Subthreshold micropulse laser for long-lasting submacular fluid after rhegmatogeous retinal detachment surgery

Purpose: To assess the safety and efficacy of subthreshold micropulse laser (SML) photo-stimulation in the management of persistent subfoveal fluid (PSF) after surgery for rhegmatogenous retinal detachment (RRD). Methods: In this pilot study, 11 eyes of 11 patients (8 men, 3 women) with long-lasting (12–18 months) PSF after surgery for RRD were evaluated before and after photostimulation with subthreshold micropulse yellow laser. Ophthalmic examination included best-corrected visual acuity (BCVA), Amsler grid test, ophthalmoscopy, autofluorescence (AF), and optical coherence tomography (OCT) with measurement of central point foveal thickness (CPFT). Primary outcome was subfoveal fluid resolution and secondary outcome was BCVA improvement. Results: The mean CPFT and BCVA were, respectively, 436.8 ± 28.8 μm and 0.25 ± 0.1 µm decimal equivalent (DE) before photostimulation and 278 ± 54.4 μm and 0.57 ± 0.2 µm DE after photostimulation, a statistically significant difference (P < 0.001). Nine (81.8%) eyes showed improved BCVA, disappearance of macular detachment on ophthalmoscopy, reduced retinal pigment epithelium distress on AF, and restored macular profile with no neuroretinal alterations on OCT scans. Conclusion: Although PSF after RRD surgery is often a self-limiting disease, our results suggest that SML photostimulation may be effective and safe in patients with clinically significant long-lasting PSF. Larger case–control studies are necessary to confirm these results. © 2022 Esposti et al

Peptidergic innervation of mesenteric lymphatics in guinea pigs: an immunocytochemical and pharmacological study.

By immunocytochemistry, substance P immunoreactive (SP-IR) and vasoactive intestinal peptide immunoreactive (VIP-IR) nerve fibers were examined in guinea pig mesenteric lymph collectors. The immunoreactive nerve fibers, located in the adventitia of lymphatics, were few and were irregularly distributed along the vessel wall. These fibers appeared to be more numerous and more evenly distributed along the corresponding artery and vein walls within the same area. SP immunoreactivity in the vascular nerves was depleted in guinea pigs injected with capsaicin but was unaffected by the injection of 6-hydroxydopamine. By contrast, VIP-IR nerve fibers were unaffected by both treatments. It is concluded that SP-IR nerve fibers in the lymphatics are likely to be of sensory origin and that VIP containing nerves in the lymph collectors are distinct from SP-containing and noradrenergic nerves. It is also suggested that lymph collectors possess a complex although limited innervation pattern not only of autonomic nerve fibers containing classic neurotransmitters but also of peptidergic nerve fibers of a different origin with a vasomotor and/or sensory action

Role of computer-assisted analysis of the corneal endothelium in vitreoretinal surgery with intraocular silicone oil injection: a technical report.

The innermost lining of the cornea consists of a single layer of cells called the endothelium. Despite its name, the endothelium of the cornea differs considerably from the vascular endothelium, both functionally and morphologically. The corneal endothelium plays a fundamental role in maintaining the transparency of the corneal membrane, as the result of both its function as a barrier against penetration of the aqueous humor in the parenchyma and its ability to remove water from the stroma (usually referred to as the endothelial "pump" function). Any abnormality in the corneal endothelium causes, first, the impairment of its function as a barrier and pump due to the loss of stromal anti-turgor mechanisms, followed by edema and possible development into keratopathy. The specular microscope is an instrument which makes it possible to see the endothelial "mosaic" in the reflected image of the posterior corneal surface. A large variety of clinical specular microscopes is presently available, both contact and non-contact, which allow, for easy and rapid photography of the corneal endothelium "in vivo". In the present case, we used a non-contact computerized specular microscope to analyze the corneal endothelium in a group of patients affected by retinal detachment who needed to undergo vitreoretinal surgery with immission of silicone oil into the vitreal chambe

MEDICAL TREATMENT OF CRVO

Purpose: A disorder of fibrinolytic power is a risk factor for both venous and arterial thrombosis. An hypofibrinolytic state has been described as a common feature in Central Retinal Vein Occlusion (CRVO) affected subjects. Aim of our study was to evaluate the efficacy of a thrombotic-risk assessement related therapy either in acute phase treatment or secondary prophylaxis in CRVO affected patients. Methods: Phase A: 60 subjects (28 female, 22 male) were respectively treated with ASA 325 mg/die (19), heparin 12500 to 25000 U/die (16) , and mesoglycan 100 mg/die (25) for one month. Phase B: 35 subjects were treated with ASA 325 mg/die for 6 months and 29 patients with mesoglycan 100 mg/die. The development of new thrombotic events was assessed by fundoscopy at one and six months. Results: In phase A 5/19 (26%) subjects in the ASA, 6/16 (37%) in the heparin and 2/25 (8%) (p< 0.001) in the mesoglycan group experienced a new thrombotic event. In phase B 13/35 (37%) in the ASA and 3/29 (10%) (p< 0.001) in the mesoglycan group showed new thrombotic signs. Conclusions: Our data suggest that a profibrinolytic treatment in thrombotic risk-profile selected subjects is safe and effective for the therapy and prophylaxis of CRVO when compared to other antithrombotic agents

Caso clinico di un corpo estraneo corneale con diagnosi e management conservativo a lungo termine

5reservedmixedI. Motolese; P. Frezzotti; M. Iester; M. Fruschelli; E. MotoleseMotolese, I.; Frezzotti, Paolo; Iester, M.; Fruschelli, M.; Motolese, Eduard

Report of two cases of subconjunctival haemorrhage as first sign of post‐pregnancy acquired haemophilia a (AHA)

Purpose: To show that subconjunctival haemorrhage may be the first sign of post-pregnancy acquired A haemophilia (AHA), a potentially fatal bleeding disorder. Methods: Case reports. Results: Two thirty-year-old caucasic women at first pregnancy presented slight pain without visual loss 2 weeks after uncomplicated spontaneous full-term delivery. The only clinical findings were a subconjunctival bleeding for both and a small haematoma in the first case. The clinical history was negative for spontaneous bleeding also in infantile age and at previous surgery and no bleeding tendency was observed in the main relatives. The first patient was lost on follow-up and admitted to urgent haemathologic evaluation due to large multiple cutaneous hematomas, a massive deep muscle haematoma, asthenia and dyspnea. In the second case quick routine coagulation labs were performed immediately after the subconjunctival bleeding. In both cases PTT ratio was increased. An extensive study of blood coagulation suggested the presence of a circulating inhibitor against factor VIII [1,2], confirming the diagnosis of AHA. First case was treated with a bypassing agent, however the eradication was obtained only with immunosuppressive therapy. Second case was initially placed in close follow-up, since the post-pregnancy form is often self-limiting, however an immunosuppressive therapy was set after clinical progression due to the appearance of spontaneous hematoma. Conclusions: AHA is a relevant acquired bleeding disorder that can be fatal if not quickly recognized and treated even when the initial clinical signs are minor [3], how it can happen in post-pregancy mainly in the first month [4]. Since it may present as spontaneous subconjunctival haemorrhage, routine hemathological and coagulation labs should be performed to exclude this serious condition or once identified, allow for proper clinical management

New generation analysis of thrombin generation in retinal vein thrombosis

Purpose To investigate potential mechanisms involved in retinal vein occlusion (RVO) we evaluated thrombin generation and soluble CD40 ligand (sCD40L) with respect to other known thrombophilic factors. Methods 68 patients affected by RVO (28 central, 40 branch) and 60 healthy controls were evaluated for endogenous thrombin potential (ETP) by a chromogenic method and sCD40L by ELISA technique. Polymerase chain reaction (PCR) was employed for genetic polymorphisms and coagulative/chromogenic methods for othe coagulation factors. Results Independently of genetic polymorphisms ETP was increased in patients with CRVO whereas sCD40L was higher in the whole cohort. Conclusions Our data indicate an involvement of global coagulative activation in CRVO patients as suggested by ETP

Pseudophakic eye globe disruption

PURPOSE: Scleral rupture due to bulb bursting can result from a heavy contusion. Owing to refined surgical techniques and the use of antibiotics and cortisone-based medication, more conservative concepts have followed. In major ruptures, the results were almost always very poor, with atrophy or subatrophy of the eyes. METHODS: A 63-year-old man with major left ocular trauma and intraocular lens dislocation in the subconjunctival area was referred to the authors for clinical and surgical evaluation. RESULTS: Surgery was performed 3 weeks after the trauma to allow for improvement in the patient's condition. The reabsorption of a palpebral-frontal hematoma, which made bulb exploration almost impossible, was fundamental in order to proceed. After 1 year, the best-corrected visual acuity was 0.9. In fact, great improvements in surgical techniques in recent years have allowed us to consider the problem of major rupture in a new way, both technically and from an organizational point of view. CONCLUSIONS: In terms of organization, the concept of urgent surgical procedures must be reevaluated, because besides traumatic damage, incomplete surgical measures may result. This makes all treatment useless, in both barely equipped and highly specialized centers

Use of hypo-osmolar ribofl avin for corneal cross-linking in thinkeratoconic corneas

Purpose To evaluate the effi cacy of UVA collagen cross linking (CXL) on thin keratoconic corneas with previous application of hypoosmolar ribofl avin solution. Methods Twelve eyes of 12 patients with progressive keratoconus and a corneal thickness of less than 400 μm without the epithelium, were submitted to collagen crosslinking after the application of an hypoosmolar ribofl avin solution. We instilled one drop every 5 seconds for 2 or 4 minutes to increase corneal thickness up to a minimum value of 400 μm. Pachimetry measurements were taken every 30 seconds to verify the eff ect on corneal stroma. Results Mean corneal thickness improved in most cases with reduction of the mean K-value of the keratoconus and no progressionwas observed at six and twelve months after CXL. One year after treatment no scarring lesions in the stroma were observed and all corneas were transparent. Improvement of visual acuity was signifi cant in three patients (25%), low but detectable in seven patients (51%) and no modifi cations of visual acuity were observed in two patients (24%). Conclusion Hypoosmolar ribofl avin solution showed to be useful to allow CXL procedure in keratoconic corneas with low stromalthickness. No progression of keratoconus was observed six months and one year afer CXL., no developing of stromal scars and patients showed good stability of visual acuity delaying time of surgery