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1.
Eur J Ophthalmol ; 34(2): 529-533, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37654069

ABSTRACT

PURPOSE: comparison between two anesthetic techniques on the ability to reduce pain during panretinal photocoagulation (PRP) treatment. METHODS: Observational retrospective single center study. Medical charts of patients who underwent PRP for proliferative diabetic retinopathy were revised. Patients were included if they had the first eye treated with oxybuprocaine hydrochloride drops, and in case of severe pain, the fellow eye received topical anesthesia in combination with 2% subconjunctival lidocaine. The groups were compared for pain perception using an analog visual scale (VAS), number of laser spots, number of interruptions, and laser session duration. RESULTS: Forty-two eyes of 21 patients (mean age: 58.3 ± 7.6 years) were analyzed. The mean number of laser spots was significantly higher under combined anesthesia (+84.2 ± 155.9 spots, p = 0.01), with a reduced time for laser execution (-2.5 ± 3.12, p = 0.0008). The use of combined anesthesia significantly decreased the number of interruptions (-40.8%, p < 0.0001) into a single session. On the pain grading scale, the pain perception was significantly lower in the combined anesthesia group (p < 0.0001). In eyes receiving topical anesthesia the treatment was stopped for pain in 5 eyes (23.8%), while 5 eyes under combined anesthesia presented subconjunctival hemorrhage (23.8%). CONCLUSION: Using combined anesthesia in patients subjected to PRP appeared to reduce pain perception limiting the treatment duration and the interruptions for pain without significant complications. Further studies on a larger scale would be desirable to replicate such findings and standardize the analgesic procedures in ophthalmology.


Subject(s)
Diabetes Mellitus , Diabetic Retinopathy , Humans , Middle Aged , Aged , Diabetic Retinopathy/surgery , Retrospective Studies , Laser Coagulation/methods , Anesthesia, Local , Pain/etiology
2.
Clin Ter ; 173(4): 377-383, 2022.
Article in English | MEDLINE | ID: mdl-35857057

ABSTRACT

Objectives: Nab-paclitaxel is a chemotherapeutic drug used to treat various solid malignant tumors. It was conceived with a solvent free formulation to overcome toxicity events and hypersensitivity reactions associated with paclitaxel. However, it still carries ocular adverse effects. The present review examines nab-paclitaxel related cystoid macular edema (CME) and the available therapeutic options. Materials and Methods: The literature was reviewed on nab-paclitaxel related CME on published articles through January 2021 using the keywords "nab-paclitaxel "and "cystoid macular edema". Results: Bilateral CME is found in patients in treatment with nab-paclitaxel and causes considerable visual acuity decline. In ophthalmology multimodal imaging has an integral role in the diagnostic work up of patients and shows characteristic findings in nab-paclitaxel related CME. The case of a patient with treatment for bilateral CME is presented and analyzed. Conclusions: The preferred management strategy for nab-paclitaxel-related CME is drug cessation that leads to complete resolution of edema. When discontinuation of treatment is not possible due to the systemic conditions of patients, effective alternative therapeutic modalities are topical dorzolamide or steroidal treatment. Given the higher complication hazards of intravitreal therapy topical treatment should be preferred owing to comparable efficacy.


Subject(s)
Antineoplastic Agents, Phytogenic , Macular Edema , Neoplasms , Albumins/adverse effects , Antineoplastic Agents, Phytogenic/adverse effects , Humans , Macular Edema/chemically induced , Macular Edema/drug therapy , Neoplasms/drug therapy , Paclitaxel/adverse effects , Tomography, Optical Coherence
3.
Eur Rev Med Pharmacol Sci ; 21(4): 662-668, 2017 02.
Article in English | MEDLINE | ID: mdl-28272719

ABSTRACT

OBJECTIVE: To assess vitreous and plasma changes of vascular endothelial growth factor A (VEGF-A), adrenomedullin (ADM) and endothelin-1 (ET-1) in proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: 9 patients with PDR in type 2 diabetes (T2DM) and 11 age-matched non-diabetic patients were enrolled. The levels of VEGF-A, ADM and ET-1 were measured using an enzyme (ELISA) and a radioimmunoassay (RIA) both in vitreous and plasma samples. RESULTS: Vitreous ADM and VEGF-A levels were significantly higher in PDR patients (p=0.04 and p=0.02), whereas no differences were found in ET-1 levels (p=0.29). Plasma ADM levels were significantly higher in the PDR group (p<0.01), whereas no significant differences were found in the plasma ET-1 and VEGF-A levels (p=0.30 and p=0.37). The ADM vitreous/plasma ratio was significantly reduced in PDR group. CONCLUSIONS: The role of ET-1 in advanced PDR is still controversial; it has been supposed a role limited to induce hypoxic state and promote angiogenesis in the early phases. Once the neo-angiogenic process starts, other mediators are mainly involved as VEGF and ADM. Our findings suggest that ADM is an important marker of advanced PDR as well as VEGF. Conversely, ET-1 is not significantly involved in the advanced stage of PDR.


Subject(s)
Adrenomedullin/metabolism , Diabetic Retinopathy/metabolism , Endothelin-1/metabolism , Vascular Endothelial Growth Factor A/metabolism , Adrenomedullin/blood , Adult , Aged , Aged, 80 and over , Case-Control Studies , Diabetes Mellitus, Type 2/metabolism , Endothelin-1/blood , Endothelium, Vascular/metabolism , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged , Vascular Endothelial Growth Factor A/blood , Vitreous Body/metabolism
4.
Clin Ter ; 164(2): e127-31, 2013.
Article in Italian | MEDLINE | ID: mdl-23698214

ABSTRACT

Filariasis or Loiasis is an eye infection caused by a parasite belonging to the species Loa loa, also known as "African eye worm" since it is present in the rainforests belt of western and central Africa. The purpose of this study is the description of a clinical case presented to our department. A 40-years-old Congolese woman, in the third month of pregnancy, complained a foreign body sensation in the right eye for which she was submitted to complete ophthalmologic examination. Slit-lamp examination revealed, in the infero-temporal subconjunctival space, the presence of a live whitish worm that moved slowly in the thickness of the tissues. Place a clinical suspicion of subconjunctival filariasis, were performed parasitological and serological analysis; laboratory test showed peripheral blood eosinophilia and the blood film examination was negative for the presence of circulating microfilariae. The worm was surgically removed under topical anesthesia and the histological examinations of the parasite confirmed that it was an adult male worm belonging to the species Loa loa. Due to the large increase of migratory flows to Europe, number of reports of loiasis is becoming more frequent; the knowledge of this emerging pathogens is essential for diagnosis and treatment planning.


Subject(s)
Conjunctival Diseases/parasitology , Loiasis , Adult , Conjunctival Diseases/diagnosis , Conjunctival Diseases/therapy , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/therapy , Female , Humans , Italy , Loiasis/diagnosis , Loiasis/therapy
5.
Panminerva Med ; 2012 Nov 09.
Article in English | MEDLINE | ID: mdl-23138727

ABSTRACT

X-linked Retinoschisis is a bilateral retinal disease with a recessive X-linked inheritance, characterized by a macular involvement. Maculopathy consists of bilateral star-shaped microcystic changes. Peripheral retina is sometimes involved with schisis. In two years, were examined 10 eyes of 5 male patients (age range 20-25 years old) with X-linked Juvenile Retinoschisis and progressive reduction of visual acuity. Macular alterations were classified as: Typical foveal schisis; Altered foveal reflection; Lines of pigmentary demarcation; Retinal pigmentary epithelium atrophy; Hole in retinal internal layer. OCT images showed a separation of neurosensorial retina that coincided with classical histopathological findings. Examination results were correlated with clinical examination and compared with ERG findings. OCT images underline an increase of retinal thickness with a separation in the nerve fiber layer in the foveal space.

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