The prevalence of vitreomacular adhesion in eyes with macular oedema secondary to retinal vein occlusion selected for intravitreal injections.

PURPOSE: To assess the prevalence of vitreomacular adhesion (VMA) in consecutive naïve eyes diagnosed with macular oedema (ME) secondary to retinal vein occlusion (RVO) and to longitudinally evaluate the incidence of vitreomacular interface changes over time and the influence on response to treatment. DESIGN: Retrospective cross-sectional analysis and longitudinal cohort study conducted at two Italian tertiary referral centres. METHODS: A total of 295 eyes, treated with intravitreal ranibizumab and/or dexamethasone for ME secondary to RVO between June 2008 and May 2018, were enrolled in the study. 280 fellow eyes met the inclusion criteria and were included as control group. The vitreomacular interface status was evaluated by spectral domain optical coherence tomography (OCT) and graded according to the OCT-based International Classification System developed by the International Vitreomacular Traction Study (IVTS) group. RESULTS: At baseline, VMA was present in 130 (44.07%) RVO eyes and 142 (50.7%) control eyes (no statistically significant difference was found; p = 0.455). Mean follow-up (FU) was 35.98 months (min 6 - max 112). Throughout the FU, the incidence of spontaneous release of VMA (RVMA) in RVO eyes was significantly higher in comparison with that of the control group [59 (41.84%) RVO eyes versus 18 (12.33%) control eyes; p < 0.0001]. The number of injections in VMA+ eyes was significantly higher when compared with VMA- eyes. No significant difference was found between VMA+ and VMA- eyes regarding their mean best-corrected visual acuity (BCVA) at baseline and at each annual time point (p = 0.2). Differences in central macular thickness (CMT) were significant only at the baseline evaluation (p = 0.0303). CONCLUSIONS: Vitreomacular adhesion (VMA) was not found to be more prevalent in eyes with RVO compared to healthy fellow eyes, and RVO, in turn, did not result in a higher persistence of VMA over time. This suggests that VMA and RVO might be two independent retinal phenomena, with no mutual pathogenetic influence. Vitreomacular adhesion (VMA) might have an impact on the response to treatment, since it was found to result in a more intensive treatment regimen; however, it did not affect visual and anatomic outcomes. These results do not support vitrectomy or PVD induction in the prevention, nor the treatment, of RVO.

Acute exudative polymorphous vitelliform maculopathy: To bolus or not to bolus?

Acute exudative polymorphous vitelliform maculopathy (AEPVM) is a rare bilateral maculopathy characterized by chronic and long-term course. We report a case of AEPVM with an unusual presentation and management in a middle-aged man. He presented with clinical features of bilateral AEPVM accompanied by multiple intraretinal cysts, with a sudden increase of intraretinal fluid and visual function deterioration over a span of few days. Therefore, we administered empirically an intravenous bolus injection of methylprednisolone. One week after, there was a full recovery of visual acuity and cystic intraretinal spaces completely disappeared.

Factors Influencing Fixation Stability Area: A Comparison of Two Methods of Recording.

SIGNIFICANCE: The authors analyze factors influencing bivariate contour ellipse area (BCEA) in healthy and pathologic eyes and how such factors may affect isolated (static BCEA) or microperimetric fixation (dynamic BCEA). They conclude that aging increases both dynamic BCEA and examination time, whereas static BCEA offers less variance and the maximum distinction with pathologic eyes. PURPOSE: The aim of this study was to assess factors influencing BCEA and the recording method that offer less variability and thus maximum distinction between healthy and pathologic eyes. METHODS: A total of 136 eyes were retrospectively reviewed, 85 eyes without ophthalmic disorders (logMAR acuity ≦0.0) and 51 eyes with late age-related macular degeneration (AMD) were enrolled. All patients underwent two consecutive examinations, a 30-second isolated fixation (static BCEA) and a microperimetric test with continuous fixation recording (dynamic BCEA). All the examinations were carried out using MP1 microperimeter (NAVIS software version 1.7.6; Nidek Technologies, Padova, Italy). RESULTS: Dynamic BCEA was significantly correlated with age (r = 0.38, P < .001), total (r = 0.32, P = .03), and tracking time (r = 0.33, P = .02) in controls, whereas no significant relationships were found in the AMD group. The greatest difference between static and dynamic BCEA was observed in 70- to 79-year decade in healthy subjects (P < .01). Logistic regression analysis showed that late AMD status was significantly predicted by ±2 SD and ±3 SD static BCEA (both P = .03). CONCLUSIONS: Dynamic BCEA is influenced by a certain degree of variability in advanced-age healthy subjects. In such cases, the use of ±2 SD and ±3 SD static BCEAs seems to offer a more accurate detection of fixation stability changes in the AMD group with respect to normal subjects.

Microperimetric evaluation in patients with adult-onset foveomacular vitelliform dystrophy.

INTRODUCTION: To compare mean best-corrected visual acuity (BCVA), retinal sensitivity (RS), and bivariate contour ellipse area (BCEA) in patients with adult-onset foveomacular vitelliform dystrophy (AOFVD) and healthy subjects (HSs), reporting also functional disease-related changes in the different stages of the AOFVD disease. MATERIALS AND METHODS: In this observational cross-sectional study, a total of 19 patients (30 eyes; 12 female and 7 male) with AOFVD were enrolled, and 30 patients (30 eyes; 16 female and 14 male) were recruited as age-matched control group (74.36 ± 9.17 years vs. 71.83 ± 6.99 years respectively, P= 0.11). All patients underwent a complete ophthalmologic examination, fundus autofluorescence and fluorescein angiography, spectral-domain optical coherence tomography and microperimetry (MP)-1 analysis. The data collection included mean BCVA, mean RS measured by means of MP-1, BCEA, and central retinal thickness. RESULTS: All the functional parameters (BCVA, RS, and BCEA) were significantly worse in AOFVD group than HS. Subgroup analysis showed that the most significant functional changes, quantified by mean BCVA, RS, and BCEA, were in the atrophic stage (P = 0.03, P= 0.01, and P= 0.001, respectively). All the functional parameters were well correlated in the different stages. CONCLUSIONS: This study further confirms the good visual prognosis in the AOFVD eyes. Fixation stability measurement using BCEA demonstrates good evaluation of visual performance integrating traditional functional parameters. It may also serve for further rehabilitative purposes in atrophic eyes.

Enhanced depth imaging optical coherence tomography in adult-onset foveomacular vitelliform dystrophy.

PURPOSE: To compare mean choroidal thickness in patients with adult-onset foveomacular vitelliform dystrophy (AOFVD) and healthy subjects, to analyze patients with AOFVD in order to evaluate choroidal thickness disease-related changes, also in relation to the different stages of AOFVD disease and to the retinal pigment epithelium (RPE) features, and to correlate mean choroidal thickness with age in both groups. METHODS: In this prospective observational cross-sectional study, a total of 63 eyes of 51 consecutive subjects were examined, consisting of a control group (n = 28 eyes) and the AOFVD group (n = 35 eyes). A complete ophthalmologic examination, fundus autofluorescence, and spectral-domain optical coherence tomography were performed in all patients. RESULTS: Mean subfoveal choroidal thickness was 214.78 ± 62.35 µm in healthy subjects and 222.31 ± 73.29 µm in the AOFVD group (p = 0.33). In the vitelliruptive group, the mean choroidal thickness was significantly thicker than in the control group at each choroidal location. Mean choroidal thickness was significantly increased in the pseudohypopyon stage when compared to the vitelliform one (+66.34 µm, p = 0.02). Eyes with subretinal fluid (SRF) showed significantly thicker choroid when compared with those without SRF. No significant correlations were found between age and choroidal thickness in the study group. CONCLUSIONS: The study of the choroid in patients with AOFVD suggested a possible role in the pathologic changes during the different stages of disease, and could help us to evaluate progression of the disease. Greater choroidal thickness associated with SRF and RPE bumps are signs of RPE alterations and could be related to evolution of the AOFVD lesion to a different stage.

Psychosis, Mood and Behavioral Disorders in Usher Syndrome: Review of the Literature.

The aim of this review is to focus the current knowledge about mental and behavioral disorders in Usher syndrome. Previous studies described the presence of various mental disorders associated with Usher syndrome, suggesting possible mechanisms of association between these disorders. The most common manifestations are schizophrenia-like disorder and psychotic symptoms. Mood and behavioral disorders are rarely described, and often are associated with more complex cases in co-occurrence with other psychiatric disorders. Neuroimaging studies reported diffuse involvement of central nervous system (CNS) in Usher patients, suggesting a possible role of CNS damage in the pathogenesis of psychiatric manifestations. Genetic hypothesis and stress-related theories have also been proposed.

Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia.

BACKGROUND: This study sought to evaluate the effect of basic fibroblast growth factor eye drops and cysteine oral supplements on corneal healing in patients treated with photorefractive keratectomy (PRK). MATERIALS AND METHODS: One hundred and twenty patients treated bilaterally with PRK for myopia were enrolled at one of two eye centers (Clinica Santa Lucia, Bologna, Italy and Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy) and were treated at the former center. Sixty patients included in the study group (Group 1) were treated postoperatively with topical basic fibroblast growth factor plus oral L-cysteine supplements, whereas 60 subjects included in the control group (Group 2) received basic fibroblast growth factor eye drops. We recorded the rate of corneal re-epithelialization and patients were followed-up every 30 days for 6 months. Statistical analyses were performed on the collected data. RESULTS: The eyes in Group 1 demonstrated complete re-epithelialization at Day 5, whereas the eyes in Group 2 achieved this status on Day 6. No side-effects were reported. CONCLUSIONS: Patients treated with basic fibroblast growth factor eye drops and L-cysteine oral supplements benefit from more rapid corneal re-epithelialization. In human eyes, this combination treatment appeared to be safe and effective in accelerating corneal surfacing after surgery. FINANCIAL DISCLOSURE: No author has any financial or proprietary interest in any material or method used in this study. TRIAL REGISTRATION: Current Controlled Trials ISRCTN73824458.

Fixation stability measurements in patients with neovascular age-related macular degeneration treated with ranibizumab.

OBJECTIVE: To evaluate which of 2 measuring units (bivariate contour ellipse area [BCEA] vs Fujii) yields more accurate measurements of fixation stability, obtained using the MP-1 device, in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal injections of ranibizumab, during a 12-month follow-up period. DESIGN: Small retrospective, noncomparative, interventional case series. PARTICIPANTS: A total of 25 eyes in 25 patients (13 males, 12 females; mean age 71.72 ± 7.98 years). METHODS: All participants were older than 50 years, diagnosed with active subfoveal choroidal neovascularization, had best corrected visual acuity (BCVA) values above 20/100, and all lesion types were included. All patients underwent a loading phase with 3 consecutive intravitreal injections of 0.05 mg ranibizumab at monthly intervals. Patients were retreated after the third injection if they exhibited a 100-µm increase in macular thickness or evidence of intraretinal and/or subretinal fluid and new subretinal hemorrhage, observed with spectral-domain optical coherence tomography and fluorescein angiography. The data collected included BCVA and mean macular sensitivities, BCEA, and fixation patterns, performed at baseline and at months 4 and 12, using the MP-1 device. RESULTS: The mean total injection number was 5.92 ± 1.18 (minimum 3, maximum 8). Mean BCVA at baseline was 0.55 ± 0.28 logMAR and increased significantly to 0.50 ± 0.33 logMAR. Mean macular sensitivity at baseline was 7.06 ± 4.59 dB and increased significantly to 8.40 ± 4.82. Mean BCEA was 2.19 ± 1.38 deg(2) and decreased significantly to 1.68 ± 1.43 deg(2). Fixation stability patterns, according to the protocol set out by Fujii, did not change significantly during follow-up. CONCLUSIONS: Compared with Fujii fixation stability patterns, BCEA correlated better with variations in macular sensitivity and BCVA. BCEA can be added to the traditional parameters used to evaluate the efficacy of intravitreal injections in patients with nAMD.

Effect of basic fibroblast growth factor and cytochrome c peroxidase combination in transgenic mice corneal epithelial healing process after excimer laser photoablation.

PURPOSE: To evaluate the role of prepared basic fibroblast growth factor (bFGF) and cytochrome c peroxidase (CCP) combination eyedrops in corneal epithelial healing of transgenic mice (B6(A)-Rpe(rd12)/J) after excimer laser photoablation. MATERIALS AND METHODS: In this prospective study, 216 eyes of 108 mice underwent bilateral photorefractive keratectomy. We considered 4 groups: A, B, C, and D. Group A received standard topical postoperative therapy with tobramycin, diclofenac, and dexamethasone eyedrops plus CCP at 3 drops per day for a week or until corneal re-epithelialization was achieved. Group B received standard topical postoperative therapy plus bFGF eyedrops and phosphate-buffered saline (PBS) 3 drops per day for a week or until corneal re-epithelialization was complete. In group C, 1 eye received standard topical postoperative therapy plus CCP eyedrops, bFGF eyedrops, and PBS 3 drops per day for a week or until corneal re-epithelialization was complete. Control eyes (group D) received a standard topical postoperative therapy plus placebo eyedrops. Mice were followed-up for a week from the day after the surgery to evaluate the rate of corneal re-epithelialization. RESULTS: Data were analyzed by ANOVA using the XLSTAT 2010 software. Eyes in group A, B, and C healed completely before the fifth postoperative day, achieving, respectively, a re-epithelialization time of 92 hours ± 10 SD, 90 hours ± 12 SD, and 86 hours ± 12 SD. Group D had a re-epithelialization time of 121 hours ± 8 SD (P < 0.05). No side effects or toxic effects were documented. CONCLUSIONS: Results suggest that re-epithelialization after phototherapeutic keratectomy can benefit from topical therapy with CCP/bFGF combination eyedrops. Further clinical studies are needed to evaluate the long-term effectiveness of these eyedrops to prevent corneal haze.

Fourier-domain optical coherence tomography and microperimetry findings in retinitis pigmentosa.

PURPOSE: To investigate the relation between the optical coherence tomography (OCT) findings and retinal sensitivity in patients with retinitis pigmentosa (RP) by assessing the retinal thickness and retinal function using Fourier-domain OCT (FD-OCT) and microperimetry, respectively. DESIGN: Observational case series. METHODS: Fifty-nine patients (118 eyes) were enrolled, mean age 47 ± 14.8 years. Thirty-two healthy subjects (HS) were enrolled as a control group. Patients were assessed by means of FD-OCT and microperimetry. We analyzed the average foveal thickness (diameter of 1 mm centered on the point of fixation), the value of the retinal sensitivities corresponding to the 4 degrees centered on the fixation point, and logMAR visual acuity for regression analysis converted from Snellen chart. RESULTS: We distinguished 4 groups of RP patients according to the macular pattern seen on OCT images. The first group of 36 eyes, mean age of 33.5 ± 7.4 years, had no macular changes, mean best-corrected visual acuity (BCVA) of 0.95 ± 0.07, mean foveal thickness of 256.3 ± 9.14 µm, and mean retinal sensitivities inside the central 4 degrees of 19.27 ± 0.87 dB (P > .05 for all the values). The second group of 28 eyes, mean age 35.4 ± 6.3 years, showed clinical macular edema (CME) on OCT images with mean BCVA of 0.72 ± 0.22, mean foveal thickness of 363.5 ± 93.45 µm, and mean retinal sensitivity inside the central 4 degrees of 15.94 ± 3.6 dB (P < .01 for all the values). The third group of 26 eyes, mean age 50.8 ± 8.7 years, showed macular vitreoretinal traction on OCT images with a mean BCVA of 0.5 ± 0.2, mean foveal thickness of 337.1 ± 71.7 µm, and mean retinal sensitivity inside the central 4 degrees of 11.78 ± 3.09 dB (P < .01 for all the values). The last group of 28 eyes, mean age 52.1 ± 13.6 years, showed macular retinal thinning on OCT images with mean BCVA of 0.36 ± 0.15, mean foveal thickness of 174.2 ± 24.40 µm, and mean retinal sensitivity inside the central 4 degrees of 10.22 ± 3.82 dB (P < .01 for all the values). CONCLUSIONS: MP-1 and FD-OCT showed high sensitivity for identifying functional and structural macular abnormalities, respectively. Future studies should investigate the relationships among photoreceptor cell loss, retinal sensitivity, and fixation in patients with RP.

High-resolution spectral domain optical coherence tomography images of Alström syndrome.

Alström syndrome is a multisystemic disorder characterized by cone-rod dystrophy, hearing loss, obesity, insulin resistance and hyperinsulinemia, type 2 diabetes mellitus, dilated cardiomyopathy, and progressive hepatic and renal dysfunction. The cone-rod retinal dystrophy usually develops within a few weeks after birth. The authors examined a young boy with Alström syndrome by means of microperimetry and spectral domain optical coherence tomography (OCT). Instead of the typical alterations observed in cone-rod dystrophies, the characteristics of the central foveal tissue suggest signs of retinal immaturity, with only a single layer of short, thick cones and rods and immature short outer segments. High-speed and high-resolution spectral domain OCT allowed a detailed analysis of retinal layers in a young patient with Alström syndrome for the first time.

Refractive surgery in patients with retinitis pigmentosa.

PURPOSE: To evaluate the refractive outcomes and safety of laser refractive surgery in a group of myopic patients with retinitis pigmentosa (RP). METHODS: This was a multicenter, retrospective, noncomparative, interventional case series. A total of 32 eyes of 16 patients with RP with at least 18 months of follow-up were treated with laser refractive surgery (photorefractive keratectomy [PRK], laser subepithelial keratectomy [LASEK]). Refractive outcomes, complete eye examination, corneal topography, and retinal sensitivities were evaluated during follow-up. Mean follow-up was 28.3 months (minimum 18, maximum 50). Mean patient age was 29.6 years (range 24-54). Mean best-corrected visual acuity (BCVA) was 0.75 preoperatively. RESULTS: Eighteen months after surgery, mean uncorrected visual acuity (UCVA) was 0.8+/-1 line (p=0.02); mean BCVA was 0.85+/-1 line (p<0.0005) with mean spherical equivalent of -0.16 D. Corneal complications were not detected during follow-up; corneal topography did not show corneal ectasia in any patient after surgery. During follow-up visits, no development or progress of macular edema was noted in any eye. Retinal sensitivities increased after surgery; there were no significant changes in electroretinogram amplitude. CONCLUSIONS: Mean UCVA and BCVA 18 months after surgery were higher than preoperative BCVA. All patients were safely treated without any significant complications. Our results support the safety of performing PRK and LASEK in patients with tapetoretinal degeneration.

Hess area ratio and diplopia: evaluation of 30 patients undergoing surgical repair for orbital blow-out fracture.

PURPOSE: To determine if the Hess area ratio is effective in predicting postoperative diplopia in patients undergoing surgery for orbital blow-out fracture. METHODS: Our retrospective, interventional case series study involved 30 consecutive cases affected by orbital fractures and diplopia undergoing surgical correction within 7 days after injury. To evaluate ocular motility disturbance, we measured the involved ocular motility range by use of a manual Hess screen test before and 4 months after surgery. The percentage of Hess area ratio % was used to express the range of ocular motility in a numerical value. RESULTS: All patients with preoperative Hess area ratio >85% had no postoperative diplopia, and most patients (57%) having a preoperative Hess area ratio <65% had postoperative diplopia. When the Hess area ratio was between 65% and 85%, surgical outcomes were variable and most patients (55%) described no problematic diplopia in the peripheral visual field. CONCLUSIONS: The Hess area ratio is a useful procedure to convert Hess graphic representation in a numerical value so that Hess chart data can be compared among clinicians and used to predict surgical outcomes in patients undergoing surgery for orbital blow-out fractures.

Role of cysteine in corneal wound healing after photorefractive keratectomy.

AIMS: To evaluate the efficacy of cysteine oral supplements in corneal wound healing after photorefractive keratectomy (PRK). METHODS: A total of 200 eyes (100 patients) underwent PRK. We divided patients into 2 groups; each group was composed of 50 patients (100 eyes). Group 1 patients were assigned to use oral L-cysteine, with a daily dose of 200 mg (100-mg pills to be taken twice a day) for a duration of 14 days, starting from the week preceding the operation; the patients in group 2 were used as a control, and received the oral supplementation of 40-mg placebo pills to be taken twice a day for a duration of 14 days, starting from the week preceding the operation. RESULTS: All the eyes of patients treated with cysteine oral supplements showed shorter times to re-epithelization than the eyes of the control group. The mean time of corneal wound healing observed in group 1 was 102 +/- 15 h, compared to an average of 159 +/- 9 h in group 2. CONCLUSION: Our research showed that oral cysteine supplementation, in a daily dose of 200 mg, reduces mean corneal wound healing time in patients after PRK.

Effect of basic fibroblast growth factor in transgenic mice: corneal epithelial healing process after excimer laser photoablation.

PURPOSE: To evaluate the role of preparedbasic fibroblast growth factor (bFGF) eyedrops in corneal epithelial healing of transgenic mice after excimer laser photoablation. MATERIALS AND METHODS: In our prospective case series, 60 eyes of 30 mice had uneventful bilateral excimer laser photoablation. In each mouse, 1 eye received the standard topical postoperative therapy with tobramicin, diclofenac and dexamethasone eyedrops, plusbFGF eyedrops 5 microg/10 microl PBS 3 times a day for 1 week, or until corneal reepithelialization was complete. The fellow eye served as the control and received the standard postoperative therapy plus placebo. The mice were monitored daily, commencing the day after surgery and for 7 days, in order to evaluate the corneal reepithelialization rate by using a video slitlamp camera with a cobalt blue light. The mean diameter of the corneal wounds was measured. Videotaped images were recorded and analyzed by computer planimetry. RESULTS: All the eyes treated withbFGF eyedrops healed completely before day 5 after surgery, with a mean reepithelialization time of 90 +/- 12 h (standard deviation); the mean reepithelialization time was 124 +/- 10 h in those eyes receiving placebo. There were no statistically significant differences between the 2 groups in corneal haze presentation during the follow-up, perhaps because the time period was too brief (7 days). However, corneal clarity on slitlamp biomicroscopy was greater in the study group than in the control group. No side effects or toxic effects were documented. CONCLUSIONS: These data suggest that the bFGF significantly accelerates epithelial healing after excimer photoablation. A further clinical study should be performed to prove the results obtained in this study as well as the long-term efficacy of bFGF to prevent corneal haze.