Efficacy and Safety of Preoperative Prophylaxis in Cataract Surgery with Combined Topical Antiseptics: A Microbiological Study.

INTRODUCTION: To evaluate the antimicrobial efficacy of an ophthalmic formulation containing hexamidine diisethionate (HD) 0.05%, polyhexamethylene biguanide (PHMB) 0.0001%, and edetate disodium (EDTA) 0.01% (Keratosept®, Bruschettini, Genova, Italy) on the microbial flora of a healthy ocular surface. METHODS: Patients were enrolled consecutively. Each patient applied two drops of Keratosept® in the eye scheduled for cataract surgery (study eye) three times daily in the 2 days prior to surgery and one time in the morning of surgery. The contralateral eyes were considered as control (control eye). Bilateral conjunctival swabs were collected before the first administration (T0) and the morning of surgery (T1). The swabs were processed within 3 h from sampling for the automated detection of the presence of replicating microorganisms (colony-forming units, CFU/mL) and the provision of real-time growth curves. RESULTS: Conjunctival swabs of 32 patients (n = 128) were examined. Six patients were excluded from the efficacy analysis because of microbial load < 50 CFU/mL at T0 in the study eye. No difference between study and control eyes was observed at T0 (p = 0.40). Compared with T0, 20 (76.9%) study eyes and 10 (38.5%) control eyes showed a ≥ 1 log reduction of the microbial load at T1, with a significant difference between groups (p = 0.005). Keratosept® showed good tolerability, and no adverse events or eye discomfort were recorded. CONCLUSIONS: This study showed that the low-dose combination of antiseptic agents in the Keratosept® ophthalmic solution effectively reduces the bacterial load of healthy flora on the ocular surface.

Outcomes of 195 consecutive patients undergoing 2-port pars plana vitrectomy with slit-lamp illumination system for posterior segment disease: a retrospective study.

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of 2-port 20-gauge pars plana vitrectomy with a slit-lamp illumination system in different vitreoretinal pathologies. DESIGN: : Retrospective, consecutive, interventional case series. METHODS: One hundred and ninety-five consecutive eyes of 195 patients underwent 20-gauge 2-port pars plana vitrectomy with a combination of slit-lamp illumination and a plano-concave contact lens, at the San Paolo Ophthalmology Center, from September 2005 through November 2007. Postoperative visual acuity at baseline and at 1, 3, and 6 months; intraoperative and postoperative complication rate; and surgical time were evaluated. RESULTS: All patients completed 6 months of follow-up. The mean overall visual acuity was 0.74 ± 0.03 (mean ± SD) at baseline, improving to 0.56 ± 0.03 (P < 0.0001), 0.48 ± 0.03 (P < 0.0001), and 0.43 ± 0.03 (P < 0.0001) at 1, 3, and 6 months, respectively. No intraoperative complications occurred. Postoperative complications included retinal detachment in three patients, epiretinal membrane recurrence in three eyes, persistent macular hole in four eyes, and phthisis in one eye. Cataract formation was observed in 25 eyes. The total mean surgical time was 28.3 ± 10.1 minutes. No one had hypotony after the surgical procedure, and no cases of endophthalmitis were observed. Conversion to standard three-port vitrectomy was not necessary in any of the cases. CONCLUSION: Two-port 20-gauge pars plana vitrectomy with slit-lamp illumination is a safe and effective procedure for posterior segment surgeries.

Single-session photodynamic therapy combined with intravitreal bevacizumab for retinal angiomatous proliferation.

PURPOSE: To evaluate the efficacy of single-session photodynamic therapy (PDT) combined with intravitreal bevacizumab (IVB) in the treatment of retinal angiomatous proliferation (RAP) in age-related macular degeneration. METHODS: In this pilot study, eight patients with RAP underwent indocyanine green angiography (ICGA)-guided single-session verteporfin PDT followed by intravitreal bevacizumab (1.25 mg) within a 0-day +/- 1-day interval. All patients were naïve to treatment. Best-corrected visual acuity (BCVA), fluorescein angiography, ICGA, and optical coherence tomography (OCT) were performed at baseline and at each follow-up visit. All patients received three consecutive monthly IVB injections; thereafter, retreatment with bevacizumab was performed in the case of worsening BCVA or a deterioration of angiographic or OCT findings. RESULTS: All patients had 9 months of follow-up. Complete resolution of angiographic leakage was achieved in all eyes at 9 months. A significant improvement in the mean BCVA was observed at 1 month, 3 months, 6 months, and 9 months after combined treatment (P = 0.004). Visual acuity improved in 62.5% and was stable in 37.5% of cases. No patients had a decrease in BCVA of three or more lines during follow-up. Mean central macular thickness was significantly reduced in all patients (P < 0.0001) as controlled at 1-month, 3-month, 6-month, and 9-month intervals from initial treatment. The mean number of injections for the 9 months were 3.2 +/- 0.4. No ocular complications or systemic events developed. CONCLUSION: Sequenced combined treatment with single-session PDT and IVB injections may be useful in treating RAP, reducing or eliminating retinal edema, and improving or stabilizing visual acuity. Further investigations are warranted to outline the appropriate treatment paradigm for combination therapy.

Grading the surgical difficulty of cataract phacoemulsification.

BACKGROUND AND OBJECTIVE: To propose a new grading system to preoperatively evaluate the difficulty of phacoemulsification surgery according to the anatomic condition of a patient's eye. PATIENTS AND METHODS: In this prospective case series, a grading system covering the entire cataract spectrum was developed and field-tested in 400 consecutive patients undergoing phacoemulsification. For each eye, nine anatomic parameters were evaluated and a level of severity was assigned. The system identifies five levels of surgical difficulty based on the combined degree of severity of each parameter considered. RESULTS: Preoperative score and intraoperative difficulty closely corresponded in the first 400 test cases. Analysis using the Fleiss-Cohen kappa coefficient showed substantial agreement between preoperative and intraoperative scores (k value = 0.76; 95% confidence interval = 0.71 to 0.81). CONCLUSION: A grading system of the preoperative difficulties of each phacoemulsification procedure is provided. This system is easy to complete and interpret and can be transmitted to the surgeon, patient, and anyone who may subsequently examine the case.

Near vision restoration with refractive lens exchange and pseudoaccommodating and multifocal refractive and diffractive intraocular lenses: comparative clinical study.

PURPOSE: To evaluate near visual performance after implantation of a pseudoaccommodating intraocular lens (IOL) (Crystalens AT-45, eyeonics) or a multifocal IOL (refractive model, AMO Array; diffractive model, AcriTec TwinSet) after lens surgery. SETTINGS: Instituto Oftalmologico de Alicante, Miguel Hernandez University, Alicante, Spain. METHODS: Forty patients were included in this prospective clinical comparative study. The patients were divided into 3 groups according to the type of IOL implanted. Group 1 included 24 eyes (12 patients) implanted with the Crystalens IOL; Group 2, 32 eyes (16 patients) with the Array IOL, and Group 3, 24 eyes (12 patients) with the TwinSet IOL. Bilateral phacoemulsification and IOL implantation were performed in all patients, and the follow-up was 1 year. The postoperative main visual outcome evaluations were uncorrected and best corrected distance and near visual acuities, mean add for near, and best distance-corrected near acuity. RESULTS: In Group 1, the mean uncorrected near acuity was 20/40 preoperatively and 20/25 after 1 year. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 2, the mean uncorrected near acuity was 20/40 and 20/25, respectively. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 3, the mean uncorrected near acuity was 20/63 preoperatively; after 1 year, it was approximately 20/25. The mean best distance-corrected near acuity was 20/50 and 20/25, respectively. A neodymium:YAG laser capsulotomy was performed for posterior capsule opacification when required, with no change in the refractive outcome. CONCLUSIONS: Implantation of multifocal and pseudoaccommodating IOLs provides adequate near vision restoration. The TwinSet IOL provided faster recovery of near vision than the other 2 IOLs. The Crystalens IOL provided less postoperative visual phenomena with favorable near vision. The Array IOL achieved the most comfortable distance and near vision.

Large-spot subthreshold transpupillary thermotherapy for chronic serous macular detachment.

PURPOSE: To report the effect of subthreshold transpupillary thermotherapy (TTT) in treating serous detachment of the neurosensory retina secondary to chronic central serous chorioretinopathy (CCSC). METHODS: Seven eyes from five patients with CCSC, persistent serous detachment of the neurosensory retina and a clinical course of between 12 and 60 months were treated. All eyes received large-spot TTT guided by indocyanine green angiography (ICGA). Subthreshold TTT was performed using an 810 nm diode laser with a spot size of 3.0 mm (power was set at 350 mW). Treatment was applied for 60 seconds to the areas of choroidal hyperfluorescence on ICGA. RESULTS: The mean number of TTT sessions was 1.4 ± 0.5. All eyes were followed up for at least 6 months (mean 9.6 ± 3.2 standard deviation; range 6-12 months). The mean logarithm of the minimum angle of resolution best-corrected visual acuity was significantly better compared with baseline. All TTT-treated eyes had stable or improved vision (P < 0.001). Mean optical coherence tomography (OCT) central foveal thickness was significantly lower in all patients (P < 0.001) compared with pretreatment OCT, with a reduction in subretinal fluid and resolution of serous detachment associated with anatomical fovea restoration. No patient had any treatment-related side effects. CONCLUSION: Modified subthreshold TTT appears to have a beneficial effect in treating patients with CCSC and persistent neurosensory detachment. The encouraging results and lack of visually significant complications suggest that further investigation is warranted.

Cytokine and chemokine levels in tears and in corneal fibroblast cultures before and after excimer laser treatment.

PURPOSE: To measure multiple cytokine and chemokine production in tears of myopic patients before and after laser in situ keratomileusis (LASIK) and in human corneal fibroblast (HCF) cultures before and after excimer laser treatment. SETTING: Department of Neuroscience, Ophthalmology Unit, University of Padua, Italy and Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain METHODS: Tear samples were obtained from 15 myopic patients before LASIK and 1 and 24 hours after LASIK. Quiescent HCF cultures were treated using the same laser energy. Culture medium was collected before treatment and after 1 and 24 hours. Cytokine concentrations were determined using multiplexed bead analysis. RESULTS: Compared with baseline values, interleukin (IL)-12 tear levels were significantly increased 1 hour after surgery and eotaxin levels were significantly increased at 24 hours (both P<.05). Culture medium of HCF contained high levels of IL-6, IL-8, and monocyte chemotactic protein (MCP)-1 and low levels of IL-1, eotaxin, and regulated on activation, normal T expressed, and secreted (RANTES) cytokine. One hour after treatment, levels of all cytokines were significantly reduced. At 24 hours, IL-1, IL-6, IL-8, and MCP-1 levels were significantly increased compared with values at baseline and at 1 hour while RANTES cytokine and eotaxin levels had returned to baseline levels. CONCLUSIONS: In vivo and in vitro studies showed that after excimer laser treatment, cytokines are released to modulate the wound-healing process; however, they can potentially induce inflammation. However, these types of in vitro studies, although useful for evaluating changes in cytokine profiles before and after treatment, only partially reproduce in vivo corneal behavior.

Follow-up of age-related macular degeneration patients treated by photodynamic therapy with optical coherence tomography 3.

BACKGROUND: Photodynamic therapy (PDT) has been described to effectively reduce or delay severe vision loss in eyes with predominantly classic form of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Optical coherence tomography 3 (OCT3) is a non-invasive diagnostic procedure which provides information about retinal thickness and volume at the posterior pole, as well as about the presence of certain structures under the retina. METHODS: Prospective interventional study. Eleven eyes (9 patients) with AMD and CNV were treated with Verteporfin PDT. A complete ophthalmologic examination was performed. Fluorescein angiography (FA) and OCT3 scans were performed before treatment and 1, 2, 4, and 12 weeks after it. RESULTS: Two different patterns of changes were observed. One group (7 eyes) showed changes in the amount of subretinal fluid (decrease, increase, and finally stable decrease), with a reduction in the CNV and the appearance of a subretinal band of hyperreflective tissue. The second group (4 eyes) showed little or no changes in retinal thickness, fluid, or reflectivity. CONCLUSION: Changes observed in OCT3 scans represent variations in retinal thickness, fluid, and CNV after PDT. OCT3 provides a useful tool in the follow-up and measurement of changes appeared in eyes with CNV associated to AMD after treatment with PDT.