Bilateral Implantation of Multifocal Intraocular Lenses: 10-Year Follow-Up.

PURPOSE: To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs). METHODS: This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patients' satisfaction, and spectacle independence. RESULTS: All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification. CONCLUSION: MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence.

Unilateral Optic Neuritis: A Rare Complication after Measles-Mumps-Rubella Vaccination in a 30-Year-Old Woman.

Purpose. To report a case of unilateral optic neuritis following Measles-Mumps-Rubella (MMR) vaccination. Methods. A 30-year-old female developed unilateral optic neuritis five days after a Measles-Mumps-Rubella (MMR) booster vaccination. The patient displayed unilateral involvement, with severe visual loss. However, visual acuity improved significantly after four days of intravenous steroid therapy with 500 mg/day of methylprednisolone. Conclusions. Optic neuritis is one of the rare complications associated with the mumps, measles, and rubella vaccine. It may be a toxic reaction to the nonviral component of the vaccine, but the exact etiology is unknown. Postvaccination neuritis is generally bilateral and usually affects children. In adults, unilateral optic neuritis is usually correlated with multiple sclerosis (MS).

The Italian Catquest-9SF cataract questionnaire: translation, validation and application.

BACKGROUND: To validate the Catquest-9SF questionnaire in Italian, assess the change in visual disability with cataract surgery and determine the correlation between pre-operative Catquest-9SF scores and Lens Opacities Classification System (LOCS) III cataract grading. METHODS: Prospective, questionnaire validation study. The Catquest-9SF questionnaire was forward and back translated and completed by 209 Italian patients before and three months following cataract surgery. Rasch analysis was used to assess its psychometric properties. RESULTS: The Italian Catquest-9SF demonstrated ordered response categories, unidimensionality (item fit statistics range: 0.73-1.34), adequate person separation (2.04), and no differential item functioning. Mistargeting was evident with a mean difference in item difficulty and person ability of 2.04 logits but improved with inclusion of pre-operative data only. There was a statistically significant (Friedman tests, p < 0.001) median improvement in visual disability of 1.92, 3.57, 1.44 and 2.94 logits in patients undergoing first eye surgery with and without ocular comorbidity, and second eye surgery with and without ocular comorbidity respectively. There was no statistically significant difference in the improvements among the four groups (Kruskal-Wallis H test, X (2) (3) = 5.445, p = 0.142). There was no correlation between Catquest-9SF scores and nuclear opalescence (r s = 0.049, p = 0.478), nuclear colour (r s = 0.008, p = 0.909), cortical (r s = 0.066, p = 0.341), and posterior subcapsular components (r s = 0.048, p = 0.494). CONCLUSIONS: The Italian Catquest-9SF demonstrated good psychometric properties and is suitable for use in Italian speaking patients. There were similar improvements in visual disability in patients undergoing first or second eye surgery, with or without ocular comorbidity. There was no correlation between pre-operative Catquest-9SF scores and LOCS III cataract grading.

Subjective quality of vision before and after cataract surgery.

OBJECTIVE: To investigate the effect of cataract surgery on subjective quality of vision. METHODS: The Quality of Vision (QoV) questionnaire (Italian translation) was completed before and 3 months after cataract surgery in 4 groups of patients recruited from September through December 2010: first eye with ocular comorbidity, first eye without ocular comorbidity, second eye with ocular comorbidity, and second eye without ocular comorbidity. The questionnaire measures 3 aspects of quality of vision: frequency, severity, and bothersome nature of symptoms. The Lens Opacities Classification System (LOCS) III was used for cataract grading. Friedman and Kruskal-Wallis H tests were performed to compare QoV scores within and between groups. Spearman rank correlations (rs) were calculated to investigate the correlation between LOCS III and QoV symptoms. RESULTS: Two hundred twelve patients (mean [SD] age, 74.2 [8.7] years) were recruited, and 212 eyes were included in the study. Improvements in QoV scores were found in all 4 groups (P < .05). There were no statistically significant (P > .05) differences among the 4 groups in the improvement in QoV scores or in the preoperative or postoperative scores. Blurred vision was correlated with posterior subcapsular cataract (rs = 0.420, P = .04). CONCLUSIONS: Cataract in one or both eyes causes a similar loss in subjective quality of vision, which is also irrespective of the presence of ocular comorbidity. Posterior subcapsular cataract causes the specific symptom "blurred vision." Cataract surgery resulted in a large and comparable improvement in subjective quality of vision, regardless of ocular comorbidity and first or second eye surgery.

Stroke dynamics and frequency of 3 phacoemulsification machines.

PURPOSE: To measure the working frequency and the stroke dynamics of the phaco tip of 3 phacoemulsification machines. SETTING: University Eye Clinic of Trieste, Italy. DESIGN: Experimental study. METHODS: A video wet fixture was assembled to measure the working frequency using a micro camera and a micropulsed strobe-light system. A different video wet fixture was created to measure tip displacement as vectorial movement at different phaco powers using a microscopic video apparatus. RESULTS: The working frequency of the Infiniti Ozil machine was 43.0 kHz in longitudinal mode and 31.6 kHz in torsional mode. The frequency of the Whitestar Signature machine was 29.0 kHz in longitudinal mode and 38.0 kHz with the Ellips FX handpiece. The Stellaris machine had a frequency of 28.8 kHz. The longitudinal stroke of the 3 machines at different phaco powers was statistically significantly different. The Stellaris machine had the highest stroke extent (139 µm). The lateral movement of the Infiniti Ozil and Whitestar Signature machines differed significantly. No movement on the y-axis was observed for the Infiniti Ozil machine in torsional mode. The elliptical path of the Ellips FX handpiece had different x and y components at different phaco powers. CONCLUSIONS: The 3 phaco machines performed differently in terms of working frequency and stroke dynamics. The knowledge of the peculiar lateral and elliptical path strokes of Infiniti and Whitestar Signature machines may allow the surgeon to fully use these features for lens removal.

Optical coherence tomography measurements with the LENTIS Mplus multifocal intraocular lens.

BACKGROUND: To investigate optical coherence tomography (OCT) measurements following implantation of the LENTIS Mplus multifocal IOL, compared with a control group. METHODS: OCT scans were performed on 50 eyes with the Topcon 3D OCT-1000 in two groups of patients. The first group consisted of patients following implantation of the LENTIS Mplus, and a second group of age-matched control eyes following implantation of a monofocal aspheric IOL. Macular thickness and macular volume values were compared between groups and assessment for any onscreen visible artifacts. RESULTS: OCT scans were successfully performed in all 50 eyes with no visible artifacts in either group during scan acquisitions. There were no statistically significant differences (p > 0.05) in any measured or calculated macular thickness or volume values between the two groups. CONCLUSIONS: OCT measurements with the Topcon 3D OCT-1000 is possible and free from visible artifacts in eyes which have had the LENTIS Mplus multifocal IOL implanted. Macular thickness and volume values were similar to those of an age-matched control group of monofocal aspheric IOLs.

Subretinal recombinant tissue plasminogen activator and pneumatic displacement for the management of subretinal hemorrhage occurring after anti-VEGF injections for wet AMD.

We describe three cases of submacular hemorrhage that occurred two to four days after anti-VEGF intravitreal injection for occult choroidal neovascularisation in age-related macular degeneration and their management with 25 gauge pars plana vitrectomy with injection of subretinal recombinant tissue plasminogen activator (rTPA) followed by fluid-air exchange and postoperative prone position. Vitrectomy, subretinal rTPA injection and fluid-gas exchange apply as a safe and effective treatment in these cases. Functional results seem to be positive especially if surgical treatment is promptly performed.

Macular star secondary to nasal branch retinal vein occlusion.

An 83-year-old woman affected by nasal branch retinal vein occlusion with macular star underwent treatment with intravitreal triamcinolone acetonide injection followed by laser treatment addressed to the leaking vascular lesions. Visual acuity improved from 20/200 to 20/40 with a remarkable reduction of the macular exudates and resolution of dye leakage on fluorescein angiography over a 2-year follow-up. Nasal branch retinal vein occlusion may rarely occur with macular edema and macular star. Intravitreal triamcinolone acetonide injection and laser treatment of the leaking vascular lesions can result in visual function improvement over a 2-year follow-up.

Retinal nerve fibre layer of perimetrically unaffected eyes of glaucoma patients: an optical coherence tomography study.

PURPOSE: The aim of this study is to evaluate whether optical coherence tomography (StratusOCT) may detect early changes in perimetrically unaffected (PU) fellow eyes of glaucomatous patients by assessing retinal nerve fibre layer (RNFL) thickness parameters. METHODS: Thirty-seven glaucomatous patients with unilateral field loss and 34 age-matched controls were recruited. In glaucoma patients, PU and perimetrically affected fellow eyes were analysed separately. For each group, mean values (+/-SD) of RNFL thickness parameters were calculated and comparisons between fellow eyes of glaucoma patients and between healthy and PU eyes of glaucoma patients conducted with paired t-test and Mann-Whitney U-test, respectively. Proportion of clock-hour sectors flagged with probability <5% or <1% was collected and differences between healthy and PU eyes were evaluated on Fisher exact test. RESULTS: Global (Average Thickness) and sectoral parameters (Inferior and Nasal Average), Maximum thickness-minimum thickness (Max-min), as well as 2-o'clock (nasal side) and 6-o'clock sectors resulted significantly thinner in PU eyes than in control group. Proportion of eyes with clock-hour position flagged with probability <5% or <1% was not significantly different between healthy and PU eyes. CONCLUSION: Despite a standard automated perimetry within normal limits, the StratusOCT detected both localized and diffuse RNFL thinning in PU eyes of glaucoma patients. These eyes should be considered at risk of developing functional damage over time and consequently require thorough monitoring for detecting any sign of progression.

Scanning laser polarimetry - a review.

Glaucoma is a leading cause of irreversible blindness worldwide. Retinal ganglion cells and their axons represent the selective target of the disease. When visual function is still intact on standard automated perimetry and optic disc appearance is suspicious, an early diagnosis may be supported by the identification of a retinal nerve fibre layer (RNFL) defect in the peripapillary area. At present days, computer-based, real-time imaging of the peripapillary RNFL is available through instruments of easy use and with high levels of accuracy and reproducibility. Scanning laser polarimetry is performed by a confocal scanning laser ophthalmoscope with an integrated polarimeter (GDx-VCC). There is a considerable amount of scientific evidence about the role of this imaging technique for glaucoma diagnosis. The aim of this review is to describe the principles of operation, the examination procedure, the clinical role, the results of main diagnostic studies and the future development of the software for the scanning laser polarimetry.

Iatrogenic retinal traumas in ophthalmic surgery.

BACKGROUND: To describe the main retinal iatrogenic traumas possibly related to ophthalmic surgery and the precautions to be adopted to avoid them. METHODS: The article reviews the main peer-reviewed literature concerning retinal injuries caused by surgically related maneuvers. Safety measures alleged to inhibit any possible iatrogenic damage are also evaluated. RESULTS: Photochemical damage of the retina, retinal complications after strabismus surgery, retinal complications related to local anesthesia for ophthalmic surgery, retinal damage during cataract surgery and retinal damage during vitreoretinal surgery are the most common iatrogenic retinal injuries. Their incidence is related to risk factors peculiar to each condition. CONCLUSIONS: Ophthalmic surgeons are aware that there are a number of circumstances in which several undesirable retinal iatrogenic injuries might occur, sometimes with serious consequences. This is why surgeons should take every precaution at each surgical step to avoid any possible retinal iatrogenic damage.

Autofluorescence in adult-onset foveomacular vitelliform dystrophy.

PURPOSE: To describe fundus autofluorescence (FAF) characteristics of adult-onset foveomacular vitelliform dystrophy (AOFVD) and to perform a comparative evaluation of FAF patterns and functional response. METHODS: Fifteen patients with AOFVD and 10 healthy volunteers underwent complete ophthalmic examination, including visual acuity determination (Early Treatment Diabetic Retinopathy Study charts), blue-light autofluorescence (BL-AF) analysis, near-infrared autofluorescence (NIR-AF) analysis, and microperimetry. RESULTS: : Three different patterns of BL-AF (normal, focal, and patchy) and two of NIR-AF (focal and patchy) were identified in AOFVD. Abnormal BL-AF and NIR-AF patterns were detectable in 86% and 100% of cases, respectively. Patchy BL-AF and NIR-AF patterns are associated with the worst functional outcomes. CONCLUSIONS: AOFVD can be associated with different FAF patterns. A functional correlate with visual acuity and retinal sensitivity, measured by means of microperimetry, can be found.

Verteporfin photodynamic therapy for anterior segment neovascularization secondary to ischaemic central retinal vein occlusion.

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for anterior segment neovascularizations (ASNVs) in patients affected by ischaemic form of central retinal vein occlusion (CRVO). METHODS: Prospective non-comparative case series including 10 consecutive patients (10 eyes) affected by ischaemic CRVO. Main outcome measure was the obliteration of ASNV. RESULTS: One month after PDT, biomicroscopic examination showed partial obliteration of iris new vessels and complete closure of angle neovascularization. Iris fluorescein angiography performed 1 week after treatment showed partial closure of the iris new vessels with no evidence of leakage in the late phases. During the subsequent examinations, a partial reopening of the iris and angle new vessels in association with dye leakage on fluorescein angiography was evident. In any case, the fluorescein leakage turned out to be still reduced with respect to the baseline aspects. CONCLUSIONS: Our results show that PDT with verteporfin can partially obliterate ASNVs in eyes affected by ischaemic CRVO preventing from the evolution towards advanced stages of neovascular glaucoma, but is not effective in cases with complete angle synechial closure.

Grid laser treatment for exudative retinal detachment secondary to ischemic branch retinal vein occlusion.

PURPOSE: To evaluate the effectiveness of macular grid laser photocoagulation (MGLP) in obtaining the reabsorption of exudative retinal detachment (ERD) in patients with ischemic branch retinal vein occlusion (BRVO). METHODS: Prospective, randomized clinical trial including 31 patients with ERD secondary to ischemic BRVO, who were randomized either to MGLP or to observation. A complete ophthalmologic examination was performed within 7 days of treatment, and was arranged to be repeated regularly every 6 months for 24 months. MGLP was performed using a krypton laser with a spot size of 100 microm at 0.1 second. The main outcome measure was the number of eyes that had gained at least 15 letters at the 24-month examination in the two groups. RESULTS: By the month 24 visit, 40% of the patients in the MGLP group had gained at least three lines of visual acuity as opposed to no patient in the control group. The mean best-corrected visual acuity passed from 20/160 to 20/125 Snellen equivalent in the MGLP group, and from 20/160 to 20/400 Snellen equivalent in the control group at month 24. The difference in the mean reabsorption time was statistically significant (P < 0.001) comparing the treated group with the controls (9.1 versus 15.8 months). CONCLUSION: Natural history of ERD secondary to ischemic BRVO is poor, and MGLP is able to prevent visual acuity deterioration through a 24-month follow-up.

Panretinal photocoagulation and photodynamic therapy for anterior segment neovascularization secondary to ischemic central retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To compare the effects of panretinal photocoagulation (PRP) and photodynamic therapy (PDT) for anterior segment neovascularization secondary to ischemic central retinal vein occlusion (CRVO). PATIENTS AND METHODS: Fifty-seven eyes were randomized to receive standard PRP (19 eyes), selective PRP (20 eyes), or PDT (17 eyes). Selective PRP was performed only when iris neovascularization and/or angle neovascularization showed progression on weekly follow-up. Primary outcome measures were the extension of anterior segment neovascularization and the rate of neovascular glaucoma development. Secondary outcome measures included visual acuity results. RESULTS: After 12 months of follow-up, iris neovascularization extension was 0.52, 2.55, and 2.27 in the PRP, selective PRP, and PDT groups, respectively. Anterior segment neovascularization extension was 0.57, 1.50, and 1.27 in the PRP, selective PRP, and PDT groups, respectively. Both showed a statistically significant difference in the PRP group. The rate of neovascular glaucoma development was similar in the three groups. CONCLUSIONS: Although PRP was better at determining iris neovascularization and anterior segment neovascularization regression, the similar rate of neovascular glaucoma development found in the three groups indicates that anterior segment neovascularization secondary to ischemic CRVO can also be safely managed using selective PRP or PDT.

Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopia.

PURPOSE: To describe changes in the retinal pigment epithelium (RPE) induced by photodynamic therapy (PDT) in eyes with subfoveal choroidal neovascularization (CNV) associated with pathological myopia (PM). METHODS: We carried out an open-label, prospective, interventional case series including 26 patients affected by subfoveal CNV in PM who underwent PDT with a 12-month follow-up. Particular attention was paid to the detection of changes at the RPE level in the areas exposed to the laser compared with baseline conditions. RESULTS: The median age of the patients was 58.5 years and the median duration of symptoms was 2 weeks. A pigmentary zone was present before PDT in 20 eyes (77%), incompletely encircling the CNV in all but two of the 20 eyes. At the end of the follow-up, the CNV in all eyes was seen to be completely or incompletely encircled by a band of hyperpigmentation, which was surrounded by RPE alterations, including depigmentation in all cases and atrophic changes in 14 eyes. CONCLUSIONS: After PDT, alterations in the RPE develop in myopic eyes. These include accentuation of the pigmentary zone surrounding the CNV and progressive atrophic changes. Further studies are needed to correlate post-PDT RPE damage with longterm visual outcome.

Correlation between optic disc area and retinal nerve fiber layer thickness: a study on scanning laser polarimetry with variable corneal compensation.

PURPOSE: To evaluate if a significant increase of the peripapillary retinal nerve fiber layer (RNFL) thickness can be measured in a sample of healthy eyes by means of scanning laser polarimetry with variable corneal compensation (GDx-VCC) as the optic disc (OD) area increases. METHODS: One eye each of 232 healthy subjects (mean age: 57.8 years; range:40-70) was considered. Temporal-superior-nasal-inferior-temporal average (TSNIT Avg) and OD area (area within the ellipse placed on inner border of peripapillary scleral ring) values were collected. Ellipse horizontal and vertical diameters provided on printout were used to estimate OD area using the equation: OD area = pi x horizontal radius x vertical radius. TSNIT Avg values were plotted against OD area and a multiple linear regression including age calculated. RESULTS: Mean OD area was 2.19 mm(2)+/-0.45 (range: 1.23-3.59) and mean TSNIT Avg was 54.3 micro +/- 3.2 (range: 45.8-61.8). Multiple linear regression equation was TSNIT Avg=57.7-0.096 x OD Area-0.055 x Age (Pearson r=-0.146: p=0.086) CONCLUSION: In our sample of healthy eyes, no significant correlation was found between TSNIT Avg and OD area. In spite of a shorter distance between OD and measurement ellipse margins, larger discs did not necessarily show a thicker RNFL. Probably the large inter-subject variability for RNFL thickness, and then for axonal count, was a predominant factor over OD area.

Subretinal neovascular membrane associated with type 2a idiopathic juxtafoveolar telangiectasis in pseudoxanthoma elasticum.

BACKGROUND: The objective was to report a case of pseudoxanthoma elasticum associated with type 2A idiopathic juxtafoveolar telangiectasis (T2AIJT) complicated by bilateral subretinal neovascular membranes (SRNVM). METHODS: The right eye with juxtafoveal SRNVM and the left eye with subfoveal SRNVM underwent laser photocoagulation and photodynamic therapy respectively. The follow-up duration was 48 months. RESULTS: Best corrected visual acuity was 20/32 in both eyes at baseline, and 20/32 in the right eye and 20/200 in the left eye at the end of the follow-up. Atrophic changes in the retinal pigment epithelium developed around the SRNVM treated with photodynamic therapy (PDT). CONCLUSIONS: Pseudoxanthoma elasticum may be associated with T2AIJT complicated by bilateral SRNVM. Further studies are needed to assess both efficacy and appropriate PDT regime in T2AIJT-related SRNVM, especially if associated with other conditions.

Subthreshold grid laser treatment of macular edema secondary to branch retinal vein occlusion with micropulse infrared (810 nanometer) diode laser.

PURPOSE: To compare the effectiveness of subthreshold grid laser treatment (SGLT) with an infrared micropulse diode laser with that of threshold grid laser treatment (TGLT) for macular edema secondary to branch retinal vein occlusion (BRVO). DESIGN: Randomized clinical trial. PARTICIPANTS: Thirty-six patients (36 eyes) were randomized either to infrared SGLT (17 eyes) or to krypton TGLT (19 eyes). METHODS: Complete ophthalmic examinations, including determination of visual acuity (VA) with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography (OCT), and fluorescein angiography, were performed at the time of the study entry and at 6-month intervals, with a planned follow-up of 24 months. MAIN OUTCOME MEASURES: Primary: decrease in mean foveal thickness (FT) on OCT. Secondary: changes of the total macular volume (TMV) over the follow-up, proportion of eyes that gained at least 10 letters (approximately > or =2 lines of VA gain) at the 12- and 24-month examinations, and timing of macular edema resolution. RESULTS: Changes in mean FT and TMV from the initial values were statistically significant for TGLT from the 6-month examination (P<0.001) and for SGLT from the 12-month examination (P<0.001). After 1 year, there was no difference in mean FT and TMV between the 2 groups. At the 12-month examination, 10 patients of the SGLT group (59%) and 11 of the TGLT group (58%) gained at least 10 letters (2 lines) in VA. At the 24-month examination, this gain was achieved by 11 patients (65%) of the SGLT group and 11 (58%) of the TGLT group. Moreover, at the 24-month examination 59% and 26% gained 3 lines in the SGLT and TGLT groups, respectively. CONCLUSIONS: Resolution of macular edema and VA improvement are similar to those obtained with conventional TGLT, but SGLT is not associated with biomicroscopic and angiographic signs. A multicenter randomized clinical trial would be needed to ascertain the real efficacy and the most appropriate settings of SGLT for macular edema secondary to BRVO.