A case of cilioretinal artery with hemiretinal distribution

The retinal vasculature is usually supplied by the central retinal artery (CRA), This is the first branch of ophthalmic artery in 77.5% (1). Cilioretinal arteries are reported to be present in up to 50% of eyes, and are considered to be the most common retinal vascular anomaly. Cilioretinal arteries take rise from a posterior ciliary artey (2). They may vary in size, number, distribution and point of origin from the optic disc. In most of the cases they are small arterioles supplying a part of central retina from the fovea to the optic disc. Only in 0.6%, large cilioretinal arteries can supply more than a quarter of the retinal circulation (3). We present a rare case of an individual with asymmetrical cilioretinal artery that arise inferiorly and supply the entire inferior emiretina. D.N., 7 years old male, affected by hyperopic astigmatism in both eyes. Clinical exam revealed no diseases. Examination of the fundus oculi showed, in the right eye, the presence of a very common small cilioretinal artery running from the disc to the foveal avascular zone. In the left eye, the central retinal artery gave rise only to two superior branches; a large cilioretinal artery entered the disc area from its inferotemporal edge, and gave rise to two inferior arterial branches. Thus, in the left eye, the CRA feeds the superior half of the retina; the large cilioretinal artery supplies the inferior half of the retina. Retinography was performed using a Confocal Color Scanning Ohthalmoscope (Eidon). This type of uncommon variant of retinal vasculature prevents extended retinal ischemia due to CRA occlusion

Anesthesia in the surgery of strabismus: role of anesthetic agents in the ocular deviation and surgical outcome

Purpose: To determine whether the changes in the ocular alignment following general anesthesia, maintained with two different inhalational anesthetic agents, sevoflurane and desflurane, can be used as a predictor for surgical outcomes in children with esotropia. Methods: The authors obtained digital photographs of 42 children with esotropia; 21 patients underwent strabismus surgery with general inhalation anesthesia with sevoflurane (group A), 21 patients with inhalatory anesthesia with desflurane (Group B), as maintenance general anesthesia agents. For each patient, the corneal reflexes position were digitally measured and compared with the preoperative ocular deviation’s angle; the correlation with surgical outcome, one year after, was considered. Results: The patients in both groups showed a decrease of the squint angle, or eye’s gap position after the induction of general anesthesia. In group B, this divergence was significantly higher than in group A (P<0.001). In both groups, there was a linear correlation between the preoperative angle and shortly after the induction of general anesthesia. Patients ranging a corneal reflexes position within 1 SD (15Δ) evidenced higher success of surgery (p<0.05) of patients>1 SD. Conclusion: Changes in the ocular deviation with sevoflurane and desflurane, can be predictive for surgery outcome in children with esotropia. Furthermore, desflurane evidenced greater effects on the ocular deviation compared to sevoflurane, thus confirming to be the inhalational anesthetic of choice in strabismus surgery

“Influence of the Therapy with Dorzolamide on the Corneal Structures: Analysis by Confocal Microscopy (CS3)”

Purpose: To value, in vivo, with the confocal microscopy(CS3) the corneal microscopic changes in a group of patients in therapy with Dorzolamide 2% eyedrops. Methods:Thirty patients (sixty eyes) with monocular hypertension (IOP21 mmHg) and no previous ipotonic therapy were recruited. The hypertensive eye (HE)was treated with Dorzolamine 2% eyedrops three times daily, the normal tension eye (NE) was used as the control eye. At the time of recruitment, one and three months after the beginning of treatment were performed: applanation tonometry, ultrasound pachimetry (USP), and a CS examination. Results: Mean age was 41,13±10,515 year, at the recruitment time: mean IOP was 16,50±2.34 mmHg in the NE and 22,06±0.68 mmHg in the HE, USP was 542,50±31,18 µ in the NE and 536,63±38,08 in the HE, endothelial cell density was (cell/mm2) 2473,37±339,58 in the NE and 2386,94±284,16 in the HE, stromal reflectivity was 0.36±0.06 in the NE and 0.36±0.05 in the HE. At each control time the IOP was statistically reduced in the treated eyes of a mean of 7,25 mmHg (p<0.01), all the corneal data didn’t show a statistically significant change during the follow–up period, only the stromal reflectivity seemed to be increased in the last control of 0,1 (p<0.005). Conclusions: The CS3 examination allowed us to value the microscopic corneal structure and to show that no clinically significant changes were produced by dorzolamide local therapy

Effects of repeated intravitreal injections of dexamethasone implants on intraocular pressure: a 4-year study

Purpose: Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants. Materials and Methods: A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards. Results: Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and −0.41 mmHg (T3) (p &lt; 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and −0.66 mmHg (T3) (p &lt; 0.05). Conclusion: Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30–90 days following the implantation procedure and responds well to topical pressure-lowering medications

Utility of ocular motility tests in orbital floor fractures with muscle entrapment that is not detected on computed tomography

Purpose: Determine the usefulness of ocular motility testing to detect the presence of muscle entrapment. Materials and Methods: Cross-sectional study of patients with symptoms of diplopia secondary to facial trauma. Inclusion criteria: age between 20 and 80 years; symptoms of diplopia following facial trauma; presence of orbital floor fracture confirmed radiologically; presence of muscle entrapment confirmed at the time of surgery; best-corrected visual acuity of 0.6 or more. Exclusion criteria: muscle entrapment visible on computed tomography; candidate for immediate surgical correction; prior history of strabismus surgery. Outcome measures: Abnormal Head Position (AHP), Hirschberg Corneal Reflexes (CR), Cover/Uncover and Alternating Cover Test, Hertel exophthalmometry, Near Point of Convergence (NPC), Kestenbaum Limbus test, Red Filter test, and Hess screen test. Results: Forty-six subjects (38 males, 8 females, mean age 27 ± 3.3 SD years). Pre-operative assessment: forty-six (100%) reported diplopia on the Red Filter test and showed some degree of abnormality on the Hess Screen test. Forty-two (91%) showed AHP. Forty-one (89%) had exophthalmometry values that differed 2 mm or more between the two eyes and insufficient NPC. Thirty-two (69.6%) showed deficits of 3 mm or more on the Kestenbaum Limbus test. Sixteen (35%) had abnormal Hirschberg corneal reflexes. Eleven (24%) demonstrated constant or intermittent strabismus. Conclusion: Ocular motility testing can differentiate non-invasively, pre-operatively, and cost-effectively the presence of muscle entrapment even when this is not visible on computed tomography

“ HRT”

Relazione come Docente al Corso di Aggiornamento in Oftalmologia con accreditamento ECM su “ Glaucoma Up to Date: quando la terapia farmacologia in associazione”. Aula Magna- Dipartimento di Scienze Oftalmologiche- Università La Sapienza Roma 9 ottobre 200

“La sindrome da disfunzione lacrimale” Diagnosi e gestione negli ambulatori oculistici distrettuali

“La sindrome da disfunzione lacrimale” Diagnosi e gestione negli ambulatori oculistici distrettual

Glaucoma: Terapia Medica

Relatore al Corso di aggiornamento "Patologie Oculistiche di Rilevanza Sociale: Progressi nella Diagnosi e nella Terapia "con accreditamento ECM . Ospedale Pertini-Aula Magna-ROM

Ruolo del dosaggio di 800mg di Citicolina per via orale nel trattamento dei deficit sensoriali del Glaucoma cronico ad angolo aperto

OBIETTIVO: Lo scopo dello studio è stato quello di valutare gli effetti della citicolina orale al dosaggio di 800 mg die per un periodo di 3 mesi consecutivi sui difetti perimetrici, variabile psicofisica indicatrice di danno glaucomatoso,di pazienti con glaucoma ad angolo aperto (CG AA) in buon compenso tonometrico (IOP≤18mmHg). Materiali e METODI: Sono stati selezionati 100 pazienti affetti da glaucoma ad angolo aperto con alterazioni perimetriche da glaucoma stabili da almeno 2 anni. I pazienti sono stati suddivisi in modo random in due gruppi di 50 (100 occhi). Un gruppo (GT) è stato trattato con Citicolina orale al dosaggio di 800 mg die (Cebrolux 800 Bausch e Lomb) per un periodo di 3 mesi, l’altro gruppo costituiva il gruppo di controllo (GC). Entrambi i gruppi sono stati sottoposti a 2 esami perimetrici con Hunphrey 30-2 all’inizio della terapia (T0) e subito dopo i 3 mesi di terapia (T1) del GT e analizzate le variazioni degli indici MD e PSD del campo visivo al T0 e al T1. RISULTATI: Dopo 3 mesi di terapia si osserva nel GT un miglioramento statisticamente significativo degli indici perimetrici MD e PSD a fronte di una stabilità o lieve peggioramento degli stessi nel GC. CONCLUSIONI: La citicolina da 800mg per via orale ha determinato un miglioramento degli indici perimetrici nel GT questo indica un effetto neuroprotettivo nel Glaucoma cronico ad angolo aperto, al pari di quanto già rilevato con la via iniettiva 6-7