Glaucoma and cigarette smoking: a review of narrative reviews

Background: Glaucoma is an optic neuropathy associated with visual field changes for which high intra-ocular pressure is a major risk factor. Emerging research indicates that modifiable factors, among which the cigarette smoke, besides IOP may be associated with the presence of glaucoma. Objective: The objective of the study was to perform a review of narrative reviews to examine on the relationship between cigarette smoking and glaucoma. Methods: The results of all narrative reviews in the scientific literature about glaucoma and tobacco smoking were analyzed. A quality assessment was performed according to an easy and convenient tool for the quality assessment of narrative reviews for systematic reviews (International Narrative Systematic assessment) the INSA tool. Literature searches were performed using PubMed. Results: 20 studies about relation between glaucoma and smoke were collected, no restriction language was applied. 15 of these studies have been excluded. We selected among them 5 reviews. With the INSA tool we measured the quality of the 5 selected narrative reviews. Studies that had a highest score with the INSA tool were two: A. Coleman et al. “Risk Factors for Glaucoma Needing More Attention” and R. Salowe et al. “Primary Open-Angle Glaucoma in Individuals of African Descent: A Review of Risk Factors”. Conclusion: The narrative reviews analyzed underline that there is no definitive association between cigarette smoking

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

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

Results of case-control studies supportthe association between contact lens useand Acanthamoeba keratitis

Acanthamoeba keratitis (AK) is ever more frequently reported in industrialized countries. The loss of the corneal surface integrity consequent to secondary microtrauma produced by the use of contact lens (CL) favors the penetration of the parasite into the corneal tissue. A scientific review was performed to investigate the association of CL wear as an Acanthamoeba keratitis (AK) risk factor. A computerized screening of 7834 Medline articles (4623 from PubMed; 3211 from Scopus) used a strict selection criteria of case-control studies involving CL wear and/or trauma. The search yielded five case-control studies published from 1995 to 2012. All studies included showed a statistically significant positive association between AK and CL use, with a combined odds ratio (OR) of 10.21 (95%, confidence intervals [CI]; 3.57-27.64). All studies included showed a statistically significant positive association between AK and CL use, though with differing OR values. Though rare, AK should be held in higher consideration when ophthalmologists are faced with CL users exhibiting simplex-like lesions associated with circular stromal infiltrates and disproportionate ocular pain in respect to the objective clinical picture.Abstract BACKGROUND: Acanthamoeba keratitis (AK) is ever more frequently reported in industrialized countries. The loss of the corneal surface integrity consequent to secondary microtrauma produced by the use of contact lens (CL) favors the penetration of the parasite into the corneal tissue. OBJECTIVES: A scientific review was performed to investigate the association of CL wear as an Acanthamoeba keratitis (AK) risk factor. METHODS: A computerized screening of 7834 Medline articles (4623 from PubMed; 3211 from Scopus) used a strict selection criteria of case-control studies involving CL wear and/or trauma. RESULTS: The search yielded five case-control studies published from 1995 to 2012. All studies included showed a statistically significant positive association between AK and CL use, with a combined odds ratio (OR) of 10.21 (95%, confidence intervals [CI]; 3.57-27.64). STATISTICAL ANALYSIS: All studies included showed a statistically significant positive association between AK

Differential activity and clinical utility of latanoprost in glaucoma and ocular hypertension

Background: The purpose of this study was to demonstrate the hypotensive efficacy and tolerability of latanoprost when used as monotherapy and as polytherapy associated with antiglaucomatous medication proven to be ineffective in keeping intraocular pressure under control. Methods: Three hundred and thirty-seven patients (672 eyes) affected by primary open-angle glaucoma and intraocular hypertension were recruited over a period of 10 years from the Glaucoma Centre, Department of Ophthalmological Sciences, University of Rome "Sapienza", and treated, subject to informed consent, with latanoprost 0.005% alone or in combination with other ocular hypotensive drugs. The patients were followed during this period at regular intervals, with determination of visual field, fundus oculi, visual acuity, and eventual onset of local and systemic side effects. Results: Latanoprost used as monotherapy and as polytherapy renders possible optimal and durable control of intraocular pressure in the form of one antiglaucomatous drug because it can substitute for one or more drugs and obtain the same hypotensive effect. Conclusion: Latanoprost can be described as the ideal hypotensive drug, not only because of its ideal compliance profile (only one daily dose in the evening), excellent hypotensive effect, and, above all, few systemic side effects. © 2012 Pacella et al, publisher and licensee Dove Medical Press Ltd

Optical coherence tomography of retinal and choroidal layers in patients with familial hypercholesterolaemia treated with lipoprotein apheresis

Detect and quantify morpho-functional alterations of the retina and choroid in patients affected by familial hypercholesterolemia (FH) treated with lipoprotein apheresis (LA) using optic coherence tomography (OCT) and optic coherence tomography-angriography (OCTA).Observational study.To be diagnosed: A group of 20 patients (40 eyes) being clinically and genetically diagnosed as FH and under treatment (FH-Group)", for at least 2 years, was compared to a control group of 20 healthy subjects (40 eyes), with a normal lipid profile and no ocular disease (CT-Group).Participants were studied with the slit lamp, binocular indirect fundoscopy, OCT and OCTA.Best corrected visual acuity (BVCA), spherical equivalent (SE), intraocular pressure (IOP), central macular thickness (CMT), choroidal thickness (CHT), retinal nerve fiber layer in four quadrants (RNFL (Superior = Sup; Inferior = Inf; Nasal = Nas Temporal = Temp), and the mean value across the four quadrants (RNFL G), foveal avascular zone (FAZ) and vascular density (VD).FH subjects had smaller RNFL superiorly (108 ± 19,38 μm OD/111 ± 16,56 μm OS FH-Group vs 127 ± 7,42 μm OD/129 ± 14,64 μm OS CT-Group; P  0,001 for both OD and OS) and inferiorly (108 ± 23,58 μm OD/115 ± 17,33 μm OS FH-Group vs 128 ± 18,15 μm OD/133 ± 17,38 μm OS CT-Group; P = 0,002 OD; P = 0,001 OS). G RNFL was consequently smaller (93 ± 12,94 μm OD/94 ± 10,49 μm OS FH-Group vs 101 ± 9,01 μm OD/101 ± 10,20 μm OS CT-Group; P = 0,03 OD; P = 0,02 OS). FH subjects had a larger FAZ (0,31 ± 0,08 mmEarly signs of retinal vessel damage in FH patients can be detected and quantified with OCT and OCTA

Association between smoking and uveal melanoma: a systematic review

Background: The aim of this study is systematically review the scientific literature on the relationship between tobacco smoking exposure and UM. Methods: The search was performed on Medline and Scopus databases. For each database, we used the following query: “smok* AND (eye OR uveal) melanoma”. Results: 3 observational studies were considered suitable, two case-control studies and one cohort study. There is no significant evidence in the scientific literature about the association between smoking and UM. Conclusions: More complete and multi-center studies are desirable, giving the importance of smoking as a risk factor in the development of cancers

Epidemiology of syphilis: new cases of neurosyphilis

Abstract The Authors report three cases of ophthalmic neurosyphilis in patients who complained a visual decrease monocular. The diagnosis was performed with physical and fundus examination, electrophysiological, hemato-chemical and microbiological tests, fluorangiografy and RMN. The physical examination provided standard results about eyes interested while the fundus examination, as well as the electrofunctional and fuorangiografy examinations, showed some alterations. The sockets and encephalon RMN were normal. Moreover; the patients were submitted to specific haematic and microbiological laboratory tests which showed positivity for syphilis. To sum up all patients received an incidental diagnosis of syphilis. This trend could be attributable to an extensive use of antibiotics that changing the natural course of disease, mask clinical evidences and make them harder to diagnose

Computerized evaluation of deambulatory pattern before and after visual rehabilitation treatment performed with biofeedback in visually impaired patients suffering from macular degeneration

Aims: The aim of this study was double: the primary endpoint was to evaluate the efficacy of visual rehabilitation of visually impaired patients with macular degeneration (AMD). The secondary endpoint was to assess the effect of rehabilitation treatment on the ambulatory pattern using a computerized evaluation of walking, focusing the attention on space-time parameters that are influenced in patients with visual impairment. Methods: 10 patients with AMD were enrolled, 6 males and 4 females, and examined 15 eyes, at Department of Sense Organs, Faculty of Medicine and Dentistry Sapienza University of Rome, Italy. Visual rehabilitation was carried out with the use of a microperimeter MP1 using the examination of biofeedback. Patients are asked to move their eyes in coordination with an audible feedback that alerts the patient when he is setting properly the fixation target previously selected. All patients were subjected to 10 sessions lasting 15 minutes each for each eye, 1 time per week. The best corrected visual acuity (BCVA) was assessed by far with the ETDRS optotype IN LOG MAR, and by close to 25 cm by adding + 4 ball (addition to near) to the BCVA. For each eye the PB ( print body) on the distance of 25 cm was measured; It fixation stability for 30 seconds was examined by microperimeter. Gait Analysis was performed with system ELITE BTS SpA (Milan, Italy). Results: At the end of the rehabilitation treatment with biofeedback it was found a marked improvement in BCVA. The BCVA before the rehabilitation treatment was ETDRS 12 LETTERS = 0.86 logMAR. At the end of the visual rehabilitation 16 LETTERS = 0.78 logMAR. The near visual acuity presented a decrease of the printer body measurement (PB) and a statistically significant improvement in the fixation stability. Analysis of the spatial and temporal parameters of gait cycle, aimed at assessing the global aspects of gait (speed, rhythm, symmetry, fluidity, dynamic balance) showed no significant changes after the treatment, indicating that the previously structured locomotor pattern was not modified. Conclusions: The results obtained by the visual rehabilitation with Biofeedback show a pronounced and statistically significant improvement in visual performance. In fact, the absolute values of retinal sensitivity before and after the visual rehabilitation cycle with biofeedback showed a marked improvement of the specific retinal sensitivity and consequently an improvement of the vision efficiency. Further studies are needed to better understand the "correlation" between low-vision and walking