Subretinal recombinant tissue plasminogen activator and pneumatic displacement for the management of subretinal hemorrhage occurring after anti-VEGF injections for wet AMD

We describe three cases of submacular hemorrhage that occurred two to four days after anti-VEGF intravitreal injection for occult choroidal neovascularisation in age-related macular degeneration and their management with 25 gauge pars plana vitrectomy with injection of subretinal recombinant tissue plasminogen activator (rTPA) followed by fluid-air exchange and postoperative prone position. Vitrectomy, subretinal rTPA injection and fluid-gas exchange apply as a safe and effective treatment in these cases. Functional results seem to be positive especially if surgical treatment is promptly performed

Analysis of the optical quality of intraocular lenses.

PURPOSE. To evaluate the optical quality of different intraocular lenses (IOLs). METHODS. An optical test bench and suitable software were used to assist in analysis of the optical Fourier transform (OFT) of a test image and to determine the quality of the lens in terms of spatial frequency response. The OFT was automatically converted, by means of an optical– electronic calibration procedure, into a modulation transfer function (MTF) for each lens. The passband value calculated by computer analysis of the MTF is an objective index of the lens quality. Three randomly acquired samples of 24 different models of foldable IOLs were compared. Statistical analysis was performed with twoway and one-way ANOVA for repeated measurements and with the Ryan-Einot-Gabriel-Welsch multiple F test. RESULTS. The method was demonstrated to be precise and accurate. A large range of passband values was found. Statistically significant differences between the mean passband values for different lenses were found. The lowest passband value (125.60 line pairs [lp]/mm) was measured for the IOL (Lenstec LH3000; Lenstec, Inc., St. Petersburg, FL) and the highest (191.48 lp/mm) for the Acrysof SA30AL (Alcon, Fort Worth, TX). CONCLUSIONS. Different IOLs can transmit different spectra of spatial frequencies. The best frequency response was provided by acrylic IOLs, particularly those with an asymmetrically biconvex profile. This could be due to a reduction of optical degradation provided by this type of profile. A lens with a higher frequency response should determine a better quality of vision once implanted and the frequency response should therefore be considered when choosing the intraocular lens model. (Invest Ophthalmol Vis Sci. 2004;45:2682–2690) DOI: 10.1167/iovs.03-102

Inflammatory cell adhesion and surface defects on heparin-surface-modified poly(methyl methacrylate) intraocular lenses in diabetic patients

2noPurpose: To evaluate the incidence of surface scratches on heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) and the possible influence of these alterations on the biocompatibility of HSM PMMA. Setting: University Eye Clinic of Trieste, Trieste, Italy. Methods: Twenty-six diabetic patients had phacoemulsification and implantation of an HSM PMMA IOL (809C, Pharmacia & Upjohn). Patients with proliferative diabetic retinopathy or iridopathy were excluded from the study. On postoperative days 7, 30, 90, and 180, specular microscopy was performed to study and photograph the anterior IOL surface. The presence of scratches on the anterior IOL surface was assessed and the inflammatory cell reaction noted and graded using a semiquantitative scale. Finally, the location of the inflammatory cells in relation to the surface scratches was established. Results: Scratches and other surface defects were found in 88.4% of cases. All patients had small cells on the IOL surface 7 days after surgery. At 30 days, small cells were observed in 88.4% of cases. The inflammatory cells were mainly located inside the scratches rather than throughout the IOL surface. Conclusions: This in vivo cytology study provides further evidence of the effectiveness of heparin surface modification in improving the biocompatibility of PMMA. in diabetic patients, inflammatory cells adhered to the exposed PMMA surface more than to the HSM surface, suggesting that the use of HSM PMMA in patients with conditions predisposing them to increased postoperative blood-aqueous barrier breakdown is beneficial. J Cataract Refract Surg 2001; 27:239-244 (C) 2001 ASCRS and ESCRS.noneopenTognetto D; Ravalico GTognetto, Daniele; Ravalico, Giusepp

Subthreshold Laser Treatment for Retinal Arterial Macroaneurysm

International audiencePurpose: To assess the effects of subthreshold laser treatment(STLT) for retinal arterial macroaneurysms(RAM) associated with foveal exudative manifestations and visual acuity deterioration. Methods: Patients with RAM associated with foveal exudative manifestations and best corrected visual acuity (BCVA) worse than 20/80 Snellen equivalent underwent a ophthalmologic examination, including ETDRS visual acuity, optical coherence tomography (OCT), and fluorescein angiography. The patients were prospectively observed for 4 months period, and in absence of spontaneous improvement, they underwent STLT using an infrared diode laser. Primary outcome measures were reduction of mean central point thickness(CPT) and BCVA changes at the 12-month examination. Secondary outcomes included changes in mean total macular volume(TMV) and central subfield thickness(CST). Results: Nine patients were enrolled and prospectively followed up. Mean baseline values of BCVA, CPT, TMV, and CST were 0.8±0.1 (logMAR±SD), 340±49µm, 7.14±0.05mm3, and 366±37ìm, respectively. At the 4-month examination following STLT, mean BCVA improved to 0.6±0.2, whereas mean CPT, TMV, and CST decreased to 274±29µm, 6.87±0.11mm3, and 296±33ìm. At the 12-month examination, mean BCVA was 0.36±0.2, mean CPT was 195±11µm, mean TMV was 6.55±0.19mm3, and mean CST was 239±14ìm, respectively. No side-effects were noted. In particular, no sign of retinal thinning and underlying backscattering typical of conventional laser treatment could be detected at the site of the laser application on OCT. Conclusion: The current pilot investigation of STLT for the treatment of symptomatic RAM shows encouraging data. A randomized clinical trial is required to ascertain the real efficacy this technique and the most appropriate settings to be employed

The Italian Catquest-9SF cataract questionnaire: translation, validation and application

Background: To validate the Catquest-9SF questionnaire in Italian, assess the change in visual disability with cataract surgery and determine the correlation between pre-operative Catquest-9SF scores and Lens Opacities Classification System (LOCS) III cataract grading. Methods: Prospective, questionnaire validation study. The Catquest-9SF questionnaire was forward and back translated and completed by 209 Italian patients before and three months following cataract surgery. Rasch analysis was used to assess its psychometric properties. Results: The Italian Catquest-9SF demonstrated ordered response categories, unidimensionality (item fit statistics range: 0.73–1.34), adequate person separation (2.04), and no differential item functioning. Mistargeting was evident with a mean difference in item difficulty and person ability of 2.04 logits but improved with inclusion of pre-operative data only. There was a statistically significant (Friedman tests, p < 0.001) median improvement in visual disability of 1.92, 3.57, 1.44 and 2.94 logits in patients undergoing first eye surgery with and without ocular comorbidity, and second eye surgery with and without ocular comorbidity respectively. There was no statistically significant difference in the improvements among the four groups (Kruskal-Wallis H test, X2(3) = 5.445, p = 0.142). There was no correlation between Catquest-9SF scores and nuclear opalescence (rs = 0.049, p = 0.478), nuclear colour (rs = 0.008, p = 0.909), cortical (rs = 0.066, p = 0.341), and posterior subcapsular components (rs = 0.048, p = 0.494). Conclusions: The Italian Catquest-9SF demonstrated good psychometric properties and is suitable for use in Italian speaking patients. There were similar improvements in visual disability in patients undergoing first or second eye surgery, with or without ocular comorbidity. There was no correlation between pre-operative Catquest-9SF scores and LOCS III cataract grading

Unilateral Optic Neuritis: A Rare Complication after Measles-Mumps-Rubella Vaccination in a 30-Year-Old Woman

Purpose. To report a case of unilateral optic neuritis following Measles-Mumps-Rubella (MMR) vaccination. Methods. A 30-year-old female developed unilateral optic neuritis five days after a Measles-Mumps-Rubella (MMR) booster vaccination. The patient displayed unilateral involvement, with severe visual loss. However, visual acuity improved significantly after four days of intravenous steroid therapy with 500 mg/day of methylprednisolone. Conclusions. Optic neuritis is one of the rare complications associated with the mumps, measles, and rubella vaccine. It may be a toxic reaction to the nonviral component of the vaccine, but the exact etiology is unknown. Postvaccination neuritis is generally bilateral and usually affects children. In adults, unilateral optic neuritis is usually correlated with multiple sclerosis (MS)