Early microvascular and neural changes in patients with type 1 and type 2 diabetes mellitus without clinical signs of diabetic retinopathy

Purpose: To assess and compare early modifications in inner retinal layer thickness and optical coherence tomography angiography parameters in patients with diabetes mellitus (DM) Types 1 and 2 without clinical signs of diabetic retinopathy. Methods: Ninety eyes of 90 subjects (24 Type 1 DM, 36 Type 2 DM, and 30 healthy controls) were prospectively evaluated with spectral domain OCT, swept-source OCT angiography, and color fundus photography (on the same day). Retinal nerve fiber layer, ganglion cell layer (GCL+), and nerve fiber layer + GCL+ (GCL++) thickness were automatically determined by the instrument in the 1, 3, and 6 central mm. On OCT angiography, the following parameters were evaluated: area of foveal avascular zone, number of focally dilated endings of the capillaries (detected only on OCT angiography), presence of regular/irregular foveal avascular zone, capillary loss, and capillary network irregularities in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Ganglion cell layer+ (P = 0.0099) and GCL++ (P = 0.0367) were significantly thicker in DM Type 1 versus DM Type 2 in 1 central mm, after adjustment for age and DM duration. The area of foveal avascular zone was significantly larger in DM Type 1 versus controls in both SCP and DCP and in DM Type 1 versus Type 2 only in DCP (P , 0.05 for all); the number of focally dilated endings of the capillaries was higher in DM Type 1 versus controls in both SCP and DCP (P , 0.01 for all); and in DM Type 2 versus controls only in DCP (P = 0.007). Perifoveal capillary loss in SCP and inner retinal layer thickness had the highest correlation in both DM types. Conclusion: There are specific neural and microvascular modifications even before clinical signs of diabetic retinopathy in DM Types 1 and 2. Perifoveal capillary loss in the SCP is highly correlated with inner retinal layer. These data may help in characterization of patients at the preclinical stage of diabetic retinopathy

Normal Values for Fundus Perimetry with the Microperimeter MP1

Normal values for fundus perimetry with the microperimeter MP1. Midena E, Vujosevic S, Cavarzeran F; Microperimetry Study Group. Collaborators (12)Luciani F, Cappello E, Tollot L, Carpineto P, Capris P, Convento E, Midena E, Radin PP, Varano M, Vujosevic S, Tedeschi E, Parodi MB. SourceDepartment of Ophthalmology, University of Padova, Padova, Italy. [email protected] Abstract PURPOSE: To identify age-stratified normal light sensitivity values for microperimetry (fundus perimetry) and to evaluate the short-term repeatability of the MP1 microperimeter in normal volunteers. DESIGN: Multicenter, prospective, observational study. PARTICIPANTS: One hundred ninety subjects. METHODS: One hundred ninety eyes of 190 healthy volunteers (age range, 20-75 years) underwent automatic, full-threshold microperimetry of the central field (20 x 20 degrees, 77 stimulated points) with the MP1 microperimeter (Nidek Technologies, Gamagori, Japan). Fixation was documented simultaneously. A subgroup of 10 subjects was retested after 1 hour and 1 week to determine the repeatability of this technique. MAIN OUTCOME MEASURES: By linear regression analyses, light sensitivity values were obtained from 4 fundus areas and were analyzed for differences related to region, age, and, in a subset of subjects, repeat testing over time and right and left eye variability. Short-term repeatability for each area was evaluated by calculating intraclass correlation coefficients. RESULTS: Linear regression analysis showed a significantly greater (P<0.0001) mean macular sensitivity of 19.6+/-0.5 dB in the 20 to 29 years of age group compared with 18.6+/-1.5 dB in the oldest age group of 70 to 75 years. These results were confirmed by the fifth percentile of light sensitivity threshold distribution. Normal and 95% confidence interval age-stratified values were calculated. When results for all 190 subjects were analyzed by region, the superior retinal sector showed significantly lower mean sensitivity values than other sectors (P<0.01, Bonferroni test). In a subset of 10 subjects, repeatability of the test performed at 3 separate visits showed consistent values over time in all areas (P<0.01, intraclass correlation coefficients). CONCLUSIONS: Automatic fundus perimetry with the MP1 microperimeter allows for an accurate, repeatable, topographically specific examination of the retinal threshold in selected retinal areas. These findings are the first extensive database of age-related, normal MP1 microperimetry results available to clinicians. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. Comment in Ophthalmology. 2011 Jun;118(6):1224; author reply 1224-5. PMID: 20472294 [PubMed - indexed for MEDLINE

COMPARISON of RETROBULBAR, SUBTENON ANESTHESIA and MEDIAL CANTHUS EPISCLERAL ANESTHESIA for 25-GAUGE POSTERIOR VITRECTOMY

Purpose: The aim of the study is to compare the efficacy, safety, and globe akinesia between retrobulbar anesthesia, sub-Tenon anesthesia, and medial canthus episcleral anesthesia for 25-gauge posterior vitrectomy. Methods: A total of 340 25-gauge vitrectomy data sheets were retrospectively collected between November 2017 and June 2019. Ninety patients were included in the study. These patients were matched by sex and age to receive retrobulbar anesthesia (group 1, n = 30), sub-Tenon anesthesia (group 2, n = 30), and medial canthus episcleral anesthesia (group 3, n = 30). Globe akinesia was recorded after the injection of anesthetic at 2, 5, and 10 minute time intervals. Patients were asked to rate the pain during administration of anesthesia, during surgery, and postoperatively using the visual analog pain scale. Results: For a perfect block, at 10 minutes, retrobulbar outperformed both sub-Tenon and medial canthus episcleral anesthesia which seemed quite similar. During administration, the three techniques did not show statistically different effects on pain. Regarding perioperative pain, retrobulbar outperformed medial canthus episcleral anesthesia. Conclusion: All three techniques allowed for safe surgery. Retrobulbar obtained the best results, although sub-Tenon proved to be a valid alternative. Medial canthus episcleral anesthesia obtained mostly good and fair blocks and acceptable pain levels during surgery. Further studies should investigate whether optimal anesthetic efficacy can be obtained with sub-Tenon and medial canthus episcleral techniques when higher volumes are used

Macular automatic fundus perimetry threshold versus standard perimetry threshold

Macular automatic fundus perimetry threshold versus standard perimetry threshold. Midena E, Radin PP, Convento E, Cavarzeran F. SourceDepartment of Ophthalmology, University of Padova, Padova; G.B. Bietti Eye Foundation, IRCCS, Roma, Italy. [email protected] Abstract PURPOSE: To evaluate if retinal sensitivity threshold obtained with an automatic fundus perimeter may be compared with a standard perimeter retinal threshold. METHODS: Automatic full-threshold fundus perimetry (microperimetry) of the macular area (10 degrees grid, 37 stimulated points) was quantified with a new automatic fundus perimeter (MP1 microperimeter) in nine normal subjects (18 eyes). Retinal threshold was also quantified using an identical grid projected with a standard Octopus 101 perimeter. RESULTS: Mean threshold registered by MP1 microperimeter was 19.7+/-0.8 dB (range 16-20 dB; 4.38+/-0.96 asb, range 4-10 asb) versus 33.1+/-1.7 dB (range 27-38 dB; 0.53+/-0.22 asb, range 0.16-2 asb) obtained with Octopus perimeter. Mean SD of intraindividual variation was 0.74 dB in MP1 and 1.51 dB in Octopus. No statistically significant differences were documented between right and left eye with both instruments (p=0.64). No reliable mathematical relationship between retinal thresholds could be obtained with the two perimeters. CONCLUSIONS: Fundus perimetry is a precise, functional fundus-related technique which allows threshold determination at selected retinal points even if fixation is unstable and visual acuity is low. This is beyond the possibility of any static standard perimetry. Normal threshold values obtained with MP1 automatic microperimeter cannot be currently compared with those obtained with standard Octopus perimeter. PMID: 17294384 [PubMed - indexed for MEDLINE

Macular and peripapillary choroidal thickness in diabetic patients.

PURPOSE: : To investigate macular and peripapillary choroidal thickness (CT) in diabetic patients with and without diabetic retinopathy (DR). METHODS: : One hundred and fifty subjects were enrolled: 102 diabetic patients (102 eyes) and 48 normals, as controls. Exclusion criteria were previously treated DR, refractive error higher than \ub13 diopters, and treated or untreated glaucoma. All patients underwent full ophthalmic examination, stereoscopic color fundus photography, and spectral domain optical coherence tomography (RS-3000; Nidek). Spectral domain optical coherence tomography examination consisted of linear scans, 6 mm in length, centered onto the fovea, and circle scan positioned around the optic disk (3.46 mm in diameter). Choroidal thickness was measured manually at the fovea and at 1, 2, and 3 mm distance along all scans in the macula. Peripapillary CT was measured at eight points along the circle scan. All measurements were performed independently by 2 masked graders. RESULTS: : Mean age was not significantly different between patients with diabetes and controls. In the macular area, CT was significantly lower in the nasal quadrant versus all other quadrants (P < 0.0001), in both groups. In the peripapillary area, CT was significantly lower in the inferior quadrant versus all other quadrants (P < 0.05), in both groups. Mean macular and peripapillary CT progressively and significantly decreased with increasing level of DR (nonproliferative and proliferative DR vs. controls, P < 0.05). No significant CT difference was found between controls and diabetic eyes without detectable DR. Diabetic macular edema did not influence CT. Interobserver coefficient of repeatability was 28.8 (95% confidence interval, 24.8-32.8) for foveal measurements and 13.0 (95% confidence interval, 11.2-14.8) for peripapillary measurements. Pearson correlation coefficient was 0.99, and P <0.0001 for all measurements. CONCLUSION: : Choroidal thickness is reduced in diabetic eyes and parallels appearance and evolution of DR. Spectral domain optical coherence tomography clearly confirms in vivo previously reported histopathologic observations. The role of choroid in the pathophysiology of DR needs to be adequately investigated

Efficacy and Satisfaction of Cyclosporine 0.1% in Patients with Vernal Keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a severe form of ocular allergy that compromises the quality of life of affected patients. Topical cyclosporine 0.1% cationic emulsion (CsA-CE) has been recently authorized for the treatment of severe VKC. We treated 29 VKC patients with on-label CsA-CE and recorded signs and symptoms, subjective patient’s treatment satisfaction and the additional use of topical corticosteroids in case of exacerbations. CsA-CE was effective in reducing signs and symptoms in daily clinical practice. The overall subjective improvement of symptoms, efficacy of the treatment, tolerability to the drug and compliance reached a high level of subjective satisfaction score.55% of treated patients required the additional use of a 3-day course of topical dexamethasone with 1.13 ± 0.81 mean courses/month. In conclusions, VKC patients reported an overall high satisfaction with used the on-label topical CsA-CE with a limited use of additional topical corticosteroid treatment

Single retinal layer changes after subthreshold micropulse yellow laser in diabetic macular edema

A pilot prospective, interventional study has been conducted on 10 patients with diabetic macular edema (DME) treated with subthreshold micropulse laser (SMPL) to evaluate changes of individual retinal layers and to correlate with functional changes. All patients underwent complete ophthalmologic evaluation including spectral-domain optical coherence tomography (OCT) and microperimetry at baseline, 3 months, 6 months, 9 months, and 12 months. Compared with baseline, a significant decrease was found in inner nuclear layer (INL) and outer retinal layer (ORL) thickness in the central 1 mm (P < .05). Increase in best-corrected visual acuity was significantly and inversely correlated to central retinal thickness (CRT) (P = .0027), INL (P = .0167), and outer nuclear layer (ONL) thickness (P = .0107). Increase in retinal sensitivity was significantly and inversely correlated to CRT and ONL thickness (P < .01). Therefore, SMPL showed to improve firstly functional parameters and then morphologic parameters. Functional parameters were inversely correlated to CRT, INL, and ONL thickness. The exact mechanism of reduction of INL thickness induced by SMPL remains to be further evaluated

Resonance Raman measurement of macular carotenoids in a European population

Purpose: Increasing evidence has linked the Macular Pigment (MP) to the risk of age\u2013related macular degeneration (AMD). This study quantifies the MP using Resonance Raman Spectroscopy (RRS) and compared MP levels in the young and the elderly, including those with age\u2013related macular degeneration, in subjects from a Mediterranean area. Methods: Sixty\u2013nine eyes from 69 subjects (age range = 25\u201380 years) living in the Veneto Region have been recruited for this study; 39 subjects had no retinal lesions (among these 7 were pseudo\u2013phakic) and 30 were patients with early non\u2013exudative AMD in the eligible eye. RRS has been obtained by illuminating the macular area for 0.25 seconds with a 1\u2013mm spot of 488\u2013nm, 1.0\u2013mW argon laser light. Results: Among normal individuals the MP level shows a significant decline with age and the population\u2019s values are best fit with an exponential curve (R2=0.39, p<0.05). We also divided this sample into 2 subgroups, one with subjects whose age was 55 years or less and the other with subjects over 55 years. In the younger subgroup the Resonance Raman Intensity (counts+SD) was 2136+789, significantly higher than the older subgroup (1231+461, p<0.0001). Pseudo\u2013phakic subjects with no retinal signs of AMD had MP levels within normal values (1248+612). Among patients with early non\u2013exudative AMD the Raman signal evidenced a statistically significant reduction (871+522) compared to age\u2013matched normal individuals (p<0.011). This observation accounts for a 29% decrease of the MP among patients with early AMD. Conclusions: Normal young subjects show a wide variation of MP levels as measured by the RRS. As age increases, an exponential reduction of macular carotenoids is apparent, even without clinically evident signs of AMD. The MP is significantly lower in the patients with early non\u2013exudative AMD, compared to age\u2013matched controls. These data confirm other studies carried out with the RRS, even though are in contrast with other studies made with flicker photometry which suggest that MP does not change with age, even when elderly subjects with AMD are considered. This difference could be explained by the need of a good compliance for psycophysical tests, such as flicker photometry, compared to more objective measurements such as given by the Raman method. Also, by comparing the data of this study within aged normals to other studies carried out in United States, it is evident that European population has a higher amount of carotenoids as measured by Raman (p<0.0001). This supports the hypothesis that genetics, diet and environment could account for the difference of the prevalence of AMD in Europe

Fundus autofluorescence and microperimetry in progressing geographic atrophy secondary to age-related macular degeneration.

PURPOSE: To prospectively analyse microperimetry, standard short-wavelength fundus autofluorescent (SW-FAF) and near infrared-wavelength FAF (NIR-FAF) changes in eyes with geographic atrophy (GA) secondary to age-related macular degeneration. METHODS: Twenty consecutive eyes (14 patients) affected by GA were enrolled. Repeated microperimetric examinations and FAF images were obtained over a mean follow-up period of 12.3\ub14.5 months. RESULTS: GA area was always wider on NIR-FAF versus SW-FAF images (5.05\ub12.40 mm(2) vs 4.45\ub12.41 mm(2), p=0.005 baseline; 5.78\ub12.87 mm(2) vs 5.21\ub12.77 mm(2), p<0.0001 follow-up). Mean retinal sensitivity significantly decreased during follow-up from 7.68\ub13.92 dB to 6.71\ub14.37 dB (p=0.0013). 47.3% of the relative dense scotomas ( 645 dB) progressed to dense scotoma (0 dB). Retinal areas showing relative dense scotoma and characterised by hypo-SW-FAF or hyper-NIR-FAF at baseline had a higher risk of evolving to dense scotoma compared with normo-FAF and hyper-FAF on SW-FAF (OR=2.62 and 2.77, respectively), or normo-FAF at NIR-FAF (OR=2.96). CONCLUSIONS: SW-FAF, compared with NIR-FAF, underestimates GA area at baseline and at follow-up. The enlargement rate of progression based on NIR-FAF is not greater than on SW-FAF. Different SW-FAF and NIR-FAF patterns show different relative risk of progression from relative to dense scotoma. Microperimetry, SW-FAF and NIR-FAF should be combined to obtain adequate morphological and functional prospective information