Juvenile idiopathic arthritis-associated uveitis: a retrospective analysis from a centre of South Italy.

PURPOSE: To investigate the clinical and laboratory characteristics of the children affected by juvenile idiopathic arthritis (JIA) who developed uveitis. METHODS: In this retrospective study, we have examined data of 109 patients aged from 3 to 16 years, affected by JIA and followed at Paediatrics Rheumatology Clinic and Ophthalmology Clinic of University Hospital of Messina in the period from 2007 to 2017. The main outcome measures were clinical and laboratory findings related to JIA and ocular involvement. The prevalence of ocular signs and symptoms was determined and correlated with age. RESULTS: Twenty-one (19.3%) subjects developed uveitis. Two different peaks of age with ocular involvement were registered. The first occurred between 4 and 6 years and the second between 10 and 12 years. All subjects in the first group resulted to be female, presented oligoarticular arthritis and chronic anterior uveitis. In the second group, the 84% of patients were male with different types of JIA and acute anterior uveitis. The prevalence of ocular complications was higher in the first group. CONCLUSIONS: Two peaks of age emerged and were characterized by different clinical outcomes of arthritis and ocular involvement. The first occurred between 4 and 6 years and interested females affected by oligoarticular JIA who develop chronic anterior uveitis. The second appeared at 10-12 years and interested older males affected by different types of JIA with acute anterior uveitis. Early diagnosis and cooperation between paediatric rheumatologist and ophthalmologist are of great importance in the proper management of JIA children with uveitis.

Comparison of Goldmann applanation tonometry and dynamic contour tonometry in the measurement of intraocular pressure in eyes with different corneal thicknesses.

PURPOSE: To compare Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) in the evaluation of intraocular pressure (IOP) in eyes with different corneal thicknesses. METHODS: GAT and DCT were performed in 70 eyes of 35 subjects aged between 21 and 59 years. Thirty eyes had normal, nonoperated corneas and 40 eyes had reduced central corneal thickness (CCT) following myopic photorefractive keratectomy. The GAT and DCT values were correlated to CCT and age and the agreement between both tonometers was determined by the Bland and Altman method. RESULTS: GAT correlated strongly with CCT (p = 0.0002), but there was no correlation between DCT and CCT (p = 0.4388). No correlation was found between IOP values obtained with both devices and age. The Bland and Altman plot evidenced a lack of agreement between both tonometers with 95% limits of agreement between 1.6 and -5.6 mm Hg. CONCLUSIONS: GAT gives significantly lower values in the eyes with thin corneas and DCT is not influenced by CCT. DCT could be recommended to evaluate IOP in eyes with out-of-range corneal thickness.

Visual outcome after excimer laser refractive surgery in adult patients with amblyopia.

PURPOSE: To evaluate the visual and refractive outcome in adult patients wi th refractive and anisometropic amblyopia treated with photorefractive keratectomy. METHODS: An interventional non-comparative study was performed on 50 consecutive patients with amblyopia treated with photorefractive keratectomy. Sixty-eight eyes of 18 participants with bilateral refractive amblyopia and 32 participants with unilateral anisometropic amblyopia were studied. The photorefractive keratectomy was performed with MEL 70 G-Scan excimer laser. Follow-up was 1, 3, 6, and 12 months after the treatment. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), refraction, and corneal transparency. RESULTS: In 64.7% of eyes, the UCVA at 12 months after the treatment was better than or equal to their preoperative BCVA. A total of 82.4% of eyes improved their BCVA one or more lines. No eye lost lines of BCVA, 17.6% remained unvaried, 50% gained one line, 20.6 % gained two lines, and 11.8% gained three lines of BCVA. The number of lines gained correlated strongly with diopters of anisometropia between eyes (p<0.01). The mean sphere changed from -5.62+/-3.37 D to -0.47+/-1 D, mean cylinder varied from -2.36+/-1.57 to -0.18+/-0.41 D, and the spherical equivalent varied from -6.82+/-3.1 to -0.45+/-1.08 D. No clinically significant haze was observed. CONCLUSIONS: Excimer laser refractive surgery appears to be a safe and efficient procedure in the treatment of ametropic and anisometropic amblyopia in adults. Adult patients with anisometropic and refractive amblyopia could benefit from the refractive treatment with significant improvement of the visual acuity.

The eye in cystic fibrosis.

PURPOSE: To investigate modifications of ocular surface and lens transparency in patients with cystic fibrosis in relation to the stage of digestive insufficiency. METHODS: Forty consecutive patients with cystic fibrosis and 24 age- and sex-matched healthy volunteers were examined. The tear tests (Schirmer's basic test, tear film break-up time) and conjunctival exfoliative cytology (CC) were used to study the ocular surface. The lens transparency was measured with the Opacity Lens Meter 701 (OLM 701, Interzeag AG, Switzerland). Digestive insufficiency was evaluated by the steatocrit method. RESULTS: Significant changes in conjunctival cytology and lens opacity, and abnormal tear tests were detected in CF patients; the alterations were more pronounced in patients with severe digestive insufficiency. CONCLUSIONS: Cystic fibrosis patients present ocular surface abnormalities and lens transparency modifications and their severity is related to the digestive insufficiency. Simple, rapid and non-invasive tear tests and cytological procedures might be used as additional tests for assessing the severity of cystic fibrosis.

Photorefractive keratectomy for compound myopic astigmatism with the MEL-70 G-Scan excimer laser.

PURPOSE: To assess the safety, efficacy, predictability and stability of photorefractive keratectomy in compound myopic astigmatism with a moderate and high cylinder component. METHODS: Photorefractive keratectomy was done in 42 eyes with compound myopic astigmatism with the spherocylindrical algorithm of the MEL-70 excimer laser, with wide ablation zones. RESULTS: Spherical equivalent refraction changed from -4.19 +/- 1.65D to -0.05 +/- 0.31D, refractive cylinder from -2.01 +/- 0.71D to -0.09 +/- 0.20D and mean sphere from -3.22 +/- 1.76D to -0.02 +/- 0.26D. Mean uncorrected visual acuity rose from 0.12 +/- 0.17 to 0.91 +/- 0.10. No eye lost lines of spectacle-corrected visual acuity. The safety index was 1.03 and the efficacy index 0.98. Six months from the treatment all eyes were within +/- 1D, 8.9% of eyes were within 0.50D and 44% were plano of target refraction. Refractive and topographical stability were achieved between one and three months after treatment. Transient haze was observed between one and three months after PRK. CONCLUSIONS: Photorefractive keratectomy with the MEL-70 excimer laser to correct myopic astigmatism was a safe and effective procedure with good stability at six months' follow-up. Refractive and visual outcome confirmed that excellent predictability can be expected.

Corneal endothelium evaluation in type I and type II diabetes mellitus.

BACKGROUND: The purpose of this study is to evaluate the corneal endothelium in type I and type II diabetic patients. METHODS: Seventy-five diabetics divided into type I and type II groups and 62 healthy volunteers took part in the study. The mean endothelial cell density and morphology, and the central corneal thickness were evaluated and statistical analysis was done. RESULTS: All evaluated parameters were found to be significantly different in both diabetic groups with reduction of the mean cell density of 5% in type II and of 11% in type I diabetes with respect to the normal age-matched control group. Important alterations of endothelial morphology were observed. The central corneal pachymetry was significantly higher in diabetics, with p < 0.01 in the type I group and p < 0.05 in the type II group. CONCLUSION: It is concluded that corneal endothelium in diabetics should still be considered as a tissue under continuous metabolic stress with consequent high vulnerability, especially in case of any external insult such as a surgical procedure.

Effect of intraocular acetylcholine and carbachol on the corneal endothelium. In vivo comparative study.

The purpose of this study is to evaluate differences in corneal endothelial cell loss after intraocular use of two different miotics in subjects who have undergone extracapsular cataract extraction with posterior chamber intraocular lens implantation. The patients were divided into two groups: the first received 1 ml of 1% acetylcholine chloride and the second 0.5 ml of 0.01% carbachol as intraocular miotics. The endothelial count was done preoperatively and then 1 month after cataract extraction. There were no statistically significant differences in the mean cell loss between both groups. The authors believe that both miotics could be used in cataract surgery.

Cystic fibrosis and lens opacity.

Cystic fibrosis (CF) is a fairly common lethal genetic disease in whites, inherited via an autosomal recessive pattern. Several clinically evident anomalies of the eye such as xerophthalmia, papilledema, retinal alterations and optic neuropathy have been described. In the present study we investigated lens changes in 40 patients affected by CF, to relate the results to the stage of digestive insufficiency. Each patient underwent an accurate ocular examination including visual acuity, slit-lamp examination, and measurement of lens transparency with the Opacity Lens Meter 701. The results were compared with those of an age- and sex-matched control group. The comparison between the lens opacity values obtained in the CF patients and those measured in the control group showed a statistically significant difference; moreover, lens transparency was more decreased in patients with severe digestive insufficiency.