Transepithelial cross-linking in keratoconus patients: confocal analysis.

PURPOSE: To analyze the modifications of the corneal layers after transepithelial (TE) corneal cross-linking (CXL). METHODS: Twenty eyes of 20 patients with progressive keratoconus were treated with TE-CXL (without epithelium debridement), and their corneas analyzed at different times, up to 18 months, by confocal microscopy using a Nidek Confoscan 4. RESULTS: The epithelial layer, after an initial disorganization due to the TE technique, returned to a normal state after 2 weeks. Keratocytes and nerve fibers in the stroma decreased in number (approximately 25%), to return to a normal density at about 6 months after the procedure. A demarcation dense line indicative of effective cross-linking could be observed after 6 months at a depth of around 60 µm below the Bowman membrane. The endothelium remained unaffected at all examination times. CONCLUSIONS: The TE-CXL procedure appears to be safe and effective at least up to 18 months. The absence of epithelium debridement (necessary in the classical technique) makes the procedure more comfortable for the patient, and allows the treatment of thinner corneas (between 360 and 400 µm) and problematic patients.

Heavy versus standard silicone oil in the management of retinal detachment with macular hole in myopic eyes.

PURPOSE: The purpose of this study was to compare pars plana vitrectomy (PPV) with 1000 cSt silicone oil endotamponade and PPV with densiron endotamponade for retinal detachment with macular hole and posterior staphyloma in highly myopic eyes. PATIENTS AND METHODS: In a prospective study, 30 eyes of 30 patients were randomly assigned to PPV and densiron (n = 15) or PPV with silicone oil (n = 15). All eyes had laser photocoagulation of the macular hole rim after PPV. Silicone oil or densiron was removed 12 weeks after surgery. Patients were followed-up for 6 months after oil removal. RESULTS: In the densiron group, the retinal reattachment rate was 100% with densiron in situ and 87% after its removal, and in the silicone oil group, the retinal reattachment rate was 67% with silicone oil in situ and 53.4% after oil removal. Thus, PPV with densiron had a better anatomical success rate than silicone oil (P = 0.04 with endotamponade and P = 0.05 after endotamponade removal). In both groups, paired comparison of preoperative and postoperative best-corrected visual acuity was not statistically significant (P = 0.08). CONCLUSION: Pars plana vitrectomy with densiron is a preferred surgical procedure for the repair of macular hole retinal detachment in highly myopic eyes with posterior staphyloma.

Confocal microscopy identification of keratoconus associated with posterior polymorphous corneal dystrophy.

We present a case of keratoconus in which the association with posterior polymorphous corneal dystrophy was established by confocal microscopy. Confocal microscopy enable us to assess the differential diagnosis between posterior corneal dystrophies, essential for a prognosis and therapeutic decision.

Microbiological features of acute bacterial conjunctivitis in a central Italian area.

The study aims to identify bacteria causing conjunctivitis in a central Italian area and to analyze chemosusceptibility. From 2005 to 2006, 91 conjunctival swabs were collected from acute conjunctivitis cases and screened for common bacteria and fungi. Susceptibility tests were performed on isolates. Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae amounted to 86.2%. Overall, 100% of strains were susceptible to chloramphenicol and 96.6% to quinolones. Conversely, 20.7% of isolates were tetracycline-resistant and, even if all Gram negative isolates were susceptible to gentamicin, the most frequently isolated pneumococci are constitutively resistant. The study provides support for a rational choice of empiric therapy.

The role of ultrasound biomicroscopy in the diagnosis of temporal arteritis.

Temporal artery biopsy is considered the gold standard for the diagnosis of temporal arteritis (TA). The aim of the study was to determine whether ultrasound biomicroscopy (UBM) findings are useful in predicting the result (positive or negative) of temporal artery biopsy in patients with TA. Sixteen consecutive patients (ten women and six men) with clinical diagnosis of TA seen at the Ophthalmology Unit, S. Marta Hospital, Catania University, were included in the study. All patients were submitted to UBM (50-MHz transducer, P45 Plus Paradigm Medical Instruments, Salt Lake City, UT, USA) before temporal artery biopsy. The results were correlated with histopathologic changes. Seven patients presented histopathologic findings consistent with the diagnosis of TA. Thus, UBM findings of these patients were compared with those of the nine patients with negative biopsy. On UBM, we searched for the presence of a hypoechoic effect surrounding the walls of temporal arteries, so-called halo sign, as well as for the intra-arterial middle reflexive filling, so-called intra-arterial filling. The halo sign and intra-arterial filling were found in all seven (100%) patients with biopsy-proven TA. However, in five (55.5%) patients, the absence of these two parameters on UBM of patients with suspected TA strongly suggested that temporal artery biopsy would be negative (negative predictive value, 100%). On the other hand, four (44.5%) of nine patients with negative biopsy presented one of these two UBM findings. In conclusion, this preliminary work suggested UBM to be an appropriate noninvasive tool for morphological imaging and evaluation of temporal arteries, helpful in obtaining an indication of the side and segment for biopsy, and may play a role in predicting negative result of temporal artery biopsy in patients with TA; however, for the time being we cannot recommend any change in the current practice.