Ocular motility alterations in orbital fractures: pre-post evaluation in maxillofacial surgical treatment.

PURPOSE: The study aims to investigate the ability of maxillofacial surgery to reduce strabismus and improve ocular clinical symptomatology in patients with fracture of the medial or lateral floor of the orbit, or both, and to evaluate such abilities relative to the temporal distance between trauma and surgery. PATIENTS AND METHODS: 25 patients with traumatic diplopia were evaluated by CT, Goldman manual field of view, Hess-Lancaster test, eye examination and orthoptic examination, before and after surgery. RESULTS: We observed: a statistically significant reduction of the deviation angle, both from close and long distance (P = 0.0054 and P = 0.0051 respectively) with a 38% reduction of the deviation from short distance and 54% from afar; a regression of diplopia in 20% of the surgically treated cases (CL from 0 to 39%), significant at the Mc Nemar test; a negative correlation with the time elapsed between the onset of the fracture and maxillofacial surgery (R = -0.26), even if the analysis did not show a statistical significance of the data (P = 0.2). However, it is evident that the maximum improvement is observed only in cases operated within 5 months of the trauma, while the failures (worsening or persistence of diplopia) were observed only in the cases operated later. CONCLUSION: We can state that the intervention reduces strabismus and improves ocular symptomatology, as it statistically significantly reduces cases of diplopia; furthermore, it would seem preferable to intervene early, especially when damage to a muscular structure is suspected, even if the data do not allow definitive conclusions in this regard.

Peribulbar anesthesia in sclero-retinal surgery: two quadrants vs single injection.

PURPOSE: To evaluate the advantage of peribulbar anesthesia in two quadrants (infero-temporal and upper nasal) vs single injection technique (infero-temporal) for scleral rhegmatogenous retinal detachment surgery (RRD). PATIENTS AND METHODS: 57 patients, aged between 33 and 75 years (57.01 ± 8.68), waiting for retinal detachment surgery, were randomized in two groups: a group S (29 patients), with single quadrant injection technique and a group C (28 patients) with two quadrants injection. Patients in Group S were injected in two quadrants with a 10 ml mixture containing Mepivacaine 2% 5 ml and Ropivacaine 0.75% 5 ml, with hyaluronidase 10 IU/ ml. Patients in group C were injected with the same anesthetic mixture in one quadrant. Number of additional injection, during surgery, in two groups, were reported. Pain was tested with VAS (Verbal Analogue Scale 0-10) after regional block, when muscles were insulated, during scleral buckling positioning, when conjunctive was closed and 6, 12, 24 hours after surgery. RESULTS: The need for a second peribulbar injection of anesthetic occurred in 9 patients of group C (32.14%); further injection was necessary in 1 patient (3.57%) of group S during scleral buckling (VAS = 7), statistically significant (p <0.05). Postoperative VAS 6 - 12 - 24 hours after surgery was not significant. CONCLUSIONS: The peribulbar anesthesia may be proposed in scleral surgery of retinal detachment; the injection in two quadrants secured solid and satisfactory anesthesia, increasing the outcome of retinal surgery in loco-regional anesthesia.

Inferior Oblique Weakening and Abnormal Head Position: Controlled Myotomy versus Recession.

Purpose. Randomized controlled trial aimed at comparing surgical outcomes in a group of patients suffering from hyperfunction of the inferior oblique (IO) muscle with abnormal head position (AHP). The surgical techniques being compared are Recession and (thread) Controlled Myotomy. Materials and Methods. The group of 20 patients suffering from medium-high hyperfunction of the IO was assessed through an ophthalmological and orthoptic examination. 10 patients underwent traditional Recession (Group A) and 10 were treated with Controlled Myotomy (Group B). Results. The average age was 19 years ± 10.7 SD. After 1 year, 20% of Group A showed a small Vertical Deviation associated with a small AHP, while 80% had orthophoria and 40% of them had a small AHP. 80% of Group B showed a small Vertical Deviation associated with an equally small AHP, while 20% had orthophoria with a full resolution of AHP. Conclusion. Based on the results obtained and the fewer intrasurgical risks involved, thread Controlled Myotomy proved to be a valid alternative to Recession. Furthermore, in case of Recession, over the long period a small residual AHP remained in the patients who had orthophoria, unlike Myotomy which led to a total resolution.

Spectral-domain optical coherence tomography analysis of persistent subretinal fluid after scleral buckling surgery for macula-off retinal detachment.

PURPOSE: To determine the predictive value of markers for persistent subretinal fluid (SRF) absorption and the influence of subfoveal fluid on visual outcome after scleral buckle (SB) surgery for rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS: This was a retrospective, observational study. We reviewed the medical records of 64 eyes of 64 patients who underwent SB surgery for macula-off RRD. Patients underwent clinical examination and spectral-domain optical coherence tomography before surgery, at 1 month and every 3 months postoperatively. The height and width of SRF bleb(s) were measured over time. RESULTS: Persistent SRF at 1 month was observed in 40 eyes (62.5%). SRF blebs were first detected 1.7 ± 2.2 months postoperatively. In 29 cases that could be fully followed up, SRF blebs were completely absorbed 7.8 ± 4.4 months postoperatively. Resolution of fluid was associated with an improvement of VA (P = 0.003). Serial measurements of SRF bleb size showed that bleb width decreased significantly at all time points during the 12-month follow-up period (P < 0.05), while significant bleb height decrease occurred from postoperative sixth month only (P < 0.05). There was no correlation between VA outcomes and subfoveal bleb height or width (P > 0.05). The cut-off value of the bleb width-to-height ratio level for predicting bleb absorption at 6 months was 7, with 89% sensitivity and 83% specificity. CONCLUSIONS: Visual improvement may occur with late resolution of residual subfoveal fluid. A bleb width-to-height ratio >7 indicates a higher risk of SRF to persist beyond 6 months after surgery.

Drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment.

BACKGROUND AND OBJECTIVE: The purpose of the study is to compare the drainage of subretinal fluid (SRF) in a scleral pocket (SP) with incision parallel to the limbus to drainage through a simple radial scleral thinning (ST), during scleral buckling surgery for rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS: Retrospective cohort study of one hundred sixty-nine consecutive buckling surgery for RRD, where a drainage puncture was performed through SP in eighty-five cases and through previous radial ST in eighty-four cases. RESULTS: PT shows significant lower complication rate. The incidence of retinal incarceration or formation of a retinal hole at the first drainage site is lower in PT group (p=0.0285). During surgery choroidal detachment have been observed in a higher percentage of cases in the SP group (p=0.0379). At the end of the surgery a certain amount of SRF behind the buckling was significant in ST group (p=0.0026). CONCLUSION: The SP drainage technique appears to be a useful, effective and safe method to drain SRF.

Ocular Complications in Cutaneous Lupus Erythematosus: A Systematic Review with a Meta-Analysis of Reported Cases.

Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease.

Intracranial aneurysm and diplopia due to oculomotor nerve palsy: pre- and post-operative study.

PURPOSE: The aim of this study was to analyze ocular signs and symptoms in patients with oculomotor nerve palsy due to compression exerted by an intracranial aneurysm. We compare the results of two surgical treatments (microsurgical clipping against endovascular embolisation) in relation with the size of the aneurysm and the time between diagnosis and therapeutical approach. MATERIALS AND METHODS: The study involved 16 patients. Each patient underwent an ophthalmological evaluation at the baseline and immediately, 6 months and 1 year after surgery, including the study of eyelid ptosis, ocular motility, pupil function, non-concomitant strabismus, diplopia and visual acuity. RESULTS: The best recovery was seen in the patients undergoing aneurysm clipping. Palpebral ptosis was the first sign to appear and the first to regress, followed by pupil and medial rectus function. Recovery of the other muscles was slower and often incomplete. CONCLUSIONS: Ophthalmological examination is essential for the correct treatment and follow-up of patients with intracranial aneurysms.

Temporary diplopia upon hyoscine-N-butyl bromide administration: case report.

Hyoscine-N-butyl bromide is a widely used antispasmodic belonging to the belladonna alkaloid class of semisynthetic quaternary ammonium compounds. These compounds exert a spasmolytic action on the smooth muscles of the bile-gastrointestinal tract, genitourinary tract, salivary glands (xerostomia), and also on the visual apparatus - in particular, the irido-ciliary complex. As a consequence, they provoke collateral effects such as mydriasis and accommodation disturbances. We report the case of a 23-year-old woman who complained of not only "dry mouth" but also "cloudy vision" and a "diplopia", both of temporary type, 2 hours after oral administration of hyoscine-N-butyl bromide.

Preliminary study on combined pharmacological and laser treatment in optic pit serous maculopathy after literature review.

The pit of the optic nerve head (ON) is a rare congenital defect that sometimes presents itself with a maculopathy of various neuroretinal layers for unknown reason. This study was focused, before and after pharmacological and parasurgical treatment, on the structural and functional visual assessment in a patient with optic pit maculopathy (OPM). In order to achieve this the latest generation of hi-tech diagnostic tests were used, such as Spectral-Domain Optical Coherence Tomography (SD-OCT), Visual Evoked Potentials (VEP), full-field Electroretinography (ERG), multifocal ERG (mfERG), Microperimetry (MP-1), Standard Automated Perimetry (SAP), Fluorescein Angiography (FA) and Indocyanine Green Angiography (ICG). The research was conducted through a review of past and recent literature.

Ocular traumatology in children. A retrospective study.

UNLABELLED: OBIECTIVE: This study assesses the descriptive epidemiology of children with eye injuries presenting to the Emergency Department of a non exclusive Paediatric University Hospital - First Division of Ophthalmology of "Sapienza" University of Rome - over a period of 12 years. STUDY DESIGN: A retrospective long term study of 12 years. PARTICIPANTS: All paediatric patients (up to 14 years of age) presenting with ocular injuries and hospitalized. METHODS: It was analyzed the incidence of the ocular trauma among males and females. The situation in which the trauma occurred, type of trauma (contusive or perforating), the presence of endo-bulbar foreign bodies, visual acuity outcome. RESULTS: There were 203 patients who presented to the Emergency Department in the period examined. Contusive traumas were 130 (90 males, 40 females). The perforating trauma were 73 (63 males, 10 females). The presence of an endo-bulbar foreign body was registered in 10 patients. A detailed analysis of the causes of the trauma is therefore provided. We evidence that males were almost exclusively involved in sport traumas (60 males versus 2 females), and in second instance accidental trauma is almost equally divided between two genders. CONCLUSIONS: Our retrospective study presents the paediatric cases of a non exclusive Paediatric University Hospital where 3% of ocular traumas requiring hospitalization were in children. Therefore our data could be useful in order to bring about the necessary preventive measures to minimize paediatric eye injuries.

Clinical manifestations due to pharmacological interactions in pediatric ophthalmic surgery: topical drugs and general anaesthesia.

INTRODUCTION: The authors consider the type and the incidence of the adverse effects due to the interaction between ophthalmic drugs and general anaesthesia in pediatric ophthalmic surgery. PATIENTS AND METHODS: The experience included 176 general anaesthesia in 100 children aged between 9,2 months and 11,4 years (mean age 4,9 years). RESULTS: In the 100 patients we reported: 4 cases (2.7% general anaesthesias) of sinus tachycardia with heart rhythm varying between 170 and 180 beats per minute (3.6%); 5 cases of sinus bradycardia, varying between 60 and 70 beats per minute (3.3%); 3 cases of bronchospasm (2%); 2 cases of psychomotor agitation/disturbances in pre-convulsive state after anaesthesia (1.3%); 3 cases of arterial hypotension (60-70 mmHg) (2%); 7 cases of skin rush around neck and chest (4.6%); 1 case of prolonged apnoea (0.6%). CONCLUSIONS: The clinical manifestations, principally on the cardio-circulatory and nervous system are subjected to critical revision, to foresee the pharmacological interferences and therefore to prepare the necessary measure of medical treatment.

Oxidative stress in the closed-eyelid test: management of glaucoma.

BACKGROUND AND OBJECTIVES: To evaluate the role of antioxidant drugs in the tonometric increase that follows the closed eyelid test (CET), a predicitive test for glaucoma, after administration of antioxidant substances was observed. MATERIALS AND METHODS: 30 subjects of 54.57+/=5.62 years, 13 males and 17 females, were examined by measuring the ocular pressure after 1 hour from the CET, both in normal conditions and after the administration of antioxidants such as: vitamin A (50,000 IU/die), vitamin E (600 mg/die), and vitamin C (1000 mg/die). The increases in temperature of the iridocorneal angle and of the iris were also measured in the same conditions with an infrared Thermo-Precision tonometer (Sola Electro-Optics, China) both before and after CET. RESULTS: The results showed increased pressure after CET and decreased pressure after the administration of each antioxidant substance, although vitamin A was found to be more effective and with statistically significant values compared to vitamins E and C. CONCLUSIONS: Considering the responses obtained after administration of antioxidant drugs, the ocular hypertension induced after CET could be a response to mixed stress, oxidative and thermic, with degenerative effects on the trabecular meshwork (TM). Besides, in light of these considerations the research results underline that the open angle glaucoma (OAG) should be considered a multifactorial degenerative disease.

[Posterior vitreous detachment and cystoid macular oedema post-cataract surgery: a case report]. / Distacco posteriore di vitreo e edema maculare cistoide post intervento di cataratta: caso clinico.

The posterior vitreous detachment consists in the separation between the posterior vitreal cortex and internal limiting membrane of the retina. This is the peak of the vitreal para-physiological age-related modifications. This problem occurs in 6% of normal people of age between 45 and 65 years and in 65% of individuals between 65 and 85 years. Several elements can be responsible for vitreous modifications, such as senility, myopia, aphakia, pseudophakia, diabetes, degeneration vitreous retinal hereditary, traumatisms, inflammation. A 75 year old male patient has come to our attention for a left eye cataract. He has undergone to a series of OCT: the first before surgery showed a perifoveal vitreous detachmen; the following ones until six months after surgery put in evidence the DPV progression accompanied by EMC, relating it with visual symptomatology. Therefore, OCT is a useful tool for a clinical analysis but also for the contribution to research concerning the pathogenesis of diseases due to vitreo-retinal modification.

OCT: Macular thickness in insulin-dependent patients without evident retinopathy: a preliminary study.

OBJECTIVES: Aim of this study was to evaluate whether OCT would be able to show subclinical retinal modifications in diabetic patients not showing clinical alterations during routine comprehensive eye examinations. Furthermore, we analyzed whether there is a seat of topographical macular predilection for the alterations and the connection between their onset and the duration of the disease. MATERIALS AND METHODS: 39 Caucasian subjects, aged between 13 and 33 years, were enrolled. 20 of them were healthy subjects, and 19 were patients affected by insulin-dependent type I diabetes mellitus. OCT scans were performed on all subjects, and macular thickness maps were obtained. Macular thickness was compared between diabetic and healthy subjects. Diabetic patients were divided in two subgroups, on the basis of disease duration (<=/> 16 years), and compared with two age-matched subgroups of healthy subjects. RESULTS: According to medical literature, macular thickness is significantly greater in men than in women. No further statistically significant differences could be detected in macular thickness if the disease has been lasting for 16 years or less. On the other hand, a statistically significant increase was detected in temporal macular thickness in patients affected by diabetes for more than 16 years. CONCLUSIONS: In patients affected by insulin-dependent diabetes for more than 16 years OCT detects early subclinical alterations in peripheral temporal macular region.

Ultrasound biomicroscopy of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts.

AIM: To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with pars plana cysts using ultrasound biomicroscopy (UBM). METHODS: 18 eyes of 12 patients with degenerative retinoschisis associated with pars plana cysts were selected through binocular indirect ophthalmoscopy and Goldmann three mirror lens examination, both with scleral depression. These patients were studied in detail with UBM. RESULTS: Study of the ciliary body with UBM showed pars plana cysts of different size and uneven shape. In cross sections the morphology of pars plana cysts in detail and the close relation of the cysts with the oral region and the peripheral retina, where areas of cystoid degeneration and retinoschisis were present, were observed. In transverse sections three main morphological aspects of pars plana cysts could be differentiated ("isolated," "confluent," and "clustered" cysts). Furthermore, ultrabiomicroscopy allowed differential diagnosis between retinoschisis and associated retinal detachment in six eyes. CONCLUSIONS: The study of peripheral degenerative retinoschisis and pars plana cysts is possible in vivo by means of UBM, showing the detailed morphology of the lesions (not otherwise evident through ophthalmoscopic examination) and the close relation between pars plana cysts, cystoid degeneration, and peripheral retinoschisis.

[Ocular electrophysiologic study of patients with a family history of diabetes]. / Etude électrophysiologique oculaire chez des malades avec antécédent familial diabétique.

The electrofunctional alterations in a group of non diabetic patients with diabetic familiarity are considered. A high percentage of electrofunctional abnormalities was found in these patients as compared with fundus eye changes and blood glucose metabolic imbalances.