Nab-Paclitaxel related cystoid macular edema.

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.

Intracameral epinephrine without the addition of intracameral lidocaine in the management of tamsulosin associated intraoperative floppy iris syndrome.

OBJECTIVE: Intracameral mydriatics using epinephrine associated with lidocaine have been reported as efficacious in reducing intraoperative floppy iris syndrome (IFIS) complications during cataract surgery. The aim of this study was to verify the efficacy of intracameral epinephrine without intracameral lidocaine as prophylaxis against IFIS in patients on tamsulosin. MATERIALS AND METHODS: This was a retrospective study on the results of cataract surgery in 18 patients on therapy with tamsulosin. Patients had undergone routine phacoemulsification in one eye. Successively, they underwent phacoemulsifcation in the fellow eye using non preserved intracameral epinephrine 1:4000 diluted with BSS. Intraoperative complications during cataract surgery had been documented and IFIS was graded based on iris billowing, miosis or iris prolapse. Follow-up was 3 months. RESULTS: Thirty-six eyes of 18 patients were included in the evaluation. The incidence of IFIS was significantly higher in the eyes where routine phacoemulsificaton had been performed (100%) with respect to eyes where phacoemulsification was carried out using intracameral epinephrine (33%) (Chi Square test =15.12, p<0.001). In routine phacoemulsification 16 eyes showed iris billowing, 14 eyes had some extent of miosis and 14 eyes had tendency to iris prolapse. In phacoemulsification with the use of intracameral epinephrine 5 eyes showed iris billowing, 4 eyes presented some extent of miosis and 2 eyes had tendency to iris prolapse. There were no serious intraoperative complications. CONCLUSIONS: Intracameral epinephrine without the addition of lidocaine was efficacious in the management of IFIS in patients on tamsulosin.

An update on intravitreal implants in use for eye disorders.

Advanced biotechnological techniques and new polymers have led to the development of many innovative intravitreal drug delivery systems. Some designs are still in an experimental phase while others have gained widespread acceptance and are commercially available. Since steroids are a mainstay of therapy for uveitis and macular edema, new intravitreal implants have been developed to provide continuous release of corticosteroids over prolonged spans of time with reduced systemic adverse effects. Today, three long-acting corticosteroid implants are commercially available: the fluocinolone acetonide implants Retisert® and Iluvien® and the dexamethasone drug delivery system Ozurdex®. They offer an alternative route in the management of macular edema due to uveitis, retinal vein occlusion, diabetes and pseudophakia. Their advantage over treatment with steroid injections and the anti-vascular endothelial growth factor ranibizumab is the long-term control of inflammation and macular edema with a reduced frequency of administration. Their potential side effects are cataract and glaucoma, therefore, careful patient selection and monitoring is essential. Further studies are warranted to define the relative efficacy and indications for each treatment option. The development of new devices is a future challenge in the strive to improve drug delivery systems.

Intravitreal bevacizumab in the successful management of choroidal metastases secondary to lung and breast cancer unresponsive to systemic therapy: a case series.

PURPOSE: Management of choroidal metastases is commonly with systemic chemotherapy; however, if tumours are refractory to treatment and vision is endangered, local therapy modalities are feasible. A novel option is the use of intravitreal bevacizumab. This report presents three cases of choroidal metastatic tumours secondary to lung and breast cancer treated with intravitreal bevazizumab. PATIENTS AND METHODS: Three patients with choroidal metastases secondary to lung and breast tumours were treated at the Ophthalmology Unit, University of Rome 'Sapienza', S.Andrea Hospital from January 2009 to August 2012. All patients developed vision loss with diagnosis of chorioidal metastasis during systemic chemotherapy. Off label intravitreal bevacizumab treatment was performed with two 1.25 mg injections in two patients and four injections in one patient at 30-day intervals. RESULTS: Vision improved, subretinal fluid resolved, and choroidal tumour regression was obtained in all cases. Follow-up was 6, 9, and 12 months and there were no complications related to treatment. CONCLUSIONS: Intravitreal bevacizumab administration represented an efficacious therapeutic option with rapid effect in the treatment of choroidal metastatic tumours unresponsive to systemic therapy. It can have a role in the management of these tumours by preventing vision loss and improving the quality of life of patients.

Macular thickness changes evaluated with spectral domain optical coherence tomography after uncomplicated phacoemulsification.

PURPOSE: To determine macular thickness changes after uncomplicated cataract surgery using spectral domain optical coherence tomography (OCT). METHODS: This was a prospective non-randomized, clinical study. Data were analysed for 40 healthy patients undergoing uneventful phacoemulsification. OCT measurements were performed before surgery and postoperatively at day 1, week 1 and 2, and month 1, 2, 3, and 6. The retinal map was divided into central point thickness (CPT), central 1-mm subfield (CSF), and two peripheral ring areas with diameters of 3 and 6 m. Fellow eyes were used as controls. Retinal thickness change between the operated and fellow eyes were compared using unpaired t-test. Correlations were analysed using the Spearman or the Pearson analysis. RESULTS: There was a progressive significant increase in retinal thickness of the operated eyes compared with the fellow eyes, with a peak at 1 month (P<0.0001) for the 3- and 6-mm areas and a peak at 2 months for CPT and CSF (P=0.01 and P<0.0001, respectively). At 6 months, retinal thickness was still significantly increased only in the peripheral areas (P<0.0001). There was no significant correlation between macular thickness changes and preoperative factors (age, axial length, anterior chamber depth, posterior vitreous detachment, best-corrected visual acuity), intraoperative factors (length of surgery, effective phaco time, phaco energy) or BCVA change. CONCLUSIONS: The present study demonstrated a significant increase in macular thickness up to 6 months after uncomplicated cataract surgery. The most important finding was the regional pattern of retinal thickening with an early involvement of the parafoveal area.

[Ophthalmological signs in thyroid pathology: our experience]. / Semeiotica oftalmologica in pazienti affetti da distiroidismo: nostra esperienza.

AIM: The aim of our study was to highlight the palpebral and ocular signs in patients with thyroid dysfunction. These patients are sometimes poorly evaluated in routine check ups. This information is useful both to the practicing ophthalmologist but also to the specialist in endocrinology. PATIENTS AND METHODS: 100 patients were enrolled. The patients had been diagnosed with the Basedow-Graves-Flajani syndrome or had hypothyroidism or thyroidits. Orbital, adnexal and ocular signs were recorded in all patients. RESULTS: Seventeen oculopalpebral signs were observed in a total of 100 patients (73 females and 27 males). These were as follows: Dalrymple, Von Graefe, Rosenbach, Inglese, Gifford, Enroth, Jellinek, Stellwag, Jeffroy, Topolansky, Moebius, Suker, Sattler, Sainton, Ballet, Cowens, Exphothalmos. DISCUSSION: The specialist in endocrinology has many laboratory and clinical tools in the diagnosis of patients with thyroid dysfunction. However, with a better awareness of the oculopalpebral signs both the ophthalmologist and the endocrinologist can work together in a multidisciplinary team towards the management of these patients.

Incidental finding of double nodular microscopic hyperplasia versus adenoma of the retinal pigment epithelium in an eye eviscerated for phthisis bulbi.

Neoplasms of the retinal pigment epithelium (RPE) are very rare and can clinically simulate choroidal melanoma. The clinical, histopathological and immunohistochemical features of incidental double pseudo-neoplastic proliferation of the RPE in an eviscerated eye for phthisis bulbi are reported. The differential diagnosis of RPE neoplasms and the utility of histopatological examination of eviscerated/enucleated eyes are discussed.

Causes of blind certification in an Italian province and comparison with other European countries.

PURPOSE: Low vision and blindness are significantly growing in both industrialized and developing countries. In Italy there are few epidemiological studies that provide data on this phenomenon. In this paper we report the main causes of blindness and the characteristics of the subjects who obtained a disability certification due to blindness in an Italian province. MATERIALS AND METHODS: Disability certificates issued by the Civil Blind Provincial Commission of the Viterbo province over a 2-year period (2002-2003) were analysed. The causes of blindness and the age of occurrence were investigated and divided into 12 groups. RESULTS: The four most frequent causes of blindness were age related macular degeneration (19%), cataract (14%), glaucoma (15%) and diabetic retinopathy (15%). The main eye pathology which caused partial blindness was age related macular degeneration (22.3%). Glaucoma (19.6%) was the main cause of total blindness. CONCLUSIONS: The estimates of blindness were based on certification for visual impairment with limited characteristics as our data was exclusively administrative. However, a general appraisal of the magnitude and causes of visual impairment was determined. This is important towards planning appropriate preventive and management measures.

Bilateral acute angle closure glaucoma and myopia induced by topiramate.

Topiramate is used in the management of epilepsy and migraine. In the present paper we present a case of bilateral acute angle closure glaucoma associated with myopia following the use of topiramate. The patient was admitted to our ward. Complete ophthalmological examination was carried out along with ultrabiomicroscopy of the anterior segment and confocal microscopic study of the corneal endothelium. Patients on treatment with topiramate should be monitored during the first two weeks of therapy and the drug should be discontinued in case of visual disturbances or other ocular symptoms.

A new method of biofeedback in the management of low vision.

Twenty-eight patients with low vision were enrolled into the study. A preliminary study was carried out on 18 eyes of 13 patients with low vision who underwent visual rehabilitation with a new instrument for biofeedback (BF) applied to vision; improved biofeedback integrated system (Ibis). Successively, eight patients (16 eyes) with bilateral low vision were subjected to biofeedback in one eye. The experimental and control eye were evaluated separately. Then a placebo training was developed on seven patients (12 eyes). Visual acuity, colour vision, automated perimetry, contrast sensitivity and flash VEP were evaluated. A brief review of the literature and the possible mechanisms behind the results are discussed.

Ultrasound biomicroscopy of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts.

AIM: To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with pars plana cysts using ultrasound biomicroscopy (UBM). METHODS: 18 eyes of 12 patients with degenerative retinoschisis associated with pars plana cysts were selected through binocular indirect ophthalmoscopy and Goldmann three mirror lens examination, both with scleral depression. These patients were studied in detail with UBM. RESULTS: Study of the ciliary body with UBM showed pars plana cysts of different size and uneven shape. In cross sections the morphology of pars plana cysts in detail and the close relation of the cysts with the oral region and the peripheral retina, where areas of cystoid degeneration and retinoschisis were present, were observed. In transverse sections three main morphological aspects of pars plana cysts could be differentiated ("isolated," "confluent," and "clustered" cysts). Furthermore, ultrabiomicroscopy allowed differential diagnosis between retinoschisis and associated retinal detachment in six eyes. CONCLUSIONS: The study of peripheral degenerative retinoschisis and pars plana cysts is possible in vivo by means of UBM, showing the detailed morphology of the lesions (not otherwise evident through ophthalmoscopic examination) and the close relation between pars plana cysts, cystoid degeneration, and peripheral retinoschisis.

Excimer laser photorefractive keratectomy for hyperopia.

BACKGROUND AND OBJECTIVE: Photorefractive keratectomy (PRK) has been extensively evaluated for the correction of myopia. This study was undertaken to assess the safety, efficacy, and reliability of PRK in the correction of hyperopia. PATIENTS AND METHODS: There were 28 eyes with refractions of +1 to +7.75 D treated for hyperopia with the Chiron Technolas 217-C excimer laser. Thorough visual assessments were made before treatment and at regular follow-up to 18 months. Complications and patient satisfaction were noted. RESULTS: At 18 months the mean subjective refraction was +0.46+/-1.00 D with 26 eyes (92.8%) within 1 D of emmetropia. Thirteen eyes (46.4%) achieved uncorrected visual acuity (UCVA) of 20/20 or better and all patients had an UCVA of > or = 20/32 or better. Best corrected visual acuity (BCVA) remained unchanged in 26 eyes (92.8%) and improved in 2 eyes (7.2%). On the seventh day from treatment, 17 eyes (25%) had a loss of 2 or more lines of BCVA. At 15 days this was reduced to 8 eyes (14.3%) and at one month to 3 eyes (3.6%). There were no cases of loss of 2 or more lines of BCVA at 18 months of follow-up. All patients expressed a high degree of satisfaction. CONCLUSIONS: Photorefractive keratectomy safely and effectively reduced hyperopia in the patients studied. The technique was reliable and still offered good results at 18 months of follow-up.

Excimer laser photorefractive keratectomy for high myopia and myopic astigmatism.

BACKGROUND AND OBJECTIVE: To determine the efficacy, safety, and predictability of excimer laser photorefractive keratectomy of high myopia and myopic astigmatism. PATIENTS AND METHODS: 76 eyes of 52 patients with myopia from -8.00 to -23.50 diopters (D) with or without astigmatism up to -5.50D were treated with the VISX 20/20 excimer laser (VISK, Santa Clara, CA) and a multi-zone ablation technique. Visual acuity, manifest refraction, corneal haze, and topography were evaluated at 1 week and 1, 3, 6, 12, and 18 months postoperatively. RESULTS: Postoperative refractions were generally stable after 12 months. At the last follow-up all patients were within - 1.96 D of the intended correction. Eighteen months postoperatively, 68% of patients undergoing photorefractive keratectomy (PRK), and 65% of patients undergoing photo astigmatic refractive keratectomy (PARK), were within 1 D of planned refraction. Furthermore, 87% of patients after PRK and 80% of patients after PARK had a visual acuity of 20/40 or better. CONCLUSIONS: High myopia with or without astigmatism was successfully treated in most of the patients using PRK. The stability of the postoperative refraction during the first 18 months seems to be good. The incidence of adverse effects was low but improvements in the future should further reduce complications, thus increasing the safety of refractive procedures.

Ocular alterations in alopecia areata.

PURPOSE: To determine the ocular alterations occurring in alopecia areata with regard to the lens and fundus. METHODS: Seventy-five patients with alopecia areata were examined. Seventy healthy control patients unaffected by skin, ocular or systemic disorders were also studied. RESULTS: Symptomless punctate lens opacities were found in 38 (51%) patients, whereas only 2 (3%) control patients had similar lens changes. Fundus alterations were found in 31 (41%) cases of alopecia areata and in only 16 (23%) controls. CONCLUSIONS: These ocular alterations and their prevalence are reported and some theories regarding the possible aetiopathogenetic mechanisms are discussed.

Sturge-Weber syndrome associated with naevus of Ota.

The association of Sturge-Weber syndrome with naevus of Ota is an infrequently reported phenomenon and there are only four previously described cases in the literature. In this paper we briefly review the literature regarding the coexistence of vascular and pigmentary naevi and present an additional patient with the association of the Sturge-Weber syndrome and naevus of Ota.

Branch retinal artery occlusion in a young woman with Ménière's disease.

An unusual case of a 32-year-old woman with branch retinal artery occlusion is presented. The patient was affected by Ménière's disease and had a history of occasional migraine headaches. A thorough clinical and laboratory investigation showed a high cholesterol level. Retinal arterial obstruction is rare in young people and it is difficult to establish the precise cause. The presumed multifactorial etiologic factors are discussed.

Structural evidence for membrane lipid changes in human cataract.

Lipid changes in relationship to cataractogenesis were studied with histochemical methods (topoptical reactions) of polarization microscopy. Frozen section of formaldehyde-fixed human lenses were used for these studies. Six lenses were transparent and 14 lenses presented early to confluent cortical opacities. Cell membrane lipids of transparent lenses showed 8.0 +/- 2.7 nm light retardation. In the early cataractous lenses the light retardation of cell membranes was 23.3 +/- 5.0 nm and that of the fusiform and globular lipids was 37.7 +/- 4.0 nm and 48.5 +/- 6.9 mn, respectively. In the non transparent cortical regions of cataractous lenses, membrane lipids were not observed. Similar to other cell membranes, normal lens membranes are composed of loosely organized lipids. In early cataract lipid density uniformly increased along the cell membranes at the clinically transparent areas, while at the areas with clinically evident fine opacities, small fusiform and globuler lipid drops were formed by even more dense lipids. Confluent cortical cataracts were associated with disappearance of membrane lipids. In our study our findings demonstrated intramembrane lipid changes associated with cataractogenesis.

Fox's modified technique using the Mersilene mesh sling in the management of blepharoptosis.

BACKGROUND AND OBJECTIVE: Frontalis suspension is the best surgical procedure for severe ptosis with poor or absent levator muscle function. In addition to autologous fascia lata, a variety of materials are available for suspension. The authors describe the use of Mersilene mesh slings developed to overcome the problems of failure, slippage, and extrusion commonly associated with various suspensory materials. PATIENTS AND METHODS: Brow suspension was performed in 20 ptotic eyelids of 14 patients. All patients had severe ptosis with levator function of 4 mm or less. The surgical technique used was a modified version of the method originally described by Fox using the Mersilene mesh sling. RESULTS: The improvement in lid height was evaluated by preoperative and postoperative vertical aperture measurements and ranged from 2 to 5 mm (average 3.5 mm). The results were maintained in all cases during a follow-up period of 18 months. CONCLUSION: The good functional and cosmetic results suggest that Fox's modified technique using the Mersilene mesh sling has a definite place in ptosis management.

Optic nerve aplasia associated with macular 'atypical colobomà'.

A 12-year-old patient presenting with absence of the optic disc and retinal blood vessels associated with atrophic macular lesion was studied. A toxoplasma IgG antibody test had been found positive at the age of 4 months. This test and the clinical findings suggested the possibility of optic nerve aplasia with atypical macular coloboma due to congenital toxoplasmosis. The pro's and contra's concerning this hypothesis are discussed by the authors.