialization time was 125 ± 8 h in eyes that received the placebo. There were no statistically significant differences between the 2 groups in corneal haze presentation during follow-up, perhaps because the time period was too brief (7 days). However, corneal clarity in the study group was greater than in the control group, as shown on slit-lamp biomicroscopy. No side effects or toxic effects were documented. Conclusions: These data suggest that cysteine significantly accelerates epithelial healing after excimer photoablation. A further clinical study should be performed to confirm the results obtained in this study, and the long-term efficacy of cysteine in preventing corneal haze.