Modesti M.,Ophthalmology Unit |
Appolloni R.,Ophthalmology Unit |
Pecorella I.,University of Rome La Sapienza |
Sourdille P.,Clinique Sourdille
Journal of Cataract and Refractive Surgery | Year: 2011
Purpose: To evaluate capsular bag size and accommodative movement before and after cataract surgery using ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT). Setting: Ophthalmology Unit, Fabia Mater Clinic, Rome, Italy. Design: Cohort study. Methods: Eyes having cataract surgery and monofocal intraocular lens (IOL) implantation were studied using UBM. The following parameters were measured preoperatively and 1, 2, and 12 months postoperatively: anterior chamber depth (ACD) (also by AS-OCT), capsular bag thickness, capsular bag diameter, ciliary ring diameter, sulcus-to-sulcus (STS) diameter, ciliary process-capsular bag distance, ciliary apex-capsular bag plane, and IOL tilting. The preoperative and postoperative capsular bag volumes were calculated at 12 months. The results were compared with the changes during accommodation. Results: The study comprised 24 eyes. With the exception of the ciliary apex-capsular bag plane, which appeared to be unmodified postoperatively, all measured parameters showed significant variation after IOL implantation. Only the ACD did not change significantly during accommodation. Conclusions: After cataract surgery, the capsular bag stretched horizontally and with reduced vertical diameter as a result of adaptation to the implanted IOL. The capsular bag-IOL complex filled all available space, compressing the zonular fibers and almost abolishing the space between the ciliary apex and the capsular bag. There was anterior chamber deepening and a decrease in the ciliary ring diameter and STS diameter. In the absence of zonular fiber tension, the shape of the ciliary processes may be modified. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes. © 2011 ASCRS and ESCRS.
Buck D.,Northumbria University |
Powell C.J.,Royal Infirmary |
Sloper J.J.,Moorfields Eye Hospital |
Taylor R.,York Hospitals NHS Trust |
And 3 more authors.
British Journal of Ophthalmology | Year: 2012
Purpose: To describe surgical outcomes in intermittent exotropia (X(T)), and to relate these to preoperative and surgical characteristics. Methods: 87 children (aged <11 years) underwent surgery in 18 UK centres; review data (mean 21 months post-surgery) were available for 72. The primary outcome measure was motor/sensory outcome (angle and stereoacuity). The secondary outcome measure was satisfactory control assessed by Newcastle Control Score (NCS). Results: 35% of patients had excellent, 28% had fair and 37% had poor primary outcome. Preoperative and surgical characteristics did not influence primary outcome. Satisfactory control was achieved in 65% of patients, while X(T) remained/recurred in 20%. Persistent over-correction occurred in 15% of children. There was no relationship between over-correction and preoperative characteristics or surgical dose/type. Median angle improved by 12 prism dioptres (PD) at near and 19 PD at distance ( p<0.001). Median NCS improved by 5 (p<0.001). 40% of those initially over-corrected remained so by last postoperative assessment; no relationship was found between an initial over-correction and good outcome. Conclusions: Whilst excellent motor/sensory outcome was achieved in one-third and satisfactory control in two-thirds of patients, the 37% poor outcome and 15% persistent over-correction rate is of concern. Surgical dose was similar in those under- and over-corrected, suggesting that over-corrections cannot be avoided merely by getting the dosage right: a randomised controlled trial (RCT) would shed light on this issue. Initial over-correction did not improve the chance of a good outcome, supporting the growing literature on this topic and further highlighting the need for randomised controlled trials of X(T) surgery.
Mantelli F.,IRCCS Fondazione Bietti |
Abdolrahimzadeh S.,Ophthalmology Unit |
Mannino G.,St Andrea Hospital |
Lambiase A.,University of Rome La Sapienza
Case Reports in Ophthalmology | Year: 2014
We report the case of a 29-year-old female patient who presented with an acute onset of anisocoria, blurred vision, nausea and severe left-sided headache. There was no history of trauma, drug abuse, or instillation of topical mydriatic compounds. The ocular history was negative for similar events. On presentation, her visual acuity was 0.2 in the left and 1.0 in the right eye with a +2.5 dpt sph. correction. Slit-lamp examination demonstrated a shallow anterior chamber as well as the presence of iris nodules in both eyes. These nodules were identified as Lisch nodules as the patient referred to the previous diagnosis as being neurofibromatosis type 1. A third nerve palsy was considered, but a brain MRI showed normal results. Her ocular motility was normal, but the left pupil was mydriatic and poorly reacting to light, with an associated raised intraocular pressure (IOP) of 38 mm Hg. An examination of the fellow eye was normal, with the IOP measuring 18 mm Hg. Gonioscopy of the right eye showed a narrow angle. On further anamnestic investigation, the patient revealed that the pain and the blurred vision begun in the morning while she was helping her mother in the garden. Finally, after showing the patient a picture of Datura flowers, which she recognized immediately, we made the unusual diagnosis of angle closure glaucoma by Datura, a well-known toxic plant with mydriatic properties. The patient was successfully treated with systemic acetazolamide and topical pilocarpine. © 2014 S. Karger AG, Basel.
Barbara R.,Bnai Zion Medical Center |
Barbara A.,Hadassah Optimal Private Medical Center |
Naftali M.,Ophthalmology Unit
Eye (Basingstoke) | Year: 2016
PurposeEvaluation of actual vs intended intrastromal corneal ring segments (ICRS) implantation depth as measured by anterior segment optical coherence tomography (OCT)MethodsProspective study evaluating 30 Intacs segments implanted manually in 19 eyes of 15 patients suffering from keratoconus. Segment depth evaluation was performed using anterior segment OCT. Measurements were performed above and below the segment at 3 points in relation to the incision site. Statistical analysis was performed using the SAS software for ANOVA, matched t-test, and GLIMMIX procedure.ResultsIntacs segment depth was 153-μm shallower than intended (58% vs 80%). Segment layout demonstrated the proximal and distal portions to be 13-μm shallower and 12-μm deeper (on average), respectively. Intacs segment thickness does not influence implantation depth. Intacs segments implanted in the same eye do not share similar implantation depths. Stromal compression is likely to occur.ConclusionIntacs are implanted at a shallower depth than intended. The 'pocketing' stage prior to implantation most likely has a stronger effect on the segment's final implantation depth than does the incisions' depth. © 2016 Macmillan Publishers Limited.
Pichi F.,University of Milan |
Morara M.,Ophthalmology Unit |
Torrazza C.,Ophthalmology Unit |
Manzi G.,Monaldi Hospital |
And 6 more authors.
American Journal of Ophthalmology | Year: 2013
Purpose: To evaluate the anatomic and functional results of the treatment with intravitreal bevacizumab in complicated retinal arterial macroaneurysm (RAM). Design: A multicenter interventional, prospective, nonrandomized study. Methods: Thirty-eight macroaneurysms of 37 patients with foveal complications were evaluated. All patients underwent a comprehensive ophthalmologic examination, fluorescein angiography (FA), and spectral-domain optical coherence tomography (SD OCT) examination. Each patient underwent 3 monthly injections of bevacizumab 1.25 mg/0.05 mL; 3 follow-up visits were planned at week 2, 6, and 12. Results: Both best-corrected visual acuity (BCVA), expressed in logarithm of minimal angle of resolution (logMAR), and central retinal thickness (CRT) significantly improved during the follow-up visits (0.57 ± 0.21 vs 0.41 ± 0.15 vs 0.23 ± 0.13 vs 0.09 ± 0.10 and 520.38 ± 191.05 vs 396.24 ± 136.18 vs 283.86 ± 71.87 vs 214.84 ± 26.86, respectively, Friedman test P <.0001 for all variables). At 6 weeks of follow-up, FA showed complete closure of the RAM in 36 of 38 cases (94.7%). Four weeks following the third injection, the macular edema had completely resolved and hard exudates regressed slowly in 100% of patients. Conclusions: Intravitreal bevacizumab is an effective therapy for complicated RAM, quickly improving BCVA and CRT. Anti-vascular endothelial growth factor (VEGF) drugs might actively close the involved pathologically permeabilized retinal artery and normalize the vessel wall formation by localized inhibition of VEGF. © 2013 Elsevier Inc.
Monaco G.,Ophthalmology Unit |
Cacioppo V.,Ophthalmology Unit |
Consonni D.,Epidemiology Unit |
Troiano P.,Ophthalmology Unit
European Journal of Ophthalmology | Year: 2011
Purpose. To determine the effects of 2 artificial tear formulas on the ocular surface in patients with glaucoma using topical preserved beta-blockers (BB) or prostaglandins (PG).Methods. This was a prospective, comparative, randomized, double-blind study with a crossover design. Twenty patients with dry eye were divided into 2 groups based on glaucoma treatment: BB (10 subjects) or PG (10 subjects). Each group was administered a 4-week course of unpreserved isotonic (300 mOsm/L) solution containing 0.2% sodium hyaluronate (SH) or a preserved isotonic (295-305 mOsm/L) solution containing 0.5% carboxymethylcellulose and 0.9% glycerin as compatible solute (CMCs) administered QID. After a 2-week washout period, the course of treatment was reversed. The primary efficacy criteria consisted of assessing symptoms according to the Ocular Surface Disease Index© (OSDI); the secondary efficacy criteria consisted of evaluating tear film confocal microscopy, central corneal thickness (CCT), and lissamine corneal and conjunctival staining (Oxford Grading System Score [OGSS]). Results. Within each group, only CMCs induced a significant improvement in OSDI and OGSS compared to baseline values: OSDI -20.5, p<0.0001; OGSS -0.9, p<0.0001. Tear film confocal microscopy improved after treatment, especially in case of patients who were administered CMCs. No difference in CCT was noticed for any subject. Conclusions. This study demonstrates for the first time that the use of concomitant CMCs in the management of glaucoma undergoing treatment with BB or PG may assist in tear film production and could lead to better compliance with intraocular pressure-lowering medication and ultimately better prognosis. © 2010 Wichtig Editore.
Panozzo G.,Ophthalmology Unit |
Gusson E.,University of Verona |
Panozzo G.,University of Parma |
Dalla Mura G.,Ophthalmology Unit
European Journal of Ophthalmology | Year: 2015
Purpose: To define the mean time of first recurrence of diabetic macular edema (DME) after a single injection of dexamethasone intravitreal implant (DEX-I), reducing the burden of monthly visits during a PRN regimen of treatment. Methods: Twenty phakic eyes with DME (12 eyes naïve and 8 eyes with edema persistent after previous treatments) were followed monthly after DEX-I injection until evidence of first recurrence of edema, defined as a change in visual acuity (VA) ≥5 letters and/or in foveal thickness (FT) ≥50 μm. Reaching this point, the eyes were re-treated. Monitored parameters were changes in VA, FT, intraocular pressure (IOP), and lens opacity. Results: Maximal efficacy was registered at month 1, when mean VA improved by 14 letters (19%), FT decreased by 325 μm (43.7%), and in 15 eyes (75%) edema was completely reabsorbed. The mean time of first recurrence was 5.1 months. No statistical difference was found between eyes with naïve or persistent DME. Five eyes needed topical medication for modest temporary IOP increase (21-24 mm Hg) between months 2 and 4. No increase in lens opacities was registered during follow-up. Conclusions: According to the results of this study, the first signs of DME recurrence after DEX-I injection appear at a mean time of 5 months, suggesting that an appropriate and prudent time schedule for a PRN regimen could be limited to monthly tonometry and a first complete examination not before 4 months. © 2015 Wichtig Publishing.
Clark A.,Ophthalmology Unit |
Balducci N.,University of Bologna |
Pichi F.,Ophthalmology Unit |
Veronese C.,Ophthalmology Unit |
And 3 more authors.
Retina | Year: 2012
Purpose: The purpose of the study is to report the incidence of changes of the retinal nerve fiber layer in the early postoperative period after internal limiting membrane peeling for idiopathic macular hole and epiretinal membrane surgery. Methods: Interventional, noncomparative retrospective case series. Fifty-six eyes of 55 patients with an epiretinal membrane and 33 eyes of 31 patients with macular hole underwent pars plana vitrectomy and internal limiting membrane peeling. All patients received a complete ophthalmic examination, infrared and autofluorescence photography, and spectral-domain optical coherence tomography preoperatively and also at approximately 1 week, 1 month, and 3 months postoperatively. Vitrectomy and gas tamponade were performed with internal limiting membrane peeling after staining with Brilliant Peel. The main outcome measures were the presence of postoperative swelling of the arcuate retinal nerve fiber layer on spectral-domain optical coherence tomography, infrared and autofluorescence photographs, and its effect on best-corrected visual acuity. Results: On infrared and autofluorescence photographs, 28 (31.46%) of 89 eyes with internal limiting membrane peeling exhibited swelling of the arcuate retinal nerve fiber layer 1 week to 1 month postoperatively. Swelling of the arcuate retinal nerve fiber layer increased during the first month after surgery and resolved after a mean period of 2 months. These features were best visualized by autofluorescence imaging, as three to five dark striae originating from the optic nerve head, radiating in an arcuate pattern toward the macula. Simultaneous spectral-domain optical coherence tomography scanning through the striae indicated that they correspond to areas of focal swelling of the arcuate nerve fiber layer. No significant differences were found in eyes with or without swelling of the arcuate retinal nerve fiber layer for mean age or pre-and postoperative best-corrected visual acuity (P > 0.05). Conclusion: Swelling of the arcuate retinal nerve fiber layer often occurs after internal limiting membrane peeling for macular hole and epiretinal membrane. It is a transient feature after surgery that does not affect visual recovery. It is best visualized using infrared and autofluorescence imaging. Simultaneous infrared and spectral-domain optical coherence tomography imaging after macular surgery can detect transient inner retinal changes, which are not visible on clinical examination.
Naftali M.,Ophthalmology Unit |
Naftali M.,Bar - Ilan University |
Jabaly-Habib H.,Ophthalmology Unit |
Jabaly-Habib H.,Bar - Ilan University
European Journal of Ophthalmology | Year: 2013
Purpose. To compare the depth of intrastromal corneal ring segments (ICRS) with the expected depth value using optical coherence tomography (OCT). Methods. This was a retrospective comparative study in an ophthalmic unit in a government hospital, the Baruch Padeh Medical Center, Poriya, Israel. Ten eyes of 8 patients with 18 ICRS were reviewed. Eleven segments were Intacs (Addition Technology, Inc.) and 7 Kerarings (Mediphacos). Using anterior segment OCT (OPKO OTI) the shortest distance from the epithelium to the segment at 3 points was measured for each segment. The 3 points are proximal, middle, and distal to the incision. Results. The mean depth of the 18 segments was 360±68 μm. The mean maximal and minimal depths were 383±70 and 336±72 μm, respectively. The mean depths of the distal, central, and proximal point measurements of all ICRS were 358±79, 361±77, and 362±59 μm, respectively; no significant difference was found. No part of the segments tended to be more superficial than others (p=0.98). There was no significant difference between Intacs and Kerarings depths (p=0.43). There was a significant difference between the expected ICRS depth and the OCT measurements (mean 480±20) and 360±68), respectively. Conclusions. The ICRS actual depth was less than expected. There was mild variability in segment depth, both between segments and along the same segment. No significant difference was found between the depth of Intacs and Kerarings. © 2013 Wichtig Editore.
Moramarco A.,Ophthalmology Unit |
Iovieno A.,Ophthalmology Unit |
Sartori A.,Ophthalmology Unit |
Fontana L.,Ophthalmology Unit
Journal of Cataract and Refractive Surgery | Year: 2015
Purpose To evaluate and compare the depth of corneal stromal demarcation line after accelerated collagen crosslinking (CXL) using continuous and pulsed light ultraviolet-A (UVA) exposure. Setting Department of Ophthalmology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Design Retrospective case series. Methods Patients with progressive keratoconus were assigned to 1 of 2 treatment protocols using the same irradiation device for accelerated CXL. Patients assigned to Group A received accelerated CXL using continuous UVA light exposure at 30 mW/cm2 for 4 minutes. Patients assigned to Group B received accelerated CXL using pulsed UVA light with 8 minutes (1 second on/1 second off) of UVA exposure at 30 mW/cm2 and energy dose of 7.2 J/cm2. One month after surgery, corneal stromal demarcation line depth was measured by 2 independent observers using anterior segment optical coherence tomography (AS-OCT). Results A total of 60 patients were assessed. Corneal stromal demarcation line was easily identified on AS-OCT scans in all eyes by both observers. The mean depth of stromal demarcation line was 149.32 ± 36.03 μm in Group A and 213 ± 47.38 μm in Group B. The difference in stromal demarcation line depth between groups was statistically significant (P <.001). Conclusions Using accelerated CXL, the corneal stromal demarcation line was significantly deeper using pulsed rather than continuous light exposure. © 2015 ASCRS and ESCRS.