S. Lupo

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.

Efficacy of intravitreal triamcinolone acetonide in long standing diabetic macular edema: a microperimetry and optical coherence tomography study.

Purpose: To investigate the efficacy of intravitreal triamcinolone acetonide in patients suffering from diffuse long standing diabetic macular edema, by the assessment of retinal thickness and retinal function by means of optical coherence tomography (OCT) and microperimetry-1. Methods: Twenty eyes received 8 mg in 0.2 mL preservative free intravitreal triamcinolone injection delivered through the pars plana. The best corrected visual acuity (BCVA), foveal thickness, and the average retinal sensitivity of the 45 stimuli were considered in our study. Patients were instructed to attend for OCT and microperimetry-1 follow-up at baseline, 1, 3, and 6. Results: At the baseline, mean macular thickness was 692&mgr; ± 70&mgr;; mean visual acuity was 0.13 ± 0.09. Mean macular sensitivity determined with the microperimetry-1 was 6.85 dB ± 2.1 dB. At the 1 month follow-up, mean OCT macular thickness decreased to 348.28&mgr; ± 132.10&mgr; (P = 0.0001); mean BCVA improved to 0.23 ± 0.15 (P = 0.019); mean retinal sensitivity improved to 8.71 dB ± 2.79 dB (P = 0.03). At the 3 months follow-up, mean OCT macular thickness changed to 363.7&mgr; ± 123.52&mgr; (P = 0.0002); mean BCVA was 0.23 ± 0.15 (P = 0.0024); mean retinal sensitivity 8.54 dB ± 2.78 dB (P = 0.048). Six months after the injection, mean OCT macular thickness was 460.61&mgr; ± 104.9&mgr; (P > 0.05); mean BCVA was 0.15 (P > 0.05); mean retinal sensitivity 7.54 dB ± 2.58 dB (P > 0.05). Conclusion: In our study, we found intravitreal effective in improving BCVA, macular thickness, and retinal sensitivities during the first 3 months. At 6 months, follow-up of the data were not dissimilar to those obtained at baseline. Further investigation is warranted to asses the correlation among daily life visual performance, retinal sensitivities, and macular thickness.

Standard Enucleation with Aluminium Oxide Implant (Bioceramic) Covered with Patient's Sclera

Purpose. We describe in our study a modified standard enucleation, using sclera harvested from the enucleated eye to cover the prosthesis in order to insert a large porous implant and to reduce postoperative complication rates in a phthisis globe. Methods. We perform initially a standard enucleation. The porous implant (Bioceramic) is then covered only partially by the patients sclera. The implant is inserted in the posterior Tenons space with the scleral covering looking at front. All patients were followed at least for twelve months (average followup 16 months). Results. We performed nineteen primary procedures (19 patients, 19 eyes, x M; x F) and secondary, to fill the orbital cavity in patients already operated by standard evisceration (7 patients, 7 eyes). There were no cases of implant extrusion. The orbital volume was well reintegrated. Conclusion. Our procedure was safe and effective. All patients had a good cosmetic result after final prosthetic fitting and we also achieved good prothesis mobility.

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 the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia

BACKGROUND This study sought to evaluate the effect of basic fibroblast growth factor eye drops and cysteine oral supplements on corneal healing in patients treated with photorefractive keratectomy (PRK). MATERIALS AND METHODS One hundred and twenty patients treated bilaterally with PRK for myopia were enrolled at one of two eye centers (Clinica Santa Lucia, Bologna, Italy and Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy) and were treated at the former center. Sixty patients included in the study group (Group 1) were treated postoperatively with topical basic fibroblast growth factor plus oral L-cysteine supplements, whereas 60 subjects included in the control group (Group 2) received basic fibroblast growth factor eye drops. We recorded the rate of corneal re-epithelialization and patients were followed-up every 30 days for 6 months. Statistical analyses were performed on the collected data. RESULTS The eyes in Group 1 demonstrated complete re-epithelialization at Day 5, whereas the eyes in Group 2 achieved this status on Day 6. No side-effects were reported. CONCLUSIONS Patients treated with basic fibroblast growth factor eye drops and L-cysteine oral supplements benefit from more rapid corneal re-epithelialization. In human eyes, this combination treatment appeared to be safe and effective in accelerating corneal surfacing after surgery. FINANCIAL DISCLOSURE No author has any financial or proprietary interest in any material or method used in this study. TRIAL REGISTRATION Current Controlled Trials ISRCTN73824458.