Refractive surgery in patients with retinitis pigmentosa.

PURPOSE: To evaluate the refractive outcomes and safety of laser refractive surgery in a group of myopic patients with retinitis pigmentosa (RP). METHODS: This was a multicenter, retrospective, noncomparative, interventional case series. A total of 32 eyes of 16 patients with RP with at least 18 months of follow-up were treated with laser refractive surgery (photorefractive keratectomy [PRK], laser subepithelial keratectomy [LASEK]). Refractive outcomes, complete eye examination, corneal topography, and retinal sensitivities were evaluated during follow-up. Mean follow-up was 28.3 months (minimum 18, maximum 50). Mean patient age was 29.6 years (range 24-54). Mean best-corrected visual acuity (BCVA) was 0.75 preoperatively. RESULTS: Eighteen months after surgery, mean uncorrected visual acuity (UCVA) was 0.8+/-1 line (p=0.02); mean BCVA was 0.85+/-1 line (p<0.0005) with mean spherical equivalent of -0.16 D. Corneal complications were not detected during follow-up; corneal topography did not show corneal ectasia in any patient after surgery. During follow-up visits, no development or progress of macular edema was noted in any eye. Retinal sensitivities increased after surgery; there were no significant changes in electroretinogram amplitude. CONCLUSIONS: Mean UCVA and BCVA 18 months after surgery were higher than preoperative BCVA. All patients were safely treated without any significant complications. Our results support the safety of performing PRK and LASEK in patients with tapetoretinal degeneration.

Hess area ratio and diplopia: evaluation of 30 patients undergoing surgical repair for orbital blow-out fracture.

PURPOSE: To determine if the Hess area ratio is effective in predicting postoperative diplopia in patients undergoing surgery for orbital blow-out fracture. METHODS: Our retrospective, interventional case series study involved 30 consecutive cases affected by orbital fractures and diplopia undergoing surgical correction within 7 days after injury. To evaluate ocular motility disturbance, we measured the involved ocular motility range by use of a manual Hess screen test before and 4 months after surgery. The percentage of Hess area ratio % was used to express the range of ocular motility in a numerical value. RESULTS: All patients with preoperative Hess area ratio >85% had no postoperative diplopia, and most patients (57%) having a preoperative Hess area ratio <65% had postoperative diplopia. When the Hess area ratio was between 65% and 85%, surgical outcomes were variable and most patients (55%) described no problematic diplopia in the peripheral visual field. CONCLUSIONS: The Hess area ratio is a useful procedure to convert Hess graphic representation in a numerical value so that Hess chart data can be compared among clinicians and used to predict surgical outcomes in patients undergoing surgery for orbital blow-out fractures.

Visual acuity and contrast sensitivity: AcrySof ReSTOR apodized diffractive versus AcrySof SA60AT monofocal intraocular lenses.

PURPOSE: To compare the visual acuity and contrast sensitivity in eyes with the AcrySof ReSTOR multifocal intraocular lens (IOL) (Alcon) and eyes with the monofocal AcrySof SA60AT IOL. SETTING: Policlinico Umberto I, Department of Ophthalmology, Rome, and private clinical practice, Rome, Italy. METHODS: One hundred eyes had phacoemulsification cataract extraction and implantation of a ReSTOR multifocal IOL in the capsular bag. Inclusion criteria were corneal astigmatism less than 1.5 diopters (D), myopia less than 4.0 D, and no associated ocular disease. A complete ophthalmic examination, including uncorrected visual acuity, best spectacle-corrected visual acuity, and contrast sensitivity, was performed 6 months postoperatively. Results were compared with those in 40 eyes with the AcrySof monofocal IOL single-piece IOL. RESULTS: In the multifocal group, 90 eyes (90%) had an uncorrected distance visual acuity of 20/25 or better (logMAR<0.10) and an uncorrected near visual acuity at 35 cm of J3 or better (logMAR 0.14). The multifocal group and monofocal group had similar distance uncorrected and best corrected visual acuities; however, the multifocal group had significantly better near uncorrected acuity. The mean contrast sensitivity values were 18.28 dB (static program) and 17.95 dB (dynamic program) in the multifocal group and 19.18 dB (static program) and 21.2 dB (dynamic program) in the monofocal group. CONCLUSIONS: The ReSTOR multifocal IOL provided a satisfactory full range of vision; 92% of the patients achieved total spectacle independence. Contrast sensitivity was lower than with the SA60AT monofocal IOL.

Pathogenesis of Vernal Keratoconjunctivitis and Associated Factors.

AIM: To investigate the role of some variables, including allergy and autoimmunity, in the pathogenesis of vernal keratoconjunctivitis (VKC). The VKC is a chronic and often severe form of bilateral keratoconjunctivitis. Usually, it begins during the first decade and disappears during the end of the second decade of life. MATERIALS AND METHODS: 26 patients with VKC were selected. The diagnosis was performed by the ophthalmologist through a score based on ocular signs and subjective symptoms before and after administration of 1% cyclosporine A (Cy) eyedrops. Each variable was graded: 0 = absent; 1 = mild; 2 = moderate; 3 = severe. Patients with a total score ≥7 were included in the study. Blood samples were collected at the initial time for the determination of autoimmunity by total IgE and antinuclear antibodies (ANA). A Skin Prick Test (SPT) was performed on each patient to common inhalants and food allergens. RESULTS: 53.8% of the children resulted atopic. The most important allergens were house dust mites and grasses. 46.1% of the patients showed total IgE >100 UI/ml and 30.8% had ANA positivity at the first determination. The photophobia occurred in 42.3% of children, most frequently with respect to other symptoms like secretion or tearing (30.8%), foreign body sensation (15.4%), itching and conjunctival hyperemia (11.5%). CONCLUSIONS: Fortunately all children improved their symptoms after Cy eyedrop therapy. Moreover, there was an elevated percentage (30.8%) of children with ANA positivity compared with the values in the general pediatric population. Despite the fact that it is a non-specific autoantibody, its high presence in a population of children with VKC may have an important role in clarifying etiopathogenesis and chronic inflammation.

Early detection of macular changes with multifocal ERG in patients on antimalarial drug therapy.

PURPOSE: To compare and to evaluate the use of the multifocal electroretinography (mfERG) to conventional systems in assessing early changes of the retinal electric signals in patients with ocular dysfunction due to antimalarial drug therapy. METHODS: This article represents an up-to-date review of the current thoughts regarding the mfERG technique and its use in providing a topographic measure of the retinal electrophysiological activity. RESULTS: Various investigations have been suggested to be useful in the assessment of toxic retinopathy, but, since they involve subjective responses by the patients and lack of sensibility, the mfERG may be particularly useful for documenting early toxic retinopathy. CONCLUSIONS: A small percentage of patients face retinal functional alterations and ocular lesions and that is possible thanks to the use of lower dosages of hydroxychloroquine (Hy) and chloroquine (CQ), but the problem still remains because of the cumulative dose of the drugs in therapy that many of these patients go through. The mfERG can be considered a good method of early detection and tracking of the progression of macular changes of retinopathy and could occupy a key position in assessing macular changes in patients on antimalarial drug therapy.