Age-related changes of the ocular surface : a hospital setting-based retrospective study

Purpose. To investigate the effects of age on the prevalence of ocular surface diseases (OSD), adherence to treatment, and recovery rates. Patients and Methods. Retrospective analysis of 3000 clinical records from a first-level general ophthalmology clinic. Patients with OSD were prospectively submitted a questionnaire to assess compliance and recovery rates. Results. OSD prevalence was 10.3%. Patients with OSD were significantly older than patients without it: 67.5 \ub1 20.3 versus 57.0 \ub1 22.0 years (P = 0.036). No significant difference in season distribution was shown. Dry eye disease (DED) represented 58% of OSD; its prevalence increased with age until 80 years old and suddenly decreased thereafter. Asymptomatic DED was 37%. Adherence to treatment in OSD was very high (94%); recovery rates were lower in patients aged 21-40 and 61-80 (resp., 65.5% and 77.8%) and this was associated with higher OSDI scores. Tear substitutes represented 50% of all prescribed medications; their use increased with age. Discussion. In a "reallife"low-tech setting, OSD showed a prevalence of 10.3%. DED was the most prevalent disease, and it was asymptomatic in more than 1/3 of cases

Biofilm formation on dental implant surface treated by implantoplasty : an in situ study

Peri-implantitis is a biofilm-related disease whose characteristics are peri-implant tissues inflammation and bone resorption. Some clinical trials report beneficial effects after implantoplasty, namely the surgical smoothening of the implant surface, but there is a lack of data about the development of the bacterial biofilm on those smoothened surfaces. The aim of this study is to evaluate how implantoplasty influences biofilm formation. Three implants with moderately rough surfaces (control) and three implants treated with implantoplasty (test) were set on a tray reproducing the supra- and sub-gingival environment. One volunteer wore this tray for five days. Every 24 h, plaque coverage was measured and, at the end of the period of observartion, the implant surfaces were analyzed using scanning electron microscopy and confocal laser scanning microscopy. The proportion of implant surface covered with plaque was 65% (SD = 7.07) of the control implants and 16% (SD = 0) of the test implants. Untreated surfaces showed mature, complex biofilm structures with wide morphological diversity, and treated surfaces did not show the formation of mature biofilm structures. This study supports the efficacy of implantoplasty in reducing plaque adhesion and influencing biofilm formation. These results can be considered a preliminary proof of concept, but they may encourage further studies about the effects of implantoplasty on biofilm formation

Repeatability and reproducibility of applanation resonance tonometry : a cross-sectional study

Background: To assess repeatability (intra-observer variability) and reproducibility (inter-operator variability) of intraocular pressure (IOP) measurements with servo-controlled Bioresonator Applanation Resonance Tonometry (ART) and to evaluate possible influential factors. Methods: The study included 178 patients (115 glaucoma and 63 controls; one eye per subject). IOP was measured once with a Goldmann applanation tonometer (GAT) and twice by ART (ART1, ART2), in randomized sequence, by a single operator to assess intra-operator variability. Each ART measurement consisted on 3 readings. To assess inter-operator variability 2 evaluators performed 2 measurements each (in random order) on the same patient. Repeatability and reproducibility were assessed by the coefficient of variation (CoV) and intraclass correlation coefficient (ICC). Results: In the entire cohort, ART1 was 0.4 \ub1 2.2 mmHg (-7.0 to 5.7 mmHg) higher than ART2 (p = 0.03) regardless of test order. Intra-operator CoV was 7.0% \ub1 6.3%, and ICC was 0.80-0.92. Inter-operator CoV ranged between 5.7% \ub1 6.1% and 8.2% \ub1 7.2%, and ICC between 0.86 and 0.97. ART1 and 2 were respectively 1.7 \ub1 3.1 and 1.3 \ub1 3.1 mmHg higher than GAT (p < 0.01). Test-retest difference with ART fell within \ub11 mmHg in 41% of cases, within \ub12 mmHg in 70%, within \ub13 mmHg in 85%. 15% had a test-retest difference higher than \ub1 3 mmHg; Bland-Altman 95% intervals of confidence were -3.9 and +4.6 mmHg. Results were unaffected by age, diagnosis, central corneal thickness, keratometry, operator, randomization sequence. Conclusions: In most cases ART repeatability and reproducibility were high, with no differences due to patients' characteristics. ART measurements overestimated GAT by a mean of 1.3-1.7 mmHg

Reproducibility of rotating Scheimpflug camera imaging system in patients with keratoconus

Purpose:To determine the reproducibility of indices for diagnosis and follow-up of keratoconus measured with Rotating Scheimpflug Camera imaging system (Pentacam). Methods:Three consecutive scans, taken by the same operator, at a 5 minute interval each, were randomly taken on one eye of 14 patients with keratoconus using Pentacam. The parameters taken into evaluation were: corneal volume (CV), maximal keratometry value (K max), radii of curvature (Rh, Rv) and mean keratometry (Rm) of front (CF) and back (CB) cornea, thinnest location (TL), x (X) and y (Y) position of TL, anterior (ACE) and posterior corneal elevation (PCE) of TL.Reproducibility was assessed by calculating percentage coefficient of variation (%CoV) for all parameters except X and Y for which standard deviation (SD) was considered. The effect of mean value on %CoV was tested by regression analysis and their association with R2. Results:Results are shown in Table 1. %CoVs were <2% in all parameters except ACE and PCE (about 5% each). SD was 0.05 for X and 0.31 for Y. Regression analysis was negative and R2 negligible for all parameters except for RmCF (y= -0,2811x +2,3185, P=0.007, R2=0.47) Conclusions:Pentacam %CoVs in patients with keratoconus were low and independent from mean values (except RmCF). Values outside these ranges should be considered suspect for progression of the disease

Citicoline oral solution in glaucoma: is there a role in slowing disease progression?

To assess the effect of citicoline on visual field rates of progression in patients with progressing glaucoma

Oct changes after idiopathic macular epiretinal membrane removal with internal limiting membrane peeling : 1 year follow up

Purpose:To analyze long term anatomical outcomes after idiopathic macular epiretinal membrane (ERM) removal with internal limiting membrane (ILM) peeling. Methods:A retrospective, observational case series of 24 eyes that underwent three-port pars plana vitrectomy for ERM was conducted. In all the eyes ERM removal and Brilliant Blue G assisted ILM peeling were performed by the same surgeon (SDC). Visual acuity examination (ETDRS chart) and OCT assessment of the macular profile were performed preoperatively and postoperatively on day 1, 7 and 14 and at 1, 3, 6 and 12 months after surgery. We divided all patients in 2 groups considering visual acuity. The correlation between the postoperative BCVA and foveal microstructural findings was evaluated Results:Visual acuity stayed the same or with 1 line improvement in 7 patients (29.16%, Group A)and improved by two or more lines of vision in 17 patients (70.84%, Group B) at twelve months. Central retinal thickness decreased significantly after surgery: the mean thickness was 453.7+/-115.4 micron before surgery and 295.4+/-73.2 micron twelve months after surgery. None of the subjects had increasing foveal thickness twelve months after surgery. Inner hyper-reflective structure, attributable to the internal limiting membrane, could not be detected in 100% of eyes on day 1 and 7 after surgery in both group. In 71.4% of patients of group A and 75% of patients in group B a new inner hyper-reflective structure could be detected at 30+/-14 days after surgery. No recurrence of ERM was observed. Conclusions:ERM removal with ILM peeling is nowadays a safe and successful surgery for vitreoretinal interface syndrome. Many authors described a correlation between postoperative visual acuity and final foveal thickness. We observed that inner hyper-reflective structure, attributable to the internal limiting membrane, becomes newly detectable after 30+/-14 days after surgery in 70.9% of the patients and this doesn\u2019t seem to have any influence on final visual outcome

Corneal Involvement In Primary Biliary Cirrhosis : An In Vivo Confocal Microscopy Study

Purpose:To investigate the corneal involvement in Primary Biliary Cirrhosis (PBC), a slowly progressive cholestatic liver disease of autoimmune etiology. Methods:Seven female patients affected by PBC underwent a slit-lamp biomicroscopy of the anterior segment with and without Goldmann's three-mirror contact lens, and laser scanning confocal microscopy (LSCM, Heidelberg Engineering Germany). LSCM images were acquired and analyzed for all layers of central and peripheral cornea (four quadrants). Results:All patients had normal findings both at slit-lamp biomicroscopy and at gonioscopy. Peculiar findings were shown at LSCM: all patients showed keratocytes activation (Figure 1); sub-basal nerve fibers with beadlike structure (Figure 2) were found in six patients (86%); four subjects (57%) had hyper-reflective stromal macro-deposits (Figure 2). No deposits suggestive for copper deposition were detected at the level of Descemet\u2019s membrane. Conclusions:To the best of our knowledge this is the first confocal microscopy study on PBC patients. LSCM could show that subclinical corneal inflammation is a very common finding also in ophthalmoscopically normal patients affected by this autoimmune disease

Tear Film Osmolarity, Ocular Surface Disease and Glaucoma: A Review

Glaucoma is the second leading cause of blindness in the world, affecting more than 60 million people globally. In order to reduce the progression of the disease, both medical and surgical treatments are used. Frequent side effects of both treatments include a range of modifications of the ocular surface grouped as the Ocular Surface Disease (OSD), which include Dry Eye Disease (DED). DED and other OSD negatively impact on the success of anti-glaucoma treatments and reduce the adherence to medical therapies. Tear film osmolarity (TFO) is a relatively novel test which has become a hallmark of DED. The aim of this paper was to review the association between OSD, DED and glaucoma in view of published TFO data, and to discuss future fields of research and treatments on the topic of glaucoma iatrogenic damage

Can treatment with citicoline eyedrops reduce progression in glaucoma? The results of a randomized placebo-controlled clinical trial

Precis:Citicoline eyedrops in patients with progressing glaucoma.Purpose:This study aimed to test whether the additional therapy with citicoline eyedrops to intraocular pressure (IOP)-lowering treatment could slow glaucoma progression in patients with worsening of damage and IOP 18 mm Hg or less.Design:This was a randomized, double-masked, placebo-controlled, multicenter 3-year study.Outcomes:The outcomes studied were difference in the visual field (mean deviation, MD, of 24-2; MD of 10-2) rates of progression and difference in retinal nerve fiber layer (RNFL) thickness change between the 2 study groups at 3 years.Methods:Patients with mild to moderate open-angle glaucoma (OAG) showing damage progression of at least -0.5 dB/y in the 2 years before enrollment despite IOP =18 mm Hg were randomized to receive citicoline eyedrops or placebo 3 times daily for 3 years. Patients were followed every 3 months and underwent a visual field examination with 24-2 and 10-2 strategies and RNFL assessment. Analysis of variance and linear models were used to test the differences between groups.Results:Eighty patients were randomized in the trial. The mean 3-year rates of progression were -1.03 (2.14) dB in the citicoline group and -1.92 (2.23) dB in the placebo group (P=0.07) for 24-2 MD and -0.41 (3.45) dB in the citicoline group and -2.22 (3.63) dB in the placebo group (P=0.02) for 10-2 MD. On average, patients receiving citicoline eyedrops lost 1.86 \ub5m of RNFL in 3 years, versus 2.99 \ub5m in the placebo group (P=0.02).Conclusions:Additional treatment with citicoline eyedrops to IOP-lowering treatment might reduce disease progression in patients with progressing glaucoma despite IOP =18 mm Hg