Treatment chronic macular edema in Vogt-Koyanagi Harada syndrome with dexamethasone intravitreal implant: description of three case

Purpose: To report our experience with dexamethasone intravitreal implant (Ozurdex, DEX implant) in the chronic cystic macular edema (ME )with Vogt-Koyanagi-Harada (VKH) Syndrome. Method: A retrospective chart review of three patients with (VKH) treated with sustained-release dexamethasone 0.7 mg intravitreal implant was performed.Complete ophthalmic examination included: best corrected visual acuity; ocular tonometry, were also evaluated signs of inflammatory activity of the anterior segment with biomicroscopy slit-lamp, and posterior segment with fundus biomiocrosopy, fundus photography and fluorescein angiography; measurement of macular morphology and thickness, optical with coherence tomography; and tolerability of the implant. Mean follow-up time post-injection was 6 months. All three eyes received 1Ozurdex implants during the follow-up period. The duration of effect of the implant was 4 to 6 months. No serious ocular or systemic adverse events were noted during the follow-up period. Results: In all three eyes, were observed a remarkable decrease ME, in angiographic and OCT , following placement intravitreal DEX implant Conclusions: The DEX implant 0.7 mg may be an effective treatment option for reduction ME in VGT, met the primary efficacy endpoint for improvement in visual acuity (VA) and safety profile was also acceptabl

Ropivacaine vs tetracaine in topical anesthesia for intravitreal injection

Aim: The object of the study was to evaluate the long term efficacy and safety of ropivacaine 0,5% vs tetracaine 0,5% for topical anesthesia in intravitreal injection of dexamethasone in patients with diabetic macular edema (DME) and anti-vascular endothelial growth factor (VEGF) therapy. Methods: Thirty-seven patients were enrolled in the study. Intravitreal anti-vascular endothelial growth factor (VEGF) and Dexamethasone were placed in DME patients. Intravitreal administration determines appropriate and long-lasting drug's concentration without systemic side effects. Topical anesthesia under ropivacaine 0,5% vs tetracaine 0,5% was performed. Results: Intravitreal injection without any supplemental anesthesia and sedation was realized. Patients reported mild pain (recorded by a 0 to 10 scale) during the procedure with optimal operative result. Conclusions: Topical anesthesia with ropivacaine and tetracaine is safe and effective in intravitreal injection. The long-lasting anesthesia secured low pain during this limited but unpleasant procedure

An Economic Analysis of the Efficiency and Sustainability of Fertilization Programs at Level of Operational Systems of Soft Wheat in Umbria

Abstract This study analyzes the fertilization strategies in the perspective of the efficiency analysis. The analysis is conducted at farm level and framed into the conceptualization of the relationship between the decisional and operational systems (Sebillotte, Allain 1991). The conceptual framework emphasizes the importance of the response function approach, of the sustainability principles ( Pretty, 2008 ) and of the organizational dimensions. Data on soft wheat were collected from FADN system. Data Envelopment Analysis indicates the importance of the operational systems organizational factors in determining the crop efficiency. The evidence suggests to consider the objectives of the fertilization program in the context of the organizational dimensions of the operational system

Neurovisual training (TRIGRAM) in young patients with visual-perceptive dyslexia

Dyslexia is a language-based learning disability. Although this condition is characterized by anatomical malformation of the brain, it seems that the typical reading pattern of dyslexic may be also related to more complex sensory deficits. Among them, visual- perceptive deficits have been described in a subtype of dyslexia, called visual-perceptive dyslexia. The distinctive feature of a patient suffering from visual-perceptive dyslexia form is marked by effortlessly recognize the characteristics of each individual stimulus. The Tetra protocol is a visual-perceptual evaluation protocol that was introduced for the diagnostic phase and the rehabilitation of visual-perceptive dyslexia. The diagnostic tests include: the eidomorphometry test, designed to evaluate the perception of spatial relationships; the contrast sensitivity threshold test, especially at low spatial frequencies; and the REPORT TEST words, to assess the speed and the reading efficiency. In addition, the rehabilitation phase is carried out with the visual neuro-enhancement program TRIGRAM, a visual training proposal designed to reduce the lateral masking phenomenon in visual-perceptive dyslexic. Thus, in this study we used the diagnostic tests of TETRA® Protocol to determine presence of visual-perceptual abnormalities in children with dyslexia. Proven time the presence of these visual-perceptual alterations, the patients were also subjected to the rehabilitation sessions of TRIGRAM, in order to investigate whether this visual training may improve the pattern of reading. At the end of the program (t1) and after three months (t2), the same subjects underwent the same diagnostic tests of TETRA® Protocol to evaluate and confirm the results obtained during rehabilitation program. The results showed a significant increase in contrast sensitivity at low and high spatial frequencies. Moreover, the same improvements in the visual system's ability to discriminate the contours of an object within the field of view, have been maintained three months after the end of treatment. We also observed a significant improvement in the perception of spatial relationships, with reduction of SRA value. In conclusion, this study demonstrates that the visual rehabilitation training (TRIGRAM) is able to improve the perception of spatial relationships, and increase contrast sensitivity in young patients affected by "visual dyslexia". Nonetheless, these data need to be confirmed in larger cohort of subjects in order to establish whether these effects can also increase lexical ability (increased reading speed and reduce errors during the lexical task)

Glycosaminoglycans in the human cornea: age-related changes

Abstract AIM: To investigate possible age-related changes in glycosaminoglycans (GAGs) in the human cornea. The substances today called GAGs were previously referred to as mucopolysaccharides. METHODS: Samples of human cornea were taken from 12 younger (age 21 ± 1.2) and 12 older (age 72 ± 1.6) male subjects. Samples were weighed, homogenized, and used for biochemical and molecular analyses. All the quantitative results were statistically analyzed. RESULTS: The human cornea appears to undergo age-related changes, as evidenced by our biochemical and molecular results. The total GAG and hyaluronic acid counts were significantly higher in the younger subjects than in the older subjects. The sulfated heavy GAGs, such as chondroitin, dermatan, keratan, and heparan sulfate, were lower in the younger subjects than in the older subjects. DISCUSSION: GAGs of the human cornea undergo numerous age-related changes. Their quantity is significantly altered in the elderly in comparison with younger subjects. GAGs play an important role in age-related diseases of the human cornea

An eighteen-month follow-up study on the effects of intravitreal dexamethasone implant in diabetic macular edema refractory to anti-VEGF therapy

Abstract AIM: To evaluate the long-term efficacy and safety of dexamethasone implants in subjects affected by diabetic macular edema (DME) resistant to anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Thirty-two DME patients were enrolled. A 700 microgram slow release Intravitreal Dexamethasone Implant (Ozurdex®) was placed in the vitreous cavity. All patients were followed for 18mo. Best-corrected visual acuity (BCVA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) and central macular thickness (CMT) exams were carried out at baseline (T0) and after 1 (T1), 3 (T3), 4 (T4), 6 (T6), 9 (T9), 12 (T12), 15 (T15), and 18mo (T18) post injection. RESULTS: Repeated measures ANOVA showed an effect of treatment on ETDRS (P<0.0001). Post hoc analyses revealed that ETDRS values were significantly increased at T1, T3, T4, T9, and T15 (P<0.001) as compared to baseline value (T0). At T6, T12, and T18, ETDRS values were still statistically higher than baseline (P<0.001 vs T0). However, at these time points, we observed a trend to return to baseline conditions. ANOVA also showed an effect of treatment (P<0.0001). CMT decreased significantly at T1, T3, T4, T9, and T15 (P<0.001). At T6 (P<0.01), T12 and T18 (P<0.001) CMT was also significantly lower than T0 although a trend to return to the baseline conditions was also observed. CONCLUSION: Our findings demonstrate that Intravitreal Dexamethasone Implant is a good option to improve BCVA and CMT in DME patients resistant to anti-VEGF therapy. Our data also show that the use of drugs administered directly into the vitreous allows achieving appropriate and long-lasting concentration at the site of disease without systemic side effects

Suspensory materials for surgery of blepharoptosis: a systematic review of observational studies

Background Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. Objectives The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. Data Source and Methods Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. Results The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. Conclusions Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results

Learning HMM State Sequences from Phonemes for Speech Synthesis

AbstractThis paper presents a technique for learning hidden Markov model (HMM) state sequences from phonemes, that combined with modified discrete cosine transform (MDCT), is useful for speech synthesis. Mel-cepstral spectral parameters, currently adopted in the conventional methods as features for HMM acoustic modeling, do not ensure direct speech waveforms reconstruction. In contrast to these approaches, we use an analysis/synthesis technique based on MDCT that guarantees a perfect reconstruction of the signal frame feature vectors and allows for a 50% overlap between frames without increasing the data rate. Experimental results show that the spectrograms achieved with the suggested technique behave very closely to the original spectrograms, and the quality of synthesized speech is conveniently evaluated using the well known Itakura-Saito measure

Adverse events associated with intraocular injection of anti-VEGF(bevacizumab) in retinal vein ccclusion: a case report

Introduction: Antiangiogenic agents are often administered for treatment of Branch Retinal Vein Occlusion (BRVO). Among them, Bevacizumab has noticeable antiangiogenic and antiedemigenic properties and possesses great capacity to penetrate the retinal tissue, particularly in pathological circumstances characterized by altered external or internal blood-retinal barrier.Bevacizumab has an optimal bio-efficacy based on inhibition of the activity of Vascular Endothelial Growth Factor (VEGF). Nonetheless, despite its efficacy, here we describe the adverse effects associated with intraocular injection of bevacizumab in a patient affected by retinal vein occlusion. Case presentation: We present a case report of an 11-year old Caucasian malesubject affected by BRVO in his left eye. The patient underwent an intra-vitreal (i.v.) injection of bevacizumab 100 (1.25 mg/0.05ml). After that, the patient was monitored over time through a series of analyses including Ocular Coherence Tomography, Fluorangiography, Bulbar Ultrasound, Angio MRI BCVA scores and Intra Ocular Pressure. Results: Immediately after the i.v. injection, the patient experienced a strong and relentless pain radiating from the left ocular orbit, caused by a serious and unexpected malignant glaucoma and phthisis bulbi. Furthermore, the patient did not show any sign of improvement in visual function in the follow-up and at last required an ophthalmic prosthesisas a result of a subatrophic and hypotonic eyeball. Conclusion: This case report suggests that i.v. injections of anti-VEGFs should be considered wit