Raffaele Turano

Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma

OBJECTIVE To evaluate the effect of Ginkgo biloba extract (GBE) on preexisting visual field damage in patients with normal tension glaucoma (NTG). DESIGN Prospective, randomized, placebo-controlled, double-masked cross-over trial. PARTICIPANTS Twenty-seven patients with bilateral visual field damage resulting from NTG. INTERVENTION Patients received 40 mg GBE, administered orally, three times daily for 4 weeks, followed by a wash-out period of 8 weeks, then 4 weeks of placebo treatment (identical capsules filled with 40 mg fructose). Other patients underwent the same regimen, but took the placebo first and the GBE last. Visual field tests, performed at baseline and at the end of each phase of the study, were evaluated for changes. MAIN OUTCOME MEASURES Change in visual field and any ocular or systemic complications. RESULTS After GBE treatment, a significant improvement in visual fields indices was recorded: mean deviation (MD) at baseline versus MD after GBE treatment, 11.40 +/- 3.27 dB versus 8.78 +/- 2.56 dB (t = 8.86, P = 0.0001, chi-square test); corrected pattern standard deviation (CPSD) at baseline versus CPSD after GBE treatment, 10.93 +/- 2.12 dB versus 8.13 +/- 2.12 dB (t = 9.89, P = 0.0001, chi-square test). No significant changes were found in intraocular pressure, blood pressure, or heart rate after placebo or GBE treatment. Any ocular and systemic side effects were recorded for the duration of the trial. CONCLUSIONS Ginkgo biloba extract administration appears to improve preexisting visual field damage in some patients with NTG.

Gonioscopic findings in patients with type 1 neurofibromatosis (Von Recklinghausen disease).

Purpose:Based on the known neurocristopathic etiology of type 1 neurofibromatosis (NF1) and the neuroectodermal embryologic derivation of the iridocorneal angle, we examined a sample of young patients affected with NF1 to see if they have evidence of underdevelopment of the angular region. Patients and Methods:We designed a case-controlled clinical study. Forty-two consecutive patients (42 eyes), 24 male and 18 female, affected with NF1 were recruited for the study. Forty-two eyes of 42 consecutive young patients (19 male and 23 female) served as a control group for the iridocorneal angle features studied. Indirect gonioscopy was performed by the means of a Goldmann lens. The intraocular pressure was measured with a Goldmann applanation tonometer. Photographs were taken of the anterior segment and of all the four quadrants of the iridocorneal angle to record the presence of abnormalities. The iridocorneal angle was graded according to the classification proposed by Spaeth. Evaluation of the angle also included the gonioscopic width of ciliary body band (CBB). Results:In this study we found that 29 of 42 eyes (69%) of the NF1 group had mild anteriorization, even if within normal limits, of the iris insertion and abundant basal iris processes. The CBB was either invisible (54.84%) or very narrow (21.4%). Three NF1 patients had bilateral juvenile congenital glaucoma. Conclusions:It seems that patients affected with NF1 often have characteristic gonioscopic findings consistent with underdevelopment of the iridocorneal angle.

Comparison of Smartphone Ophthalmoscopy With Slit-Lamp Biomicroscopy for Grading Vertical Cup-to-Disc Ratio.

Purpose of the Study:The purpose of the study was to determine the agreement between smartphone ophthalmoscopy and slit-lamp indirect biomicroscopy when assessing vertical cup-to-disc ratios (VCDRs). Materials and Methods:This was a clinical-based, prospective, comparative instrument study performed in 110 patients with ocular hypertension (OH) or primary open angle glaucoma (POAG). Patients underwent estimation of VCDR by undilated smartphone ophthalmoscopy and slit-lamp biomicroscopy by 2 masked glaucoma specialists. Results:The differences between the mean VCDR estimations obtained by each techniques were not statistically significant. Overall exact agreement between the 2 modalities was found in 21 of 29 eyes (72.4%; simple &kgr;=0.63, confidence interval, 0.52-0.73, P<0.001) in POAG patients and in 52 of 78 eyes (66.7%) in OH patients. The optic nerve head was not gradable with smartphone ophthalmoscopy in 1 eye with POAG and in 2 eyes with OH because of media opacities and/or small pupil diameter. Conclusions:Smartphone ophthalmoscopy showed substantial agreement with slit-lamp examination for the estimation of the VCDR. The ubiquitous diffusion of the smartphones, together with their connectivity and portability features, enables an extensive benefit for this technology to be used in glaucoma screening, especially in low-resource settings.

Arteriolar Diameters in Glaucomatous Eyes with Single-Hemifield Damage.

Purpose To examine the association between retinal arteriolar caliber and lumen, retinal sensitivity (RS), and retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes with single-hemifield loss. Methods We conducted a prospective, nonrandomized, case-control study of 20 eyes of 20 patients with glaucoma with visual field damage confined to a single hemifield. The control group was composed of 20 eyes of 20 normal subjects. For all the eyes, we performed optical coherence tomography to assess the RNFL and standard automated perimetry to evaluate RS. External and internal arteriolar diameters were assessed in vivo using scanning laser Doppler flowmetry. Results The RNFL was significantly thinner in glaucomatous eyes than in normal eyes (p < 0.001). In glaucomatous eyes, a positive correlation between sectorial RNFL thickness and the corresponding external and internal arteriolar diameters was found (r = 0.43, p = 0.05; r = 0.63, p = 0.003, respectively). The internal arteriolar diameter significantly correlated with RS in the corresponding abnormal hemifield (r = 0.44, p = 0.04). Compared with the normal hemifield, the internal arteriolar diameter, RNFL thickness, and RS were significantly reduced, whereas the external arteriolar diameter was unchanged in the abnormal hemifield. Conclusions In glaucomatous eyes with single-hemifield damage, attenuation of retinal vessels was associated with a thinner RNFL and reduced RS. Moreover, a narrower lumen with increased wall-to-lumen ratio was found in the abnormal hemifield, supporting the hypothesis that vessel narrowing is likely secondary to a lower demand for blood flow in the glaucomatous areas of the retina.

Combination of ranibizumab and indomethacin for neovascular age-related macular degeneration: randomized controlled trial

Purpose The aim of this study was to evaluate whether indomethacin eye drops and intravitreal ranibizumab (IVR) injections would provide additional benefit over ranibizumab alone in the treatment of choroidal neovascularization (CNV). Participants and methods This was a randomized, prospective pilot study of eyes with new-onset CNV. Fifty-eight patients were randomized 1:1 into a ranibizumab monotherapy (RM) group and a ranibizumab plus indomethacin (RI) group. All patients received monthly 0.5 mg IVR injections for 3 months, followed by monthly injections administered as needed. RI group patients also self-administered one drop of 0.5% indomethacin three times a day for 12 months. All patients were followed up for 12 months. Results At 12 months, both groups showed significant improvement in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). The mean BCVA change from baseline to 12 months was −0.12±0.04 LogMAR and −0.20±0.04 LogMAR in the RM and RI groups, respectively, with the degree of change being significantly different between the two groups (P=0.04). At 12 months, the mean CRT in the RM group (316±41.2 µm) was significantly higher than that in the RI group (287±31.5 µm; P=0.004). The mean required number of IVR injections was 7.38±0.78 and 6.34±0.67 in the RM and RI groups, respectively (P<0.001). Conclusion Compared to IVR monotherapy, combination therapy with indomethacin eye drops and IVR provides superior anatomical and visual outcomes in patients with naive CNV lesions. Moreover, topical indomethacin might reduce the frequency of IVR injections, which is very beneficial considering the chronic and expensive nature of IVR therapy.