Sandro Saviano

Grid laser treatment in macular branch retinal vein occlusion

Abstract · Background: Macular branch retinal vein occlusion (MBRVO) is a subgroup of branch retinal vein occlusion in which the occlusion is limited to a small venous vessel draining a sector of the macular region. The present study aimed to evaluate prospectively whether grid laser treatment is useful in improving the visual acuity of eyes affected by MBRVO with significant macular edema. · Methods: Ninety-nine patients affected by MBRVO of recent onset were prospectively studied during a 24-month period; eyes were randomly assigned to the control group, the early grid laser treatment group or the delayed grid laser treatment group. Clinical and angiographic features were recorded during the whole follow-up; parameters such as visual acuity and macular edema were carefully evaluated, the latter even by means of stereophotography. · Results: With respect to the baseline mean visual acuity values, a statistically significant improvement was noted at the 3-month follow-up and at the 1-year follow-up . No additional improvement was noted at the 2-year follow-up. No statistically significant difference was found between the treated groups and the control group. · Conclusions: We hypothesize that the abrupt ischemic damage subsequent to MBRVO is the main factor causing the central function impairment. Grid laser treatment is not able to reduce the macular edema more than the natural evolution, and does not improve visual acuity.

Carotenoids in Age-related maculopathy Italian study (CARMIS): Two-year results of a randomized study

Purpose The high concentration of carotenoids in the macula, plus evidence linking oxidative stress to age-related macular degeneration (AMD) and carotenoids to antioxidation, generated the hypothesis that higher antioxidant intakes can prevent AMD. The aim of this study was to determine whether nutritional supplementation with a targeted nutritional supplement improves visual acuity and visual function in AMD. Methods In this multicenter, prospective open-label randomized study, 145 patients were randomly assigned to 2 different treatment groups. Interventions were lutein (10 mg), zeaxanthin (1 mg), astaxanthin (4 mg; AZYR SIFI, Catania, Italy), and antioxidants/vitamins supplementation formula or no dietary supplementation for 2 years. Primary outcome was mean changes in visual acuity (VA) at 12 and 24 months. Other measures included contrast sensitivity (CS) and National Eye Institute visual function questionnaire (NEI VFQ-25) scores at 12 and 24 months. Results Patients in the treated group showed stabilization of VA with significantly (p=0.003) better VA scores (81.4±7.2) compared to the nontreated group (76.8±8.9) at 24-month follow-up. An improvement in CS (p=0.001) and final mean NEI VFQ-25 composite scores at 12 and 24 months higher in treated group compared to nontreated group were also shown (p<0.001). Conclusions Patients treated with lutein/zeaxanthin and astaxanthin together with other nutrients were more likely to report clinically meaningful stabilization/improvements in VA, CS, and visual function through 24 months compared with nontreated subjects. Further studies are needed with more patients and for longer periods of time.

Grid laser treatment of macular edema in macular branch retinal vein occlusion

Aim: Macular branch retinal vein occlusion (MBRVO) is a subgroup of branch retinal vein occlusion in which the occlusion is limited to a small venous vessel draining a sector of the macular region. The present study aims to evaluate the efficacy of grid laser treatment for macular edema in MBRVO. Methods: 77 Patients with MBRVO of recent onset were prospectively studied during a 24 month period. Eyes were randomly assigned to a grid laser treatment group and to a control group. Clinical parameters such as visual acuity, presence of macular edema and angiographic features were recorded during the follow-up period. Results: Visual acuity increased significantly in both groups after 3 months of follow-up (p<0.001) and after 1 year of follow-up (p<0.005). No additional improvement was noted at the two year control. There was no statistical difference between the two groups. Conclusions: The visual prognosis of MBRVO is not improved after grid laser treatment of macular edema. This suggests that sudden ischemic damage to central photoreceptors rather than macular edema is the main factor for permanent visual acuity reduction.

Photodynamic therapy of subfoveal recurrences after laser photocoagulation of extrafoveal choroidal neovascularization in pathologic myopia

BackgroundPhotodynamic therapy with verteporfin (Visudyne; Novartis, Bülach, Switzerland) has been proposed for the treatment of subfoveal choroidal neovascularization secondary to pathologic myopia. We retrospectively evaluated the effects of verteporfin therapy of subfoveal recurrences of extrafoveal myopic CNV previously treated with thermal laser photocoagulation.MethodsTwelve eyes, previously treated with thermal laser photocoagulation for extrafoveal choroidal neovascularization, received photodynamic therapy with verteporfin for subfoveal recurrence of choroidal new vessels. Thirteen eyes that did not receive photodynamic therapy served as control group. Vision and fluorescein angiography outcomes were analyzed on all study visits (every 3 months) through month 12. Visual acuity was measured in Snellen lines.ResultsOn average, at the month 12 examination the verteporfin-treated group had gained 2 lines and the untreated group had lost 1 line of vision. Eleven eyes of the verteporfin-treated group compared with nine eyes of the untreated group lost fewer than 3 lines of vision, including four eyes versus none improving at least 1 line of vision.ConclusionPhotodynamic therapy with verteporfin might increase the chance of stabilizing or improving vision in patients with subfoveal recurrences of extrafoveal myopic CNV previously treated with thermal laser photocoagulation. A prospective, randomized study on larger series of patients is mandatory.

IRIS ARTERIOVENOUS COMMUNICATION : CLINICAL AND ANGIOGRAPHIC FEATURES

Background: Iris arteriovenous communication (IAVC) represents a quite rare congenital anomaly, consisting of abnormal vascular connection bypassing the iris capillary bed. The aim of the present study is to describe clinical and angiographic pattern of IAVC on iris fluorescein angiography (IFA) and on indocyanine green videoangiography (IICGV). Methods: During a mean follow-up period of 33.5 months, eight patients affected by IAVC underwent at least three ophthalmological examinations completed by IFA and IICGV. Results: IFA allows the detection of IAVC vascular structures, evidencing afferent and efferent branches, which show a rapid filling, without any evidence of leakage or iris hypoperfusion. IICGV shows more precisely the entire vascular pattern of IAVC, revealing also the presence of iris hypoperfusion in the sector in which the IAVC lay. One patient underwent cataract surgery; three months later, two neovascular tufts appeared in the hypoperfused area related to IAVC. In all other patients, periodical examinations did not reveal any clinical or angiographic changes. Conclusion: In IAVC, the clinical picture appears stable throughout the follow-up; both angiographic techniques seem able to precisely delineate the vascular pattern. Nevertheless, IICGV is superior in showing iris hypoperfusion surrounding the vascular abnormality. Particular care must be drawn to patients affected by IAVC who need cataract surgery.

Branch retinal vein occlusion and macroaneurysms

Background: Macroaneurysms can represent common consequences of branch retinal vein occlusion(BRVO). The aim of the present study is to evaluate the clinical and angiographic aspects of 31 cases of branch retinal vein occlusions (BRVO) in which retinal macroaneurysms developed, in an attempt to analyze their pathogenic features. Methods: One hundred and sixty-one consecutive patients affected by BRVO were considered. Each patient underwent an ophthalmological examination including fluorescein angiography, at an average interval of two months (range: 1–4 months) from the onset of the disease, with a mean follow-up of 43months (range: 32–56 months). The macroaneurysms were subdivided according to size into small (from 100 to149 microns), medium (from 150 to 249 microns), and large (greater than 250 microns), and according to origin into arterial, venous, capillary and collateral-associated. Results: Thirty-one patients (19.3%) developed retinal macroaneurysms. The total number of detected macroaneurysms was 51; ten (19.6%) were large, 21(41.2%) were of medium-size and 20 (39.2%) were small in dimension. Three lesions were of arterial origin, 22 were capillary and 26 were from collateral vessels. In27 patients (87.1%) the lesions were located outside the macular region, and in 4 patients (12.9%) in the macular region. Patients with retinal macroaneurysms did not show a different prevalence of capillary non-perfusion when compared with others. With regard to the number of retinal venous collaterals patients with macroaneurysms developed fewer than other patients, and the difference was statistically significant (p < 0.001). Conclusion: The insufficient number of retinal venous collaterals can be considered the most contributory factor in the development of macroaneurysms secondary to BRVO.

Iris fluorescein angiography and iris indocyanine green videoangiography in pseudoexfoliation syndrome

Background Precise evaluation of the iris vascular pattern in pseudoexfoliation syndrome (PXS) may be difficult with iris fluorescein angiography (IFA) because of the frequent presence of a heavily pigmented iris and conspicuous late leakage. However, iris indocyanine green videoangiography (IICGV) can precisely visualize details of the iris vascular pattern. This study analyzed the utility of IICGV in detecting microvascular changes in PXS and compared these findings with those of IFA. Methods Twenty-eight patients with PXS in both eyes underwent an ophthalmic examination including IFA and IICGV. IICGV was done with the IMAGEnet system H1024. Results IICGV gave better visualization of iris hypoperfusion and anastomotic vessels whereas iris microneovascularisation was far more clearly visible on IFA. IICGV also detected iris pigment epithelium defects. Conclusions IICGV can be considered a useful tool for evaluation of the iris vascular pattern in PXS. Iris hypoperfusion did not appear to contribute to the development of iris microvascular changes.

Subretinal fluid ferning test in rhegmatogenous retinal detachment

Purpose The ferning test involves a process of crystallization achieved simply by removing water and is feasible for all ocular fluids. The ferning test of subretinal fluid (SRF) from patients with rhegmatogenous retinal detachment (RRD) reveals three different patterns: type 1 showing thin crystals, type 2 with larger crystals and type 3 with small, curvilinear structures with no tree-like appearance. The present study was designed to determine whether the SRF ferning test is correlated with the clinical features and the surgical outcome of RRD. Methods A series of 65 consecutive patients with RRD at the first onset were considered. Particular attention was paid to duration, extension, and surgical outcome of RRD. SRF samples were collected during scleral buckling surgery. The fluid was dropped onto the slide of a light microscope, left to dry, and examined under the microscope. Results There was a significant difference between SRF ferning types 1 and 2 as regards duration and extension (both p < 0.001). There was also a significant difference between SRF ferning types 2 and 3 as regards duration (p<0.001), extension (p<0.001), and surgical outcome (p<0.05). Conclusions The ferning test of SRF is quick and simple and can be regarded as a useful tool for obtaining information about clinical features, such as duration or extension of first onset in uncomplicated cases of RRD especially for purposes of forensic medicine.

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

Abstract Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.

Detection of recurrent choroidal neovascularization in age-related macular degeneration: comparison of clinical examination, fluorescein angiography and indocyanine green videoangiography

Several reports and clinical trials have assessed the efficacy of laser treatment in selected cases of choroidal neovascularization (CNV) in age-related macular degeneration (AMD)1-3. However, in spite of laser photocoagulation, more than 50% of treated eyes develop persistent or recurrent CNV within 3 years after treatment4,5. Consequently, in order to identify as soon as possible the recurrence and to prevent a severe visual loss, there is a general agreement on the opportunity to perform frequent post-treatment clinical and instrumental examinations.