Retinal nerve fibre layer measurements and optic nerve head analysis in multiple sclerosis patients.

PURPOSE: To verify whether scanning laser polarimeter with the new variable corneal compensation algorithm (GDx VCC) and scanning laser ophthalmoscopy (Heidelberg Retina Tomograph (HRT)) allow measuring retinal ganglion cell loss in patients with multiple sclerosis (MS). PATIENTS AND METHODS: We enrolled 23 MS patients with a history of previous demyelinating monocular optic neuritis. Examination included visual evoked potentials (VEPs), scanning laser ophthalmoscopy, and scanning laser polarimeter. HRT was performed to assess optic nerve head (ONH) shape, while GDx VCC was used to evaluate the retinal nerve fibre layer thickness (RNFLt) around the ONH. Statistical analysis was performed comparing results obtained for each eye with the available normative database and with the unaffected fellow eye. RESULTS: When the affected eye group was compared to the fellow-eye group, a significant (P<0.05) difference was found for few GDx VCC parameters. In contrast, no significant correlation was observed between clinical assessment and imaging techniques when the normal database of HRT and GDx VCC was used. A significant association was observed between VEP latency and some GDx VCC parameters. CONCLUSIONS: Our results suggested that scanning laser polarimetry could detect loss of ganglion cells following demyelinating optic neuritis, but further studies are needed.

The effect of pneumatic trabeculoplasty on intraocular pressure: the results of a 6-month, open-label, multicenter study.

PURPOSE: To evaluate the effects of pneumatic trabeculoplasty (PNT) in ocular hypertension and glaucoma subjects. METHODS: A total of 63 consecutive subjects, either treated (79%) or untreated (21%), with intraocular pressure (IOP) between 20 and 25 mmHg were enrolled; the eye with higher IOP (or, in case of identical IOP, worse visual field) was treated with PNT, with the fellow eye used as control. Subjects underwent a baseline evaluation the day before treatment, two PNT treatments at day 0 and 7, visits at day 1, 8, 14, and at each month until the end of the study, which lasted 6 months. Safety was addressed at all visits; an IOP curve (at 8 and 10 AM, 2 and 4 PM) was obtained at baseline and during monthly visits. RESULTS: In PNT eyes, baseline IOP was 22.2-/+1.6 mmHg. Following PNT a statistically significant reduction of IOP occurred at all visits (p<0.0001), with a mean decrease ranging from -2.7-/+2.5 (-11.9-/+10.8%) to -3.6-/+2.6 mmHg (-16.0-/+11.6%); mean reduction was 12.8-/+11.5%. Although IOP diminished also in the control eyes after baseline (p<0.05), the change in IOP was significantly higher in PNT group at each visit (p<0.05). Mild side effects were experienced by 76% of subjects and they all resolved without sequelae. CONCLUSIONS: The results suggest the effect of this procedure in reducing IOP in glaucoma and ocular hypertensive subjects.

Rarebit perimetry and frequency doubling technology in patients with ocular hypertension.

PURPOSE: To test the capability of rarebit perimetry (RP), a recent non-conventional perimetric technique, in detecting early functional damage in subjects with ocular hypertension (OHT) and to compare RP findings with those obtained by frequency-doubling technology (FDT) perimetry. METHODS: Thirty patients with OHT were matched with 30 healthy subjects. All were tested with RP and FDT. Frequency-doubling technology mean deviation (MD) and pattern standard deviation (PSD), as well as RP mean hit rate (MHR), of the two groups were analyzed. The agreement between the two techniques was tested by Kappa analysis. RESULTS: In the OHT group the mean (SD) FDT MD was 0.5 (2.1), the mean (SD) FDT PSD was 4.2 (1.6), and the mean (SD) RP MHR was 81.4 (6.7). In the control group, corresponding values were mean (SD) FDT MD 1.1 (1.4), mean (SD) FDT PSD 3.0 (0.3), mean (SD) RP MHR 96.2 (2.0). The differences between the two groups were not significant for the studied indexes. Eleven (36.6%) out of the 30 OHT eyes had abnormal RP results; 12 (40.0%) eyes had abnormal FDT results. Five (16.6%) eyes had abnormal RP and FDT findings. Only 1 eye (3.3%) in the control group had abnormal RP results and 3 eyes (10.0%) had abnormal FDT results. RP and FDT showed a moderate agreement (Kappa=0.43; 95% CI: 0.42 to 0.51). CONCLUSIONS: RP and FDT showed VF defects not shown in standard automated perimetry in the OHT group. This may be indicative of an increased risk in developing glaucoma, even if a gold standard for detecting subtle defects is not currently available. RP has the additional advantage of not requiring any expensive device to be used. The poor agreement between these techniques in identifying eyes with early damage warrants further investigations. Large longitudinal studies are needed before defining the role of RP in early glaucoma diagnosis.

Crenosoma vulpis in dog: first case report in Italy and use of the FLOTAC technique for copromicroscopic diagnosis.

Crenosoma vulpis is a metastrongylid nematode that infects the bronchi, bronchioles, and trachea of wild and domestic canids and various other carnivores. It is endemic in the red fox population in the north-eastern parts of North America and in Europe, including Italy. Dogs are susceptible to infection with clinical signs consisting primarily in a chronic cough. The present paper reports-to the authors' knowledge-the first case of spontaneous C. vulpis infection in a dog in Italy. In addition, it also reports, for the first time, the use of the FLOTAC technique for C. vulpis diagnosis in canine fecal samples, with results compared to the following four standard copromicroscopic techniques: the Baermann technique, the McMaster technique, the simple flotation technique, and the Wisconsin technique. The results showed that the FLOTAC technique produced mean larvae per gram of feces greater than that produced by the other more widely used diagnostic tools. After the treatment of the C. vulpis infected dog with a single oral dose of 0.5mg/kg milbemycin oxime, the clinical signs resolved and the shedding of larvae ceased. In conclusion, the discovery of C. vulpis for the first time in a dog in Italy indicates that the fox lungworm should be considered in the differential diagnosis of respiratory disease in dogs; in addition, the findings of the comparison study showed that the FLOTAC technique may improve the ability to accurately diagnose canine lungworm infections.

Sector-based analysis of frequency doubling technology sensitivity and optic nerve head shape parameters.

PURPOSE: To evaluate which Heidelberg Retina Tomograph (HRT) parameter is the best predictor of frequency doubling technology (FDT) sensitivity by using a sector based analysis between FDT and optic nerve head shape parameters such as cup shape measure (CSM) and rim area (RA), which have been shown to have the best correlation with FDT indices among all the HRT parameters. METHODS: One eye was randomly chosen from 100 patients with primary open angle glaucoma (abnormal visual field and/or abnormal optic nerve and untreated intraocular pressure above 21 mm Hg). All the patients were examined with Humphrey field analyzer (HFA), program 24-2, SITA standard, FDT program C 20, and HRT. RA and CSM for the HRT analysis and mean deviation, pattern standard deviation, and the sensitivity of each tested point for the FDT test were considered in this study. All the parameters were calculated as both global and sector measurements. Findings were analyzed using Pearson's correlation coefficient and linear regression model. RESULTS: Significant (p<0.001) correlation was found between FDT indices and HRT RA and CSM. Significant (p<0.001) sector correlation was found between FDT sensitivity and RA and CSM, but when a linear regression model was applied, RA was the most predictive parameter of FDT. Temporal CSM was more strongly correlated to FDT fovea sensitivity than temporal RA. Furthermore, sector HRT parameters were better correlated to HFA than to FDT. CONCLUSIONS: In this glaucomatous group, cup shape measure and RA were significantly correlated to FDT indices. RA was more predictive of FDT abnormality than CSM in all the considered sectors except in the temporal one. However, HFA was a stronger predictor of HRT parameters than FDT.

Detection of glaucomatous optic nerve head by using Heidelberg topographic maps.

PURPOSE: To evaluate the capacity of a new topographic map analysis to detect abnormal optic discs from healthy ones in a new cohort of subjects. PATIENTS AND METHODS: Only one eye was chosen randomly from each subject included in the study. In total, 20 normal eyes with a normal visual field, an IOP of <22 mmHg and no history of glaucoma in their family, and 20 glaucomatous eyes with an abnormal visual field and an open angle were selected. All the subjects were examined with the Heidelberg Retina Tomograph (HRT, Heidelberg Engineering GMBH, Heidelberg, Germany) and Humphrey Perimeter, program 30-2 (Humphrey Instrument, Inc., San Leandro, CA, USA). Topographic maps analysis was performed to each HRT optic nerve head image. Sensitivity, specificity, and diagnostic precision were calculated. RESULTS: When the topographic map analysis was applied to the group, a sensitivity of 80%, a specificity of 75%, and a diagnostic precision of 77.5% were obtained. CONCLUSION: Using the topographic map analysis, the HRT capacity to differentiate normal optic discs from those with glaucoma was similar to those already published in the literature, but using this technique there is no input from the observer to draw the contourline and reference plane is not necessary.

Retinal pigment epithelial tear following intravitreal injection of bevacizumab (Avastin).

PURPOSE: To report one case of retinal pigment epithelium tear following intravitreal bevacizumab injection for neovascular age-related macular degeneration. METHODS: A 59-year-old patient presented with occult choroidal neovascularization associated with a serous pigment epithelial detachment secondary to age-related macular degeneration. The patient was treated with an intravitreal injection of bevacizumab. RESULTS: The patient developed a retinal pigment epithelium tear 60 days following the intravitreal injection. CONCLUSIONS: This report describes the development of retinal pigment epithelium tear after intravitreal bevacizumab injection. Future studies should be performed to evaluate which subtypes of lesions are most susceptible to this potential devastating visual complication.

Intravitreal triamcinolone acetonide as primary treatment for diffuse diabetic macular edema: a prospective noncomparative interventional case series.

PURPOSE: To evaluate the efficacy and safety of one intravitreal injection of 25 mg of triamcinolone acetonide as primary treatment for diffuse diabetic macular edema. METHODS: Intravitreal triamcinolone acetonide injection was performed in 30 eyes with previously untreated diabetic macular edema. The main outcome measures were logMAR visual acuity (VA) and central macular thickness (CMT) at 1, 3, and 6 months. A secondary outcome was intraocular pressure progression. RESULTS: Visual acuity results for 30 eyes that had a follow-up of at least 6 months are presented. Twenty of them were followed up to 10.1+/-2.38 months. Preoperatively, VA was 0.54+/-0.27. At 1, 3, and 6 months follow-up, VA was 0.44+/-0.29 (p=0.001), 0.43+/-0.28 (p=0.001), and 0.45+/-0.29 (p=0.006), respectively. Preoperatively, CMT was 417.3+/-143.5 microm. At 1, 3, and 6 months follow-up, CMT was 277.3 +74.0 microm (p<0.0001), 279.6+/-94.4 microm (p<0.0001), and 297.07+/-114.87 microm (p=0.002), respectively. For the 20 eyes with a follow-up of 10.1+/-2.38 months, VA was 0.5+/-0.25 and 0.50+/-0.32 at baseline and at the last follow-up visit, respectively (p>0.05). Preoperatively, intraocular pressure (IOP) was 15.13+/-1.48 mmHg. IOP was 18.26+/-2.71 mmHg, 20.07+/-4.27 mmHg, and 20.4+/-6.18 mmHg, at 1, 3, and 6 months, respectively (p<0.0001). Four eyes underwent uncomplicated filtrating surgery for intractable glaucoma. CONCLUSIONS: Intravitreal triamcinolone as primary treatment effectively increases VA and reduces CMT due to diffuse diabetic macular edema. Longer follow-up and randomized clinical trial are warranted. Safety results highlight the need to further study the relationship between triamcinolone and intraocular pressure.

Intravitreal triamcinolone acetonide as primary treatment for diffuse diabetic macular edema: A prospective noncomparative interventional case series.

PURPOSE: To evaluate the efficacy and safety of one intravitreal injection of 25 mg of triamcinolone acetonide as primary treatment for diffuse diabetic macular edema. METHODS: Intravitreal triamcinolone acetonide injection was performed in 30 eyes with previously untreated diabetic macular edema. The main outcome measures were logMAR visual acuity (VA) and central macular thickness (CMT) at 1, 3, and 6 months. A secondary outcome was intraocular pressure progression. RESULTS: Visual acuity results for 30 eyes that had a follow-up of at least 6 months are presented. Twenty of them were followed up to 10.1+/-2.38 months. Preoperatively, VA was 0.54+/-0.27. At 1, 3, and 6 months follow-up, VA was 0.44+/-0.29 (p=0.001), 0.43+/-0.28 (p=0.001), and 0.45+/-0.29 (p=0.006), respectively. Preoperatively, CMT was 417.3+/-143.5 micronm. At 1, 3, and 6 months follow-up, CMT was 277.3 +74.0 micronm (p<0.0001), 279.6+/-94.4 micronm (p<0.0001), and 297.07+/-114.87 micronm (p=0.002), respectively. For the 20 eyes with a follow-up of 10.1+/-2.38 months, VA was 0.5+/-0.25 and 0.50+/-0.32 at baseline and at the last follow-up visit, respectively (p>0.05). Preoperatively, intraocular pressure (IOP) was 15.13+/-1.48 mmHg. IOP was 18.26+/-2.71 mmHg, 20.07+/-4.27 mmHg, and 20.4+/-6.18 mmHg, at 1, 3, and 6 months, respectively (p<0.0001). Four eyes underwent uncomplicated filtrating surgery for intractable glaucoma. CONCLUSIONS: Intravitreal triamcinolone as primary treatment effectively increases VA and reduces CMT due to diffuse diabetic macular edema. Longer follow-up and randomized clinical trial are warranted. Safety results highlight the need to further study the relationship between triamcinolone and intraocular pressure. (Eur J Ophthalmol 2006; 16: 129-33).

Conventional perimetry, short-wavelength automated perimetry, frequency-doubling technology, and visual evoked potentials in the assessment of patients with multiple sclerosis.

PURPOSE: To evaluate the diagnostic power of conventional, achromatic, automated perimetry (CAP), short-wavelength automated perimetry (SWAP), frequency-doubling technology (FDT) perimetry, and visual evoked potentials (VEP) in a group of patients with multiple sclerosis (MS) with or without a history of optic neuritis. METHODS: Thirty eyes of 15 patients (5 male, 10 female, average age 38+/-7 years) with confirmed diagnosis of MS underwent CAP, SWAP (Humphrey 750-II VFA, program central 30-2, full-threshold strategy), FDT perimetry (program N-30), and pattern VEPs. Sixteen eyes (53.3%) had no history of ocular involvement and a negative ophthalmologic examination. They were matched with a control group of 10 healthy volunteers (4 male, 6 female, average age 31+/-10 years). The mean deviation (MD) and the pattern standard deviation (PSD) of the two groups were compared (t-test). Fourteen eyes (46.7%) had, on the contrary, a history of optic neuritis. Inside this group, the MD and the PSD of the three techniques were correlated (Spearman's rank test), in order to investigate whether any significant differences might be revealed by these techniques in pointing out the total amount of visual field damage. RESULTS: When comparing MS patients without signs or symptoms of ocular involvement and a control group, no significant differences were found for CAP MD, CAP PSD, and FDT PSD. Significant differences were found, on the contrary, for SWAP MD (p=0.0014), SWAP PSD (p=0.0001), and FDT MD (p=0.0001). When considering the MD and the PSD of the three techniques in the group of MS patients who had a history of optic neuritis, a significant correlation was found only between CAP MD and SWAP MD (r=0.0057), with a tendency by SWAP to reveal a higher rate of visual field loss. The other correlations were not significant. According to predefined criteria, the group of asymptomatic subjects had abnormal CAP in 1 eye (6.25%), abnormal SWAP in 9 (56.2%), abnormal FDT in 11 (68.7%), and abnormal VEPs in 7 (43.7%). The combined use of all techniques allowed us to identify silent optic nerve impairment in 15 (93.7%) eyes. CONCLUSIONS: Short-wavelength automated perimetry and FDT perimetry are two non-conventional perimetric techniques that were mainly developed for the early detection of glaucomatous damage. The results of this study demonstrate their efficacy also in detecting early visual field deficits in MS patients without clinical signs of optic neuropathy. Frequency doubling perimetry, in particular, proved to be an easy, fast, and sensitive technique in the assessment of patients with MS. Our results also suggest that subclinical visual involvement in MS can be better diagnosed using multiple (neurophysiologic and psychophysical) tests.

Branch retinal artery occlusion combined with branch retinal vein occlusion in a patient with hepatitis C treated with interferon and ribavirin.

PURPOSE: To report a case of a combined branch retinal artery and vein occlusion in a patient with hepatitis C treated with interferon and ribavirin. METHODS: A 29-year-old man with a 1-week history of sudden visual field defect and decrease of central visual acuity was examined. RESULTS: Ophthalmoscopy and fluorescein angiography demonstrated an ischemic whitening of the inferior hemi-retina involving part of the macular region, numerous intraretinal hemorrhages, and a significant delay in arterial and vein filling of the dye. CONCLUSIONS: The findings of a retinopathy associated with interferon and ribavirin treatment of hepatitis C are important. The symptomatic permanent visual field defect and decrease of central visual acuity developing following a branch retinal artery and vein occlusion event emphasizes the need for careful and regular ocular monitoring of patients receiving interferon for hepatitis C.

Intravitreal triamcinolone in the treatment of serous pigment epithelial detachment and occult choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: To report two cases of occult choroidal neovascularization (CNV) and serous pigment epithelial detachment (PED) treated with intravitreal triamcinolone (IVT) injections. METHODS: Interventional case reports. RESULTS: Both patients showed an increase in visual acuity and a complete flattening of the PED at 10 months (Case 1) and 4 months (Case 2) after IVT injections. No complications or adverse effects are reported. CONCLUSIONS: Future studies should be designed to investigate if IVT can effectively influence the clinical and functional outcome of eyes with serous PED and occult CNV secondary to age-related macular degeneration, for which at the moment no treatment has been shown to be effective.

Multiple bilateral choroidal metastatic tumors from a small-cell neuroendocrine carcinoma of unknown primary site.

PURPOSE: To report one case of multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary. METHODS: The case of a 30-years-old white female who developed multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary is presented. RESULTS: The patient had a disseminated disease and died 6 months after. The oncologic work-up, including physical examination, laboratory and radiographic study, fails to identify the primary site. CONCLUSIONS: Intraocular involvement from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary has not yet reported. We describe this case together with a review of the literature.

Multiple bilateral choroidal metastatic tumors from a small-cell neuroendocrine carcinoma.

PURPOSE: To report one case of multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary. METHODS: The case of a 30-years-old white female who developed multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary is presented. RESULTS: The patient had a disseminated disease and died 6 months after. The oncologic work-up, including physical examination, laboratory and radiographic study, fails to identiy the primary site. CONCLUSIONS: Intraocular involvement from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary has not yet reported. We describe thic case together with a review of the literature. (Eur J Ophthalmol 2005; 15: 148-52).

Branch retinal artery occlusion combined with branch retinal vein occlusion in a patient with hepatitis C treated with interferon and ribavirin.

PURPOSE: To report a case of a combined branch retinal artery and vein occlusion in a patient with hepatitis C treated with interferon and ribavirin. METHODS: A 29-year-old man with a 1-week history of sudden visual field defect and decrease of central visual acuity was examined. RESULTS: Ophthalmoscopy and fluorescein angiography demonstrated an ischemic whitening of the inferior hemi-retina involving part of the macular region, numerous intraretinal hemorrhages, and a significant delay in arterial and vein filling of the dye. CONCLUSIONS: The findings of a retinopathy associated with interferon and ribavirin treatment of hepatitis C are important. The symptomatic permanent visual field defect and decrease of central visual acuity developing following a branch retinal artery and vein occlusion event emphasizes the need for careful and regular ocular monitoring of patients receiving interferon for hepatitis C.

Intravitreal triamcinolone in the treatment of serous pigment epithelial detachment and occult choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: To report two cases of occult choroidal neovascularization (CNV) and serous pigment epithelial detachment (PED) treated with intravitreal triamcinolone (IVT) injections. METHODS: Interventional case reports. RESULTS: Both patients showed an increase in visual acuity and a complete flattening of the PED at 10 months (Case 1) and 4 months (Case 2) after IVT injections. No complications or adverse effects are reported. CONCLUSIONS: Future studies should be designed to investigate if IVT can effectively influence the clinical and functional outcome of eyes with serous PED and occult CNV secondary to age-related macular degeneration, for which at the moment no treatment has been shown to be effective.

Choroidal hemangioma treated with photodynamic therapy using verteporfin: report of a case.

PURPOSE: To report the results of treatment of circumscribed choroidal hemangioma with a single application of photodynamic therapy (PDT) with verteporfin according to the Treatment of Age-related Macular Degeneration with Photodynamic Therapy study. METHODS: A 44-year-old man with unilateral decreased vision and macular subretinal fluid secondary to a circumscribed choroidal hemangioma diagnosed by fluorescein and indocyanine green angiography and ultrasonography underwent PDT with verteporfin therapy. RESULTS: One year after PDT, subretinal fluid was absent and visual acuity improved. CONCLUSIONS: The results obtained in this case are in keeping with previously reported results; however, future randomized studies are necessary to evaluate and standardize different infusion times in order to obtain maximum efficacy of treatment.

Quality of vision with presbyopic contact lens correction: subjective and light sensitivity rating.

PURPOSE: To quantify the quality of vision achieved with multifocal and bifocal contact lenses. METHODS: We analyzed differential light sensitivity by computerized automatic perimetry in 21 patients wearing monofocal soft contact lenses (group 1, controls) and multifocal and bifocal contact lenses (groups 2 and 3, respectively). Seven patients each were fitted with multifocal or bifocal contact lenses; seven patients were without contact lenses (without correction for testing the visual periphery and with near-vision correction using monofocal contact lens for testing the central 30 degrees of vision). The type of correction was randomly changed in a crossover fashion so that each eye was examined at different times with different corrections. Humphrey 640 VFA computerized automated perimetry was used to test visual fields at baseline, 45 days, and 3, 4.5, and 6 months. RESULTS: A statistically significant difference was found between the global sensitivities (GS) of the central visual field in patients with near-vision monofocal contact lenses and with bifocal contact lenses (P=0.0273) and between the GS of the central visual fields with multifocal contact lenses and with bifocal contact lenses (P=0.0261). In both cases, the GS were significantly reduced with bifocal contact lenses (total GS: group 1, 11256 dB (Decibels); group 2, 11154 dB; group 3, 10679 dB). CONCLUSIONS: The results indicate that there is reduced differential light sensitivity in the central 30 deg of the visual field with bifocal contact lenses compared with multifocal contact lenses and monofocal contact lenses (controls).