Evaluation of the progression of visual field damage in patients suffering from early manifest glaucoma

Abstract BACKGROUND: This retrospective study aimed to determine how often a perimetric examination should be carried out in order to identify visual field (VF) changes in patients with relatively early manifestation glaucoma. MATERIALS AND METHODS: Patients included had a relatively recent manifestation of primary open-angle glaucoma. Patients with a minimum follow-up of 5 years and a minimum of seven VF tests were included. Statistical analysis was performed to verify the trend of variations in mean defect (MD) over time (PeriData). The results were subjected to a t-test for a comparative analysis of progression of VF changes over time. The annual rate of progression provided by PeriData considering all the VFs analyzed was compared with that obtained on half of the VF examinations during the same follow-up period. An analysis of the MD trend over time was also carried out in relationship to the number of VF tests done and by dividing the sample into a high-frequency group (more than eight VFs) and a low-frequency group (fewer than eight VFs) in the follow-up period. RESULTS: A total of 96 eyes of 96 patients were included, and overall 846 VFs were examined. The paired t-test performed comparing the MD index of all the VFs against half of them did not show statistical significance (P=0.537). The high-frequency group comprised 39 eyes (average VF 11.05±1.91, average time interval 0.76 years) while the low-frequency group comprised 57 eyes (average VF 6.95±0.6, average time interval 1.21 years). The analysis of the MD trend in the high-frequency patients showed significance (P=0.017); the low-frequency group did not show statistical significance (P=0.08). CONCLUSION: The number of VFs in a determined time interval was not significant. However, a greater frequency of tests provides a predictive evaluation of the rate of progression of early manifestation open-angle glaucoma

A review of the role of ultrasound biomicroscopy in glaucoma associated with rare diseases of the anterior segment

Ultrasound biomicroscopy is a non-invasive imaging technique, which allows high-resolution evaluation of the anatomical features of the anterior segment of the eye regardless of optical media transparency. This technique provides diagnostically significant information in vivo for the cornea, anterior chamber, chamber angle, iris, posterior chamber, zonules, ciliary body, and lens, and is of great value in assessment of the mechanisms of glaucoma onset. The purpose of this paper is to review the use of ultrasound biomicroscopy in the diagnosis and management of rare diseases of the anterior segment such as mesodermal dysgenesis of the neural crest, iridocorneal endothelial syndrome, phakomatoses, and metabolic disorders

Unusual choroidal vessels in neurofibromatosis type 1 observed with near infrared reflectance and spectral domain optical coherence tomography

No abstract availabl

Blefarocongiuntiviti e Cheratopatie Superficiali.

Traduzione dall’inglese in italiano del Cap.

Excimer laser photorefractive keratectomy for hyperopia

BACKGROUND AND OBJECTIVE: Photorefractive keratectomy (PRK) has been extensively evaluated for the correction of myopia. This study was undertaken to assess the safety, efficacy, and reliability of PRK in the correction of hyperopia. PATIENTS AND METHODS: There were 28 eyes with refractions of +1 to +7.75 D treated for hyperopia with the Chiron Technolas 217-C excimer laser. Thorough visual assessments were made before treatment and at regular follow-up to 18 months. Complications and patient satisfaction were noted. RESULTS: At 18 months the mean subjective refraction was +0.45+/-1.00 D with 26 eyes (92.8%) within 1 D of emmetropia. Thirteen eyes (46.4%) achieved uncorrected visual acuity (UCVA) of 20/20 or better and all patients had an UCVA of greater than or equal to 20/32 or better. Best corrected visual acuity (BCVA) remained unchanged in 26 eyes (92.8%) and improved in 2 eyes (7.2%). On the seventh day from treatment, 17 eyes (25%) had a loss of 2 or more lines of BCVA. At 15 days this was reduced to 8 eyes (14.3%) and at one month to 3 eyes (3.6%). There were no cases of loss of 2 or more lines of BCVA at 18 months of follow-up. All patients expressed a high degree of satisfaction. CONCLUSIONS: Photorefractive keratectomy safely and effectively reduced hyperopia in the patients studied. The technique was reliable and still offered good results at 18 months of follow-up

Long-term follow-up of adult patient with neurofibromatosis type 1 with retinal astrocytic hamartoma using spectral domain optical coherence tomography: a review of the literature and a report of a case

Background: Retinal astrocytic hamartoma (RAH) is a tumor that can be sporadic or in the context of tuberous sclerosis complex (TSC) and has been reported to be associated with neurofibromatosis type 1 (NF1) in a few cases. Patient and methods: A 65-year-old male patient with NF1 was referred for ophthalmological evaluation. Comprehensive examination, near-infrared reflectance (NIR), spectral-domain optical coherence tomography (SDOCT), fluorescein angiography (FFA), and indocyanine green angiography (ICGA) were carried out. The follow-up of the patient was at 4 and 7 years. Results: Best-corrected visual acuity (BCVA) was 20/20 in both eyes. Anterior segment examination revealed bilateral Lisch nodules. Fundus examination was unremarkable but at NIR and SDOCT the patient presented choroidal hamartoma, microvascular retinal alterations, and enlarged choroidal vessels in both eyes. NIR also revealed an unusual area of peripapillary hyporeflectivity in the right eye. On SDOCT, this corresponded to an elevated peripapillary mass characterized by intralesional optically empty cavities in the retinal nerve fiber layer (RNFL) and ganglion cell layer-inner plexiform layer (GCL-IPL), diagnosed as a RAH. Four years later, BCVA was 20/25 with a retinal schisis departing from the lesion to the macula. At 7 years, BCVA was stable at 20/25, the lesion was smaller, and there was a slight reduction of the schisis. Conclusion: RAH is a rare finding in NF1 and the translucent type has not been previously reported. RAH in NF1 has a peripapillary location and demonstrates clinically unpredictable behavior; thus, close monitoring with multimodal imaging is advisable

An update on the ophthalmic features in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome)

Hereditary haemorrhagic telangiectasia (HHT) or Osler-Rendu-Weber syndrome is a rare autosomal dominant disease, characterised by systemic angiodysplasia. Dysfunction of the signalling pathway of β transforming growth factor is the main cause of HHT principally owing to mutations of the genes encoding for endoglin (ENG) and activin A receptor type II-like 1 (ACVRL1). Clinical manifestations can range from mucocutaneous telangiectasia to organ arterio-venous malformations and recurrent epistaxis. The early clinical manifestations may sometimes be subtle, and diagnosis may be delayed. The main ophthalmic manifestations historically reported in HHT are haemorrhagic epiphora, and conjunctival telangiectasia present in 45–65% of cases, however, imaging with wide-field fluorescein angiography has recently shown peripheral retinal telangiectasia in 83% of patients. Optimal management of HHT requires both understanding of the clinical presentations and detection of early signs of disease. Advances in imaging methods in ophthalmology such as wide-field fluorescein angiography, spectral domain optical coherence tomography, and near infrared reflectance promise further insight into the ophthalmic signs of HHT towards improved diagnosis and early management of possible severe complications

Incidental finding of double nodular microscopic hyperplasia versu adenoma of the retinal pigment epithelium in an eye eviscerated for phthisis bulbi

Neoplasms of the retinal pigment epithelium (RPE) are very rare and can clinically simulate choroidal melanoma. The clinical, histopathological and immunohistochemical features of incidental double pseudo-neoplastic proliferation of the RPE in an eviscerated eye for phthisis bulbi are reported. The differential diagnosis of RPE neoplasms and the utility of histopatological examination of eviscerated/enucleated eyes are discussed

An update on intravitreal implants in use for eye disorders

Advanced biotechnological techniques and new polymers have led to the development of many innovative intravitreal drug delivery systems. Some designs are still in an experimental phase while others have gained widespread acceptance and are commercially available. Since steroids are a mainstay of therapy for uveitis and macular edema, new intravitreal implants have been developed to provide continuous release of corticosteroids over prolonged spans of time with reduced systemic adverse effects. Today, three long- acting corticosteroid implants are commercially available: the fluocinolone acetonide implants Retisert r and Iluvien r and the dexamethasone drug delivery system Ozurdex r. They offer an alternative route in the management of macular edema due to uveitis, retinal vein occlusion, diabetes and pseudophakia. Their advantage overtreatment with steroid injections and the anti- vascular endothelial growth factor ranibizumab is the long- term control of inflammation and macular edema with a reduced frequency of administration. Their potential side effects are cataract and glaucoma, therefore, careful patient selection and monitoring is essential. Further studies are warranted to define the relative efficacy and indications for each treatment option. The development of new devices is a future challenge in the strive to improve drug delivery systems