Optical devices in highly myopic eyes with low vision: a prospective study.

AIMS: To compare, in relation to the cause of visual impairment, the possibility of rehabilitation, the corrective systems already in use and the finally prescribed optical devices in highly myopic patients with low vision. Some considerations about the rehabilitation of these subjects, especially in relation to their different pathologies, have also been made. MATERIALS AND METHODS: 25 highly myopic subjects were enrolled. We evaluated both visual acuity and retinal sensitivity by Scanning Laser Ophthalmoscope (SLO) microperimetry. RESULTS: 20 patients (80%) were rehabilitated by means of monocular optical devices while five patients (20%) were rehabilitated binocularly. We found a good correlation between visual acuity and retinal sensitivity only when the macular pathology did not induce large areas of chorioretinal atrophy that cause lack of stabilization of the preferential retinal locus. In fact, the best results in reading and performing daily visual tasks were obtained by maximizing the residual vision in patients with retinal sensitivity greater than 10 dB. A well circumscribed area of absolute scotoma with a defined new retinal fixation locus could be considered as a positive predictive factor for the final rehabilitation process. DISCUSSION: A more careful evaluation of visual acuity, retinal sensitivity and preferential fixation locus is necessary in order to prescribe the best optical devices to patients with low vision, thus reducing the impact of the disability on their daily life.

Early lamellar macular hole in Alport syndrome: case report and review of the literature.

PURPOSE AND METHOD: To present a 26-year-old Italian woman affected by genetically ascertained Alport syndrome. The patient underwent a complete ophthalmological examination including: visual acuity, anterior and posterior segment biomicroscopy, MP1-microperimetry, colour fundus retinography, electrofunctional examinations (electrooculogram, electroretinogram, visually evoked potentials), computerized perimetry and Spectral Domain Optical Cohrence Tomography. RESULTS AND CONCLUSIONS: Nephritis, haematuria but no hearing impairment was observed. Visual function was normal, also confirmed by electrofunctional tests and computerized perimetry. The ocular involvement was only expressed by an early lamellar macular hole characterized by a density rarefaction in the tomographic images of both inner retina and superficial choroid. A rarefaction of the inner choroid in the whole macular region and in the peripapillary area, unusual for the young age of the patient, was also evident. We suppose that these tomographic findings might be caused by alterations of type IV collagen, typical of Alport syndrome.

Spontaneous closure of bilateral full thickness macular holes without surgery: an eleven-year follow-up.

PURPOSE AND METHOD: To present a 60-year-old woman affected by bilateral full thickness macular hole, showing without surgery a spontaneous resolution of the disease in both eyes that remains unchanged during an eleven-year follow-up. To our knowledge, this clinical case is uncommon as no similar reports with such a long follow-up have been published in the scientific literature at this time. RESULTS AND CONCLUSIONS: A spontaneous and bilateral closure of full thickness macular holes was detected, as a consequence of a complete posterior vitreous detachment documented by optical coherence tomography images. An initial reduction up to a complete resolution of the central macular scotoma was also observed by performing scanning laser ophthalmoscope microperimetry. Both these anatomical and functional results did not change during the whole period of follow-up. According to this study, the release or the weakening of the vitreous tractions at the foveal edges seems to play a key role in the spontaneous resolution of macular holes in not surgically treated patients.

Reduction of optic nerve fiber layer thickness in CADASIL.

Our study aims to assess nerve fiber layer (NFL) thickness in patients affected by cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). Six CADASIL patients (mean age 42 +/- 16 years, best corrected visual acuity >20/20 with refractive error between +/-3 diopters, intraocular pressure <18 mmHg) were enrolled. They were compared with 16 age-matched controls. In all subjects enrolled, NFL thickness was measured by optical coherence tomography (OCT). Three different measurements were taken in each quadrant (superior, inferior, nasal, and temporal) and averaged. The data from all quadrants (12 values averaged) were identified as NFL overall. In CADASIL eyes there was a reduction of NFL thickness in each quadrant and in the NFL overall evaluation compared with the values observed in control eyes. Our results suggest that in CADASIL patients there is a reduction of NFL thickness evaluated by OCT. This morphological abnormality could be ascribed to an impairment of the retinal vascular supply leading to a global neuroretinal involvement. These anatomical changes may precede the onset of the neurological clinical manifestations.

Photodynamic therapy outcomes in a case of macular choroidal neovascularization secondary to Candida endophthalmitis.

PURPOSE: To evaluate the effects on visual function and choroidal neovascularization (CNV) progression in a case of subretinal CNV due to Candida endophthalmitis treated with a combination of photodynamic therapy (PDT) and drugs. METHODS: A 28-year-old one-eyed woman with CNV in the right eye came to our observation. The CNV developed as a consequence of Candida endophthalmitis. The CNV was treated with six PDT treatments with verteporfin in association with systemic steroid therapy with prednisone (100 mg/day to reduce) and fluconazole (800 mg/day to reduce). Visual acuity (VA) was assessed in pre-PDT conditions and after six PDT treatments (24 months of follow-up). RESULTS: Pre-PDT VA was 20/125; after 24 months of follow-up, six PDT re-treatments, and pharmacologic therapy, VA was stabilized at 20/100. CONCLUSIONS: In our case, associated PDT and drug therapies were safe and useful to maintain VA and to arrest CNV progression in the foveal region after 2 years of follow-up.

Visual acuity and macular sensitivity in myopic eyes before and after laser in situ keratomileusis.

PURPOSE: To evaluate the changes in visual acuity (VA) and in macular sensitivity in myopic eyes subjected to laser in situ keratomileusis (LASIK) refractive surgery. METHODS: In 38 myopic eyes, VA by Snellen's table and macular sensitivity by scanning laser ophthalmoscope (SLO) microperimetry were assessed before and after 24 weeks after LASIK surgery. The myopic eyes were divided into three age-matched groups: Group A = from -5 diopters (D) to -7 D and normal SLO-macular sensitivity (15 eyes); Group B = from -8 D to -16 D and normal SLO-macular sensitivity (9 eyes); and Group C = from -8 D to -16 D and abnormal SLO-macular sensitivity. RESULTS: Group A and B eyes, at the first week after LASIK surgery, we observed a significant analysis of variance, p<0.01) reduction in VA and SLO-macular sensitivity with respect to baseline values, while after 12 and 24 weeks no differences (p>0.01) were found when compared to baseline. In Group C patients, at 1 and 4 weeks after surgical treatment, we observed a significant (p<0.01) reduction in VA and SLO-macular sensitivity with respect to baseline values. At 12 and 24 weeks the values of VA were reduced, but not significantly (p>0.01), while values of SLO-macular sensitivity were still significantly (p<0.01) reduced. CONCLUSIONS: LASIK could induce a reduction in VA and SLO-macular sensitivity in all myopic eyes during the 4 weeks following the surgery. This reduction is still present after 24 weeks only in eyes with the highest preoperative degree of myopia combined with the greatest reduction in macular sensitivity.

Visual acuity and macular sensitivity in myopic eyes before and after laser in situ keratomileusis.

PURPOSE: To evaluate the changes in visual acuity (VA) and in macular sensitivity in myopic eyes subjected to laser in situ keratomileusis (LASIK) refractive surgery. METHODS: In 38 myopic eyes, VA by Snellen's table and macular sensitivity by scanning laser ophthalmoscope (SLO) microperimetry were assessed before and after 24 weeks after LASIK surgery. The myopic eyes were divided into three age-matched groups: Group A = from -5 diopters (D) to -7 D and normal SLO-macular sensitivity (15 eyes); Group B = from -8 D to -16 D and normal SLO-macular sensitivity (9 eyes); and Group C = from -8 D to -16 D and abnormal SLO-macular sensitivity. RESULTSGroup A and B eyes, at the first week after LASIK surgery, we observed a significant analysis of variance, p<0.01) reduction in VA and SLO-macular sensitivity with respect to baseline values, while after 12 and 24 weeks no differences (p>0.01) were found when compared to baseline. In Group C patients, at 1 and 4 weeks after surgical treatment, we observed a significant (p<0.01) reduction in VA and SLO-macular sensitivity with respect to baseline values. At 12 and 24 weeks the values of VA were reduced, but not significantly (p>0.01), while values of SLO-macular sensitivity were still significantly (p<0.01) reduced. CONCLUSIONS: LASIK could induce a reduction in VA and SLO-macular sensitivity in all myopic eyes during the 4 weeks following the surgery. This reduction is still present after 24 weeks only in eyes with the highest preoperative degree of myopia combined with the gre a test reduction in macular sensitivity.

Scanning laser ophthalmoscope microperimetry.

In this article, the methodologies and clinical applications of microperimetry performed by scanning laser ophthalmoscope (SLO) are described. This technique provides functional results by direct visualization of the macular area. We present the most interesting data about clinical applications in ocular pathology. SLO microperimetry is a new diagnostic tool in ophthalmic practice. It permits an exact, point-to-point correspondence between fundus image and perimetric results, impossible to achieve by projection perimetry, so representing the most suitable device for simultaneous fundus imaging and psychophysical testing. Microperimetry is performed by SLO (Rodenstock),1 which permits other applications. SLO microperimetry allows the real-time functional study of retinal sensitivity by direct ophthalmoscopic control of the retinal surface. Foveal or excentric fixation can be assessed as well. Instability of fixation during computerized perimetry is a possible misleading factor resulting in unexplainable findings, especially in eyes with decreased visual acuity. The main characteristic of microperimetry is the ability to see the stimuli presented on the retina in real time: this permits an accurate monitoring of fixation and correlation of anatomical or pathological features directly with retinal function.

Scanning laser ophthalmoscopy in the early diagnosis of vitreoretinal interface syndrome.

BACKGROUND: The purpose of this study was to estimate if and to what extent scanning laser ophthalmoscopy can help in the early diagnosis and follow-up management of the vitreoretinal interface syndrome, which includes disorders such as cellophane maculopathy, pseudomacular hole, macular pucker, and macular hole. METHODS: The 35 fellow eyes of 35 patients with vitreoretinal interface syndromes in the first eye underwent scanning laser ophthalmoscopy microperimetry and argon, helium-neon, and infrared scanning laser ophthalmoscopy. Fellow eyes were defined as clinically positive or negative for vitreoretinal interface syndrome. Fellow eyes then were classified based on scanning laser ophthalmoscopy techniques. Patients were observed for an average of 18 months (range, 10-26 months). RESULTS: Thirty-two of the 35 fellow eyes were classified as clinically negative, and three of the 35 were classified as clinically positive. Fifteen of the 32 clinically negative fellow eyes were redefined as positive on scanning laser ophthalmoscopy. None of the clinically positive eyes proved to be negative on scanning laser ophthalmoscopy. During the average follow-up period (18 months), the condition of five of 18 fellow eyes that were positive on scanning laser ophthalmoscopy worsened. None of the 17 eyes that were negative on scanning laser ophthalmoscopy worsened. CONCLUSION: Scanning laser ophthalmoscopy can produce beautifully clear images of structures that are otherwise difficult to see and document, such as posterior hyaloid and the inner retinal layers. Despite a relatively limited number of cases and the short duration of the follow-up period, the present study suggests that scanning laser ophthalmoscopy has good sensitivity and specificity for the early diagnosis of vitreoretinal interface syndromes.

Copper intraocular foreign body: diagnosis and treatment.

Copper intraocular foreign bodies (IOFB) are relatively common after penetrating eye injuries. Ocular signs and symptoms vary greatly in relation to the copper content, ranging from chronic uveitis and severe visual loss for IOFB containing more than 85% copper, to local copper deposits with no severe ocular damage for less toxic alloys. Reported here is the case of a ten-year-old boy who suffered from recurrent chronic uveitis five months after a perforating eye injury due to copper wire. Diagnostic ultrasound and computerized tomography revealed an IOFB within the lens and X-ray spectrometry (DXS) indicated the nature of the IOFB as copper, and accurately measured the dissolution of the metal. The patient underwent cataract extraction and standard three-port pars plana vitrectomy with gas-fluid exchange. Twelve months after surgery the retina was flat and visual acuity had risen to 20/60. Undiluted vitreous samples obtained in the course of the intervention, studied by immunohistochemical techniques, showed an inflammatory reaction with a prevalence of PMN-N and CD3 T-lymphocytes. DXS thus appears to be a new and reliable diagnostic tool for the early detection and management of copper and other toxic metal IOFB.