Comparative analysis of robot-assisted simple prostatectomy: the HUGO™ RAS system versus the DaVinci® Xi system.

BACKGROUND: Robot-Assisted Simple Prostatectomy (RASP) has emerged as a promising alternative in the treatment of benign prostatic obstruction (BPO). However, there is currently a lack of comparative studies evaluating different robotic platforms for performing RASP. Therefore, we aimed to compare perioperative and functional outcomes of RASP performed using the HUGO™ RAS System versus the DaVinci® Xi System. METHODS: Forty consecutive cases of RASP performed between May 2021 and March 2023 with the HUGO™ RAS and the DaVinci® Xi at OLV Hospital (Aalst, Belgium) were included in this retrospective study. All surgeries were performed by three experienced surgeons using the same approach. Baseline characteristics, peri-operative and functional outcomes were collected and compared between the two groups. RESULTS: The population was equally divided between the two groups with 20 patients in each group. There were no significant differences in preoperative patient characteristics between the two groups, except for the presence of bladder stones prior to the surgery (p = 0.03). No significant differences in total operative time and console time between the two groups were reported (p = 0.3). No cases required conversion to open surgery or additional port placement. During one case performed with the HUGO™ RAS, a malfunctioning monopolar curved shear had to be replaced. However, there was no statistically significant differences in terms of technical robotic problems between the groups (p = 0.3). There was no significant difference between the two groups in perioperative and functional outcomes (all p ≥ 0.2). CONCLUSIONS: We did not observe any statistically significant difference in perioperative and functional outcomes in case of RASP performed with the HUGO™ RAS System and with the DaVinci® Xi System. These findings provide compelling support for considering the HUGO™ RAS as a promising tool for robot-assisted procedures, thereby expanding the utilization of robotics for benign conditions.

Ophthalmological aspects of IBD.

Ocular manifestations occur in 4-12% of patients with IBD. Uveitis and iritis are more frequently associated with ulcerative colitis while episcleritis is more common in Crohn's disease. Some ocular manifestations in IBD can be secondary to treatment and/or effects of the intestinal disease itself. The specific management of ocular manifestations in IBD requires the use of topical steroids and FANS, cycloplegics, systemic steroids or immunosuppressive drugs. When conventional therapies fail to control the ocular manifestations in IBD, the new biologic drugs can be considered as good alternative treatments. Early diagnosis and effective treatment may avoid the onset of severe and sometimes persisting complications. In some cases, a surgical approach is required to treat eye complications, i.e. cataract, and to improve the patient's quality of life.

Unusual coexistence of bilateral keratoconus and optic disc pit: a case report.

PURPOSE: To report the unknown coexistence of bilateral optic disc pit and keratoconus. METHODS: A 23-year-old man with bilateral keratoconus underwent complete ophthalmology screening, with an unexpected detection of undiagnosed optic disc pit in both eyes. Computerized corneal topography (CT), Orbscan, corneal pachometry, endothelial microscopy, and optical coherence tomography (OCT) examination were performed. RESULTS: The corneal CT showed a keratoconus pattern in both eyes, evolved in the right eye with a minimum corneal pachometry of 336 micronm in the right eye and 405 micronm in the left eye. Mean endothelial cell density was 1937 cells/mm2 in the right eye and 1912 cells/mm2 in the left eye. The OCT scans showed the presence of the disc pit in both eyes with a normal macular thickness and profile in the right eye, and in the left eye an augmented retinal thickness in the nasal macular zone due to retinal oedema and schisis, with an initial detachment of the neuroepithelium in the parapapillary area starting from the optic pit. CONCLUSIONS: This is the first clinical report of bilateral optic disc pit and keratoconus. Further investigations will be necessary to assess if there is a possible pathogenetic correlation between these two ocular pathologies or if this is an unusual coexistence of separate entities.

Femtosecond laser-assisted in situ keratomileusis for the correction of residual ametropia after deep anterior lamellar keratoplasty: a pilot investigation.

PurposeTo evaluate the refractive and visual results of one-stage laser-assisted in situ keratomileusis with femtosecond laser (Femto-LASIK) for the correction of residual ametropia after deep anterior lamellar keratoplasty (DALK).MethodsThis retrospective study included 13 eyes of 12 patients, who underwent corneal Femto-LASIK to correct refractive errors after DALK. IntraLase FS150 was used to create a lamellar flap and excimer laser ablation for refractive correction was performed using the Star S4 IR Excimer Laser in eight cases and the Technolas 217z Excimer Laser in Tissue Saving mode in five cases. Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction and corneal topography.ResultsThe mean spherical equivalent preoperatively was -4.85±2.82 (range, -9.5 to 0 D). At the last visit the mean postoperative spherical equivalent (SE) was -0.44±0.67 D (P<0.05). The mean postoperative UDVA was 0.12±0.12 logMAR. There was a statistically significant increase in CDVA 6 months after Femto-LASIK (P<0.05). Intraoperative and postoperative complications did not develop in this series of eyes.ConclusionsCorrecting the preoperative manifest refractive error with Femto-LASIK led to a significant improvement in the UDVA and CDVA without surgical complications.

Necrotic uveal melanoma with orbital inflammation.

PURPOSE: Extraocular extension of uveal melanoma can be accompanied by proptosis and signs of orbital inflammation but this clinical presentation is an uncommon feature if the tumor is solely intraocular. METHODS: Case report. RESULTS: The authors describe a patient with a medium-sized necrotic uveal melanoma, without extraocular spread, presenting with the clinical picture of orbital cellulitis. CONCLUSIONS: The ophthalmologist needs to be aware of this uncommon presentation of uveal melanoma, and not assume the presence of proptosis and orbital inflammation as signs of extraocular extension.

Optical coherence tomography and focal electroretinogram evaluation of cystoid macular edema secondary to retinitis pigmentosa treated with intravitreal triamcinolone: case report.

PURPOSE: To assess macular structure and function by optical coherence tomography (OCT) and focal electroretinogram (FERG) before and after intravitreal triamcinolone acetonide (IVTA) administration for cystoid macular edema (CME) in a patient with retinitis pigmentosa (RP). METHODS: A 33-year-old man with RP and refractory bilateral macular edema was treated with IVTA in his left eye and evaluated with visual acuity, OCT, and FERG for 6 months. RESULTS. Compared to the fellow eye, after IVTA mean retinal thickness significantly decreased, while FERG amplitude and phase did not show significant changes at the end of follow-up. Visual acuity showed a significant tendency to improve. CONCLUSIONS: In this case report, IVTA improved macular anatomy and visual acuity; this result, however, was not associated with a similar electrophysiologic response.

Efficacy and safety of bimatoprost in patients with uncontrolled glaucoma as alternative to filtration surgery.

PURPOSE: To evaluate the efficacy and safety of bimatoprost 0.03% as an alternative to filtration surgery in patients with uncontrolled glaucoma. DESIGN: Interventional study. METHODS: A total of 83 consecutive patients (83 eyes) awaiting glaucoma surgery were enrolled in eight ophthalmic centers. Reasons for listing were inadequate intraocular pressure (IOP) control despite medical therapy and documented progression of visual field loss. All patients discontinued the previous treatment and were switched to bimatoprost 0.03% QD (one drop at 9 pm). The primary efficacy outcome was a 20% IOP reduction from baseline at each timepoint. IOP was measured at day 7, day 30, day 60, and day 90 of treatment; less than 20% IOP reduction was considered as a failure. RESULTS: An IOP reduction of at least 20% was achieved in 74 patients (89.1%) after 7 days and in 64 patients (86.5%) after 30 days. Sixty-two patients (74.6%) maintained IOP readings 20% lower than baseline after 60 and 90 days. In these patients, visual field indices improved in 8 eyes (13%), and remained unchanged in 54 eyes (87%). Ocular side effects were conjunctival injection (15.6%), burning sensation (9.6%), foreign body sensation (4.8%), and eyelash growth (2.4%). CONCLUSIONS: This preliminary study shows that bimatoprost 0.03% could represent a useful therapeutic tool that might defer filtration surgery.

Antioxidant pattern in uveal melanocytes and melanoma cell cultures.

PURPOSE: To investigate the antioxidant status of cultured uveal melanocytes from patients with uveal melanoma and uveal melanoma cells to characterize some of the biochemical properties of these cells in respect to the normal cutaneous melanocytes. METHODS: The fatty acid pattern of membrane phospholipids, intracellular vitamin E level, and superoxide dismutase (SOD) and catalase activities were studied in uveal melanocytes (n = 10) and uveal melanoma cell (n = 10) cultures, by gas chromatography mass spectrometry or by spectrophotometer. RESULTS: Among the uveal melanocyte cultures, two groups were differentiated, according to catalase activity: group A with catalase values comparable to those of cutaneous ones and higher SOD activity and group B with catalase values 2 SD lower (P<0.001) and lower SOD activity. Vitamin E concentration was not significantly different between melanoma cells and melanocytes, whereas a significantly higher percentage of polyunsaturated fatty acids was found in melanoma cells and the B group of melanocytes (P = 0.022). In uveal melanoma cells SOD activity was significantly lower than that detected in uveal melanocytes (P< 0.005). CONCLUSIONS: These results show a different pattern of antioxidants in uveal melanocytes with respect to cutaneous ones, possibly related to the anatomic distribution. However, as in cutaneous melanocytes, two subgroups were identified on the basis of the antioxidant pattern that could be the expression of a constitutional increased susceptibility to oxidative stress in some subjects. Moreover, an imbalance of the antioxidants was observed in melanoma cells, possibly related to the disease status and progression.

3p13 region: a possible location of a tumor suppressor gene involved in uveal melanoma.

To contribute to a better understanding of the role of chromosomal rearrangements in the tumorigenesis of uveal melanoma, we present a case in which a structural aberration of chromosome 3 could indicate the specific region in which an uveal melanoma tumor suppressor gene could be located. We obtained a primary cell culture, characterized by cytogenetic study, through GTG- and CBG-banding techniques by using a mechanical dissection of a tumor sample obtained from an uveal melanoma. Cytogenetic analysis performed in the primary cell culture highlighted the presence of a structural rearrangement involving chromosomes 3 and 22. A t(3;22)(p13;p11) was observed as the only present clonal aberration. The 3p13 breakpoint involved in the aberration observed in our case could be essential in restricting the candidate region for the locus of an uveal melanoma tumor suppressor gene located on chromosome 3.

Four techniques for retreatment after excimer laser photorefractive keratectomy.

BACKGROUND: Retreatment should be considered for patients unsatisfied because of undercorrection and/or haze following excimer laser photorefractive keratectomy (PRK) for myopia. It is unclear if any specific type of retreatment is superior to another, especially in terms of post-treatment myopic shift and haze. METHODS: After a mean follow-up of 12.4 +/- 5.5 months, we retreated 10 eyes by four different techniques following failed PRK: only PRK, PRK with phototherapeutic keratectomy (PTK), only PTK, and mechanical scraping. RESULTS: After a mean follow-up of 11.4 +/- 7.8 months (range, 6 to 28 mos), the final mean refraction was 2.40 +/- 2.00 D (range, 0 to -6.00 D). Corneal clarity improved in 70% of eyes. The mean uncorrected visual acuity improved from 20/200 to 20/40. Of the four retreatment techniques, only scraping proved ineffective, due to unstable outcome. CONCLUSIONS: PRK alone, PRK with PTK, and PTK alone appeared safe and effective methods of retreatment, with no worsening of corneal clarity.

Role of the corneal epithelium in refractive changes following laser in situ keratomileusis for high myopia.

PURPOSE: Epithelial hyperplasia is one of the factors that plays a role in myopic regression after photorefractive keratectomy (PRK). We evaluated the role of the epithelium following excimer laser in situ keratomileusis (LASIK) performed on highly myopic eyes. METHODS: Fifty eyes of 32 patients (18 females and 14 males; mean age, 31.7+/-6.5 years) were treated with LASIK for myopia with an attempted correction ranging between -8.50 and -12.25 D (mean, -10.48+/-1.43 D). No sutures were placed. The thickness of the central epithelium was evaluated either with a 50-MHz ultrasonic pachymeter or an ultrasound biomicroscope. Postoperatively, topical corticosteroid drops were administered for at least 1 month. RESULTS: Follow-up was at least 12 months. Epithelium measurements were thicker compared to preoperative measurements from the first week postoperatively (mean, +1.9 microm, +2.77%; P<.05). Epithelial thickness peaked at the third month after LASIK (mean, +6.5 microm, +9.5%; P<.05) and remained stable through 12 months. A negative correlation between epithelium thickness and manifest refraction from the first month postoperatively to the end of follow-up was present. CONCLUSION: The epithelium seemed to have a role in the regression of refractive effect after LASIK to correct high myopia.

Histological, immunohistochemical, and ultrastructural findings in human corneas after photorefractive keratectomy.

BACKGROUND: Four human corneas that had undergone photorefractive keratectomy (PRK) and subsequent penetrating keratoplasty were examined by means of light and electron microscopy in an attempt to detect possible causes for complications after PRK. METHODS: Four eyes with a central corneal leukoma resulting from a previous PRK treatment underwent penetrating keratoplasty respectively 3 days, 3 months, 5 months, and 13 months after the refractive procedure. Different excimer laser instruments (Meditec MEL 50, Summit UV200, and VISX 20/20) had been used. The corneal buttons removed were submitted for light microscopy, electron microscopy and immunohistochemistry. RESULTS: An immature (one to two layers, basement membrane anomalies) but continuous epithelium was present even in the 3-day specimen; between six and eight epithelial layers could be seen in the 13-month specimen, which still presented an undulated aspect of the otherwise normal basement membrane. A continuous acellular collagen layer underlying the epithelium of the ablated area was detected in the superficial stroma of all examined corneas. No Descemet's membrane or endothelial alterations could be seen. CONCLUSIONS: Despite recovery of a continuous epithelial layer as early as 3 days after PRK, abnormalities of both epithelium and superficial stroma could be detected in all specimens, including the one obtained 13 months after the refractive procedure.

Effect of myopic excimer laser photorefractive keratectomy on the electrophysiologic function of the retina and optic nerve.

PURPOSE: To assess by electrophysiologic testing the effect of photorefractive keratectomy (PRK) on the retina and optic nerve. SETTING: Eye Clinic, S. Salvatore Hospital, L'Aquila University, Italy. METHODS: Standard pattern electroretinograms (P-ERGs) and standard pattern visual evoked potentials (P-VEPs) were done in 25 eyes of 25 patients who had myopic PRK for an attempted correction between 5.00 and 15.00 diopters (D) (mean 8.00 D). Testing was done preoperatively and 3, 6, 12, and 18 months postoperatively. The contralateral eyes served as controls. During the follow-up, 3 patients (12%) developed steroid-induced elevated intraocular pressure (IOP) that resolved after corticosteroid therapy was discontinued. RESULTS: No statistically significant differences were seen between treated and control eyes nor between treated eyes preoperatively and postoperatively. CONCLUSION: Myopic excimer laser PRK did not seem to affect the posterior segment. The transient steroid-induced IOP rise did not seem to cause functional impairment.

Videokeratographic changes after laser in situ keratomileusis to correct high myopia.

PURPOSE: To evaluate the videokeratographic changes and patterns after laser in situ keratomileusis (LASIK) in high myopia using computerized videokeratography. SETTING: San Salvatore Hospital, Chair of Ophthalmology, University of L'Aquila, L'Aquila, Italy. METHODS: Forty-one eyes of 26 patients treated with no-suture nasal-hinged flap LASIK for an attempted mean spherical equivalent correction of -13.9 diopters (D) +/- 4.1 (SD) (range -8.0 to -22.0 D) were evaluated. Mean patient age was 35.2 +/- 9.8 years. Mean follow-up was 15.1 +/- 6.7 months (range 6 to 26 months). RESULTS: Thirty-five eyes (85.4%) were within +/- 2.0 D of the planned correction, with a refractive error greater than 3.0 D in the 7.3% of eyes. Mean central corneal power decreased from 43.2 +/- 1.8 D (range 38.70 to 47.40 D) to 35.8 +/- 3.8 D (range 30.3 to 42.6 D). Mean preoperative corneal astigmatism decreased from 1.2 +/- 0.9 D (range 0.2 to 4.2 D) to 0.9 +/- 0.9 D (range 0.2 to 3.3 D). Videokeratographic qualitative analysis showed corneal shape changes within 15 days after surgery. Corneal patterns then stabilized, and 37 eyes (90.3%) had no significant modifications in corneal refractive power after 1 month. CONCLUSION: After LASIK in highly myopic eyes, videokeratographic maps showed corneal power stabilized within 1 month in most eyes and there was no irregular astigmatism if the treatment was well centered.

Specular microscopy of the corneal endothelium after excimer laser photorefractive keratectomy.

PURPOSE: To evaluate endothelial cell morphology and density after excimer laser photorefractive keratectomy (PRK). METHODS: We used a noncontact specular microscope to examine the central corneal endothelium of 50 eyes of 50 patients who had PRK for an attempted correction between -2.5 and -17.0 diopters (D) (mean -7.8 D) beginning 18 to 24 hours postoperatively. RESULTS: After a follow-up of 11.4 +/- 6.1 months (mean +/- standard deviation), mean endothelial cell density was 2577.6 +/- 402.0 cells/mm2 with rare signs of polymegathism and pleomorphism. Preoperative and untreated fellow eye endothelial cell density values were used as a control. Paired Student's t-test and analysis of variance results were not significant (P > .05). CONCLUSION: Excimer laser PRK did not significantly change cell density and morphology.

Intravitreal triamcinolone in cystoid macular edema due to uveitis and repeated surgery after a penetrating trauma.

PURPOSE: To test the effectiveness of intravitreal triamcinolone acetonide in treating macular edema due to multiple vitreoretinal surgical procedures and uveitis after a penetrating trauma with metallic foreign body retention in a 37-year-old man. METHODS: The patient received two intravitreal injections of triamcinolone acetonide-2 mg/0.05 mL and 4 mg/0.1 ml(-1) month apart. The 6-month follow-up included best-corrected visual acuity (BCVA) measurement and optical coherence tomography evaluation. RESULTS: After the first injection (2 mg) the foveal thickness (685 microm, as compared to a normal value of <165 microm) and the BCVA (20/200) remained unchanged with respect to the preinjection values; 1 week after the second injection (4 mg), the foveal thickness went down to 130 microm and the BCVA improved (20/80). Such results were unchanged at the 6-month control. No complications occurred. CONCLUSIONS: A 2 mg dose of triamcinolone acetonide did not improve the anatomic and functional status of the macula. A 4 mg dose markedly improved BCVA and reduced the macular thickness in this case of macular edema.

PERG and P-VEP after surgical trabeculectomy in primary open-angle glaucoma.

Pattern-reversal electroretinograms (PERG) and visual evoked potentials (P-VEP) were measured for 10 eyes from 10 rigorously selected patients with bilateral advanced primary open angle glaucoma (POAG), before and after surgical trabeculectomy. The aim was to establish whether electrofunctional examinations improved after major IOP reduction. Only one eye at random was operated, and the fellow eye was used as control. The aim of this study, using electrofunctional examinations, was to clarify whether ganglion cell damage was reversible after marked reduction of IOP by surgery. The results indicate that glaucomatous damage seems to be irreversible.

Escherichia coli endophthalmitis after trans-scleral resection of uveal melanoma.

PURPOSE: To report a case of Escherichia coli endophthalmitis after trans-scleral resection of an uveal melanoma. METHODS: A large ciliary body melanoma was treated by trans-scleral resection and full-thickness sclerectomy because of epibulbar tumor extrusion, followed by adjuvant ruthenium plaque therapy. RESULTS: Two months after treatment the patient developed wound dehiscence and consecutive endophthalmitis. Cultures of the involved sclera yielded Escherichia coil. The infection resolved after systemic intravenous ciprofloxacin and ceftriaxone, with aggressive topical ciprofloxacin and tobramycin. Final visual acuity was light perception. CONCLUSIONS: We assume that the ruthenium plaque placed over the scleral patch was responsible for the delay in scleral healing, with consequent wound dehiscence and E. coli endophthalmitis.

Iris diaphragm implantation in post-traumatic aniridia and tractional retinal detachment.

The implantation of an artificial iris diaphragm is described in a case of aniridia and traumatic aphakia with a relapsed, tractional retinal detachment. The addition of heparin and dexamethasone to the infusion liquid is useful to reduce the fibrinous exudation which seems to be the main cause of diaphragm obliteration.

Local excision of retinal metastasis from cutaneous melanoma.

The incidence of cutaneous melanoma is constantly rising. Ocular involvement is rare and the choroid is the most accessible structure to metastatic emboli. The case described is noteworthy on account of several particular features: 1) the missed diagnosis of the primary malignancy. This might be because either cutaneous melanoma or cutaneous nevi show several common features; 2) the rarity of the retinal metastatic site. Unlike the choroid, the retina is an unusual metastatic site but, regardless of organ blood flow, the metastatic efficiency may be related to interactions between tumor cells and host tissue; 3) the treatment of the retinal metastasis, excised conservatively. As far as we know, this is the first report of a retinal metastasis being treated by local resection.