Search

Purpose: To report potential choroidal changes in eyes undergoing femtosecond laser cataract surgery (FLACS) and phacoemulsification surgery (PCS) by OCT.Methods: The patients were images by means Spectral Domain OCT imaging with EDI technology which may obtain OCT image. We exported a single EDI-OCT scan passing through the fovea and then it was imported into ImageJ program to perform a quantitative analysis.Main outcome measures: The main outcome measures were: (i) sub foveal choroidal thickness (SFCT); (ii) the choroidal vascularity index (CVI); and (iii) central retinal thickness (CRT).Results: At postoperative 1 week, FLACS group showed an increased CRT (241.2 ± 31.6–245.5 ± 36.4 µm; p= 0.016). Likewise, CVI and SFCT exhibited a slight increase but no statistically differences were highlighted (p> 0.05). At the follow-up visit of 1 month, all OCT parameters did not display any significant difference (p> 0.05). At post-operative 1 week, the PCS group displayed a significant increase in CRT, SFCT, and CVI. On the contrary, at the follow-up visit of 1-month, all choroidal parameters were characterized by a no statistically significant reduction (p> 0.05).Conclusions: Our study exhibited a significant increase in CT and CVI in eyes that underwent conventional cataract surgery. Femtosecond laser-assisted cataract extraction did not result in macular change due to less postoperative inflammation.

Introduction: Few months after the COVID-19 pandemic burst, many aspects of the human life, including education, dramatically changed. Because of the lockdown measures taken to limit the virus spread in Italy, in-person teaching and learning have been interrupted in all health care disciplines and readapted in virtual formulae.Methods: As academic ophthalmology departments, we had to maintain the educational needs of medical and orthoptic students, internships, surgical training of residents, as well as to cover the scientific update of health care personnel (HCPs), and the continuation of research and academic activities. To assure these needs we ideated an educational strategy and a team, which was then translated on a multichannel virtual platform created with Microsoft Teams.Results: In this platform there were 21 channels organized in a public view mode, open to all Team members, or in private view mode to separate non-permanent HCPs, internships, residents, and students’ tasks, from permanent HCPs tasks. Virtual channels were dedicated to provide theoretical lessons, clinical cases, surgical video, internal meetings and webinar, to offer news from scientific societies, requests of appointments from biomedical companies, links with ophthalmological websites, to move forward research projects, to participate at institutional academic duties, and to obtain feedbacks from users. Residents continued their training on surgery using a surgical simulator, after consulting an agenda uploaded into the dedicated virtual channel.Conclusion: These positive initial results should represent a boost to rapidly proceed with the development of even more versatile virtual learning solutions, given that the forecasts for the duration of the COVID-19 pandemic are not encouraging.

Purpose: To report variation of choroidal thickness (CT) and choroidal vascularity index (CVI) in subjects with drusen and subjects with reticular pseudodrusen (RPD) compared with healthy individuals using the Spectral-domain (SD)-Optical Coherence Tomography with enhanced depth imaging (EDI) system.Design: A prospective, observational, cross-sectional study.Subjects: Eighty-four participants.Methods: The patients were imaged using the Heidelberg Spectralis device (Heidelberg Engineering, Heidelberg, Germany) with EDI mode. EDI-OCT images were exported and then imported into image analysis ImageJ software (National Institutes of Health, Bethesda) and a semiautomated algorithm was used for subsequent quantitative analysis.Main outcome measures: This study evaluated two choroidal parameters: (i) choroidal thickness (CT); (ii) choroidal vascularity index (CVI).Results: CT analysis was performed in three different regions: (i) foveal region, (ii) parafoveal region; (iii) perifoveal region. All the analyzed regions were significantly decreased in RPD pattern, as compared with both the drusen group (p< .005) and healthy eyes (p< .005). CVI was significantly decreased in the RPD pattern, as compared with healthy eyes (p< 0.001). However, the drusenoid pattern did not have statistical significance in comparison with the control group suggesting the lower incidence of this pattern on choroidal vasculopathy.Conclusions: We report CT and CVI difference in RPD and drusen eyes. The RPD pattern seems to be a consequence of an alteration in the choroidal vascularity resulting in severe ischemia and excessive hypoxia inducing an increased risk of late AMD compared to the drusenoid pattern.

Background: To investigate choroidal vascularity index (CVI) changes after oral eplerenone treatment in chronic central serous chorioretinopathy (cCSC) using the Spectral-domain (SD)-Optical Coherence Tomography (OCT) with enhanced depth imaging (EDI) mode. Methods: Thirty-six eyes of 18 patients suffering from cCSC with monolateral foveal subretinal fluid (FSRF) successfully treated with oral eplerenone treatment and 18 age-matched healthy subjects were enroled in this retrospective study. EDI-OCT images obtained using Heidelberg Spectralis OCT device in patients with cCSC and FSRF (group 1); fellow eye (group 2) or healthy patients (healthy) were exported and then imported into image analysis ImageJ software for subsequent quantitative analysis. The main outcome measures were luminal area (LA) and CVI. Results: A higher value of CVI was detected in group 1 compared to healthy eyes (p= 0.006). LA and CVI significantly reduced during follow up in group 1 and group 2. LA at 120 days was significantly lower compared to all previous time points both in group 1 and group 2 (p&lt; 0.001). Median and [1st -3rd quartile] CVI values were 0.8 [0.7; 1.1] at baseline, 0.8 [0.7; 0.9] at 30 days; 0.7 [0.6; 0.9] at 60 and 90 days and 0.6 [0.5; 0.8] at 120 days in group 1 (p= 0.007) and 0.7 [0.6; 0.9] at baseline, 0.7 [0.7; 0.8] at 30 days; 0.7 [0.6; 0.7] at 60 and 90 days and 0.6 [0.6; 0.7] at 120 days in group 2 (p= 0.018). Conclusions: Choroidal vascularity index reduced in cCSC patients after oral eplerenone treatment during follow up both in eyes with SRF and fellow eyes thus demonstrating the effectiveness of mineral corticoid receptor antagonists in recovering choroidal morphology.

In this narrative-review, we report the most recent data from the literature of anti-vascular endothelial growth factor treatment for myopic choroidal neovascularization (mCNV). Myopic CNV is the most frequent sight-threatening complication of pathologic myopia. The natural course of mCNV can result in expanding macular atrophy and /or fibrosis, leading to irreversible visual loss after 5 years. Retinal multimodal imaging is mandatory for early diagnosis and monitoring of the disease during treatment. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is recommended as the first-line treatment option for mCNV. Prompt treatment of active mCNV with intravitreal anti-VEGF therapy has been demonstrated to be effective in terms of visual outcome improvements reducing the occurrence of late-stage complications.

Purpose: In this pilot study we reported variation of superficial (SCP) and deep (DCP) capillary plexuses flow in macular and near/mid periphery regions in healthy subjects using widefield swept source-optical coherence tomography angiography (SS-OCTA). Methods: In this prospective, cross-sectional study, enroled subjects were imaged with an SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). OCTA scans were taken in primary and extremes of gaze and a montage was automatically created. Quantitative analysis was performed in the macular and peripheral regions. In addition, SCP and DCP variables were further investigated in distinct fields within these three different regions. Results: Fifty-five young healthy subjects (55 eyes) were enroled. The retinal periphery displayed a higher SCP perfusion density (39.6?±?1.7% and 40.7?±?1.4%, P?&lt;?0.0001) and SCP vessel diameter index (3.5?±?0.2 and 3.6?±?0.2, P?&lt;?0.0001), in comparison with the macular region. At the DCP level, the retinal periphery was characterized by a lower perfusion density (41.6?±?3.7% and 37.9?±?2.9%, P?&lt;?0.0001) and vessel length density (14.6?±?6.0% and 9.9?±?2.6%, P?&lt;?0.0001). In the analysis investigating the DCP in the retinal periphery, the temporal sector was characterized by a reduction in perfusion density, vessel length density, and vessel diameter index. In univariate analysis, the retinal thickness was found to have a significant direct relationship with DCP perfusion density (P?&lt;?0.0001), but not with SCP perfusion density (P?=?0.712). Conclusions: We report quantitative mapping of the SCP and DCP in healthy individuals. The DCP perfusion appears to have a wide topographical variation, which is strictly dependent on the retinal thickness.

Purpose To describe and clarify a possible pathogenetic origin for choroidal caverns in young healthy individuals through a topographical analysis using swept-source optical coherence tomography angiography (SS-OCTA).Methods A cross-sectional evaluation of 44 healthy volunteers (44 eyes), aged 20–32 years with no systemic or ocular comorbidities. The topographical analysis of choroidal caverns was performed through a 15 × 15 mm volumetric scan cube using SS-OCTA (PLEX Elite 9000). The number, topographic localization within the perifovea and midperipheral retina, as well as the density of choroidal caverns in the area with the highest number, were analyzed. Factors influencing the presence of choroidal caverns were identified using a logistic regression model.Results The overall prevalence of choroidal caverns was 18.2% in our cohort. The subjects exhibiting choroidal caverns presented a greater AXL (+1.19 mm, 95%CI: 0.09, 2.29). Areas with the highest density of caverns presented an average of 1.98 ± 1.01 caverns/mm2. On a qualitative evaluation, the area with the highest density was along the inferior vascular arcade in 6/8 (75%) eyes. The main predictor of choroidal cavern development was represented by AXL (adjusted risk ratio of 2.13, P= 0.02).Conclusion Choroidal caverns in young, healthy individuals may form due to mechanical stress in predisposed eyes, where an increased lateral and anteroposterior choroidal stretching due to globe elongation can result in the formation of these cavities. Future longitudinal studies are encouraged to understand their prognostic implications.

Objectives to evaluate long-term effectiveness and safety of fluocinolone acetonide (FAc) implant used as second-line treatment in patients with persistent diabetic macular edema (DME).Methods retrospective data chart review of 241 pseudophakic eyes of 178 patients treated with FAc from July 2017 to December 2021 in 10 medical retinal units in Italy. The primary endpoint was the change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 2 years. A Student's paired t-test was used. Additional therapies for DME and intraocular pressure (IOP)-related events were also evaluated.Results efficacy of FAc was assessed in a subset of 111 eyes with at least 24 months of follow-up. Mean BCVA increased at 2 years by 5.1 ETDRS letters (95%CI = 2.6–7.5; p< 0.001) while mean CMT decreased by 189 µm (95% CI 151–227; p< 0.001). Thirty-eight of these eyes (34.2%) needed additional intravitreal treatments, mainly anti-VEGF. Safety was evaluated on the entire cohort of 241 eyes treated with FAc. Overall, 66 eyes (27.4%) required emergent IOP-lowering medications (typically within the first-year post FAc) while 14 eyes (5.8%) underwent trabeculectomy, mostly during the second year of follow-up.Conclusion FAc implant provides a substantial long-term functional and anatomical benefit when used as second-line treatment in eyes with DME. IOP rise can be adequately managed with topical agents although some eyes may require IOP-lowering surgery.

BACKGROUND AND OBJECTIVE:To describe the presence of eyelashes artifact in ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) images.PATIENTS AND METHODS:In this prospective, cross-sectional study, 52 healthy, young subjects were imaged with the SS-OCTA system. OCTA scans were taken in primary and extremes of gaze, and a montage was automatically created. The en face choriocapillaris images were then exported, and a semi-automated algorithm was used for subsequent quantitative analysis.RESULTS:The authors noted the presence of some linear regions of reduced brightness, which were assumed to represent a shadow effect due to patient eyelashes. In order to quantify this effect, the authors performed a quantitative analysis of the superior and inferior regions in the retinal and choroidal vessels.CONCLUSIONS:The authors' qualitative and quantitative analysis showed the presence of regions of false-positive hypoperfusion secondary to eyelashes artifacts. To the authors' knowledge, this represents the first description of this new type of shadowing artifact affecting OCTA images.[[Ophthalmic Surg Lasers Imaging Retina.2019;50:740–743.]

To report variation of choriocapillaris flow in peripapillary, macular, and near- and mid-periphery regions in healthy participants using widefield swept-source (SS) OCT angiography (OCTA).

Background: Central serous chorioretinopathy (CSC) is the fourth most frequent retinal disorder in terms of prevalence. It typically occurs in young subjects and affects men more often than women. CSC is characterized by serous retinal detachment (SRD) involving mainly the macular area. The clinical course is usually selflimited, with spontaneous resolution within 3 months. The persistence of SRD or multiple relapse may result in a chronic form of CSC distinguished by permanent retinal pigment epithelium (RPE) and photoreceptor damage. As the pathogenetic mechanism of CSC primarily involves RPE and choroidal vascularization, the current therapeutic approaches aim to restore the normal functions of RPE and normal choroidal vascular permeability. In this review, the authors aim to summarize the current therapeutic approach to CSC. Methods: A comprehensive review of the literature was conducted in PubMed by searching for relevant studies on the current therapeutic options for CSC, including simple observation, conventional laser treatment, subthreshold laser treatment (SLT), photodynamic therapy (PDT) with verteporfin, treatment with mineralocorticoid receptor (MR) antagonists and treatment with anti-vascular endothelial growth factor drugs. Results: Since most cases resolve spontaneously, the most common initial CSC treatment is observation. Current evidence suggests that PDT and SLT are valuable in improving visual acuity, reducing subretinal fluid and maintaining long-term effectiveness. No clear evidence of efficacy has been achieved for anti-VEGF. MR antagonists might be a viable choice for the treatment of chronic CSC. Conclusion: The pathophysiology of CSC remains poorly understood and as a consequence, the gold standard of care for CSC is yet to be defined. To date, PDT and SLT continue to offer good clinical outcomes. Positive preliminary results seem to emerge from the studies of MR antagonists.

BACKGROUND AND OBJECTIVE:The aim of the study was to determine optical coherence tomography angiography (OCTA) findings and to identify mutations in the The aim of the study was to determine optical coherence tomography angiography (OCTA) findings and to identify mutations in the RS1gene in a three-generation family with X-linked juvenile retinoschisis (XLRS).PATIENTS AND METHODS:Clinical and genetic assessments were performed in 12 family members. OCTA was performed at baseline (12 members including cases and carriers) and after acetazolamide administration (three cases). Twenty healthy subjects (20 eyes, controls) were chosen for comparison. Molecular genetic analysis of the Clinical and genetic assessments were performed in 12 family members. OCTA was performed at baseline (12 members including cases and carriers) and after acetazolamide administration (three cases). Twenty healthy subjects (20 eyes, controls) were chosen for comparison. Molecular genetic analysis of the RS1gene was performed in all family members.RESULTS:Deep capillary plexus density was reduced in cases compared with controls (Deep capillary plexus density was reduced in cases compared with controls (P< .01) and was negatively related with retinal thickness (P< .05). After treatment, retinal thickness decreased (P< .05) and deep capillary plexus density increased (P< .05) in cases. In three cases and in four carriers, p.Arg197 His mutation was found.CONCLUSION:OCTA shows reduced macular deep vessel density in patients with XLRS probably related to vessel displacement and disruption due to schitic cysts.[[Ophthalmic Surg Lasers Imaging Retina. 2018;49:e20–e31.]

The authors present the case of a 59-year-old woman in treatment with interferon alfa-2b for stage IV melanoma and widespread metastases who presented with interferon-associated retinopathy. An ocular examination revealed multiple retinal cotton-wool spots and hard exudates. Interferon treatment was suspended. The patient was followed up for 5 months following the baseline visit by means of en face optical coherence tomography (OCT), spectral-domain OCT, and OCT angiography. Multimodal imaging was useful in the follow-up of this condition, permitting the characterization of all the lesions hallmarking the interferon-retinopathy and showing that this illness was related to a reduction of the retinal vascular perfusion.[[Ophthalmic Surg Lasers Imaging Retina.2017;48:498–504.]

Purpose To assess the reproducibility and repeatability of foveal avascular zone (FAZ) area measurements using swept-source optical coherence tomography angiography (SS-OCTA) in healthy subjects.Methods Sixty-four eyes of 64 healthy volunteers were randomly subjected to FAZ area measurements using SS-OCTA by 2 examiners in 2 different sessions.Results The FAZ areas measured by the first and second observer were 0.269 ± 0.092 mm2and 0.270 ± 0.090 mm2, respectively. Within subjects, the coefficients of variations were 2.44% (95% confidence interval [CI] 1.95% to 2.93%) and 2.66% (95% CI 2.00% to 3.31%) for the first and second observers, respectively. The coefficient of repeatability average measurements of FAZ area were 0.021 mm2and 0.024 mm2. The intraclass correlation coefficient values were 0.993 (95% CI 0.989 to 0.996) and 0.991 (95% CI 0.986 to 0.995). Interobserver and intraobserver concordance correlation coefficients ranged from 0.998 (95% CI 0.997 to 0.999) to 0.999 (95% CI 0.998 to 0.999) and from 0.989 (95% CI 0.982 to 0.993) to 0.987 (95% CI 0.979 to 0.992), respectively.Conclusions The FAZ area measurements by means of SS-OCTA showed high reproducibility and repeatability in healthy eyes.

In eyes affected by wet AMD, the optical coherence tomography angiography shows superficial vascular plexus flow density changing after aflibercept treatment. Moreover, the treatment did not cause a reduction in lesion area, but rather reduced the flow inside the CNV.

AimsTo investigate associations between changes in retinal vessels and alterations detected by spectral domain optical coherence tomography (SD-OCT) scans in intermediate stage age-related macular degeneration (AMD).MethodsThirty eyes of 30 patients with intermediate dry AMD were enrolled in the study. Of the cohort study, 15 eyes (changes-AMD group) showed OCT changes preceding the development of drusen-associated atrophy. A control group of healthy subjects was selected for statistical comparisons. All patients underwent an ophthalmologic evaluation, including OCT angiography (OCTA) and SD-OCT scans. Main outcome measures were superficial vessel density, deep vessel density, macular thickness.ResultsFoveal macular thickness was 215.2±32.9 μm in changes-AMD patients and was significantly thinner than no changes-AMD patients (248.3±23.3 μm, p=0.002) and healthy subjects (268.1±19.2 μm, p<0.0001). Furthermore, in the parafoveal area, the thicknesses of both the inner retina and the outer retina were reduced in the changes-AMD group, after comparison with the two other groups. Parafoveal superficial vascular plexus flow density was 43.3±2.7% in changes-AMD patients and was decreased compared with the no changes-AMD group (48.7±3.3%, p=0.003) and healthy controls (50.4±6.1%, p=0.001). A direct correlation of the superficial plexus flow density with the inner retina parafoveal macular thickness (R2=0.761, p=0.028) was found.ConclusionsWe demonstrated an association between SD-OCT signs and retinal blood supply in patients with intermediate AMD and we showed that patients with signs predicting development of geographic atrophy have a reduced flow in superficial vascular plexus and damage of the inner and the outer retina.

A single heterozygous mutation in the BEST1gene can be associated with a severe phenotype resembling autosomal recessive bestrophinopathy phenotype, thus expanding genotype–phenotype combinations of bestrophinopathies.

In eyes affected by dry age-related macular degeneration, the optical coherence tomography angiography shows that both superficial and deep retinal plexuses are altered.

To assess the reproducibility and repeatability of foveal avascular zone (FAZ) area measurements using optical coherence tomography angiography (OCT-A) in healthy subjects.

PURPOSE:To evaluate intraocular lens (IOL) axial movements and refractive changes during a 6-month follow-up period after femtosecond laser-assisted cataract surgery and conventional cataract surgery, investigate the influence of capsulorhexis features on postoperative IOL axial changes, and assess the prediction error for both techniques.METHODS:Eighty eyes of 80 candidates for cataract extraction were randomized into two groups: femtosecond laser (40 eyes) and manual (40 eyes).RESULTS:The overall anterior chamber depth variation was significantly lower in the femtosecond laser group compared to the manual group during follow-up (The overall anterior chamber depth variation was significantly lower in the femtosecond laser group compared to the manual group during follow-up (P< .001). At 30 and 180 days postoperatively, the mean spherical equivalent showed a hyperopic shift (0.09 ± 0.28 diopters [D]) in the femtosecond laser group and a myopic shift in the manual group (−0.25 ± 0.18 D). Median absolute error was not significantly different between the two groups with standard formulas ranging between 0.29 and 0.64 (Hoffer Q) in the femtosecond laser group and between 0.24 (SRK-T) and 0.55 D (Hoffer Q) in the manual group. There was a significant lower deviation from intended versus achieved capsulotomy/capsulorhexis area in the femtosecond laser group (P< .001) compared to the manual group. The femtosecond laser group showed better IOL centration compared to the manual group at all time periods (P< .001).CONCLUSIONS:Femtosecond laser-assisted cataract surgery was related to a lower overall variability of anterior chamber depth compared to conventional cataract surgery with more stable postoperative refraction. The two techniques did not show significant differences of prediction error.[[J Refract Surg.2015;31(8):524–530.]

PURPOSE:To evaluate cellular inflammation and apoptosis induced in the central portion of capsulorhexes/capsulotomies during cataract surgery, comparing a conventional manual technique and a femtosecond laser-assisted procedure at different energy settings using two laser systems.METHODS:Fifty-six capsulorhexes/capsulotomies were divided into four groups: the manual group (14 capsulorhexes) performed with the manual technique; the 7.0-Fifty-six capsulorhexes/capsulotomies were divided into four groups: the manual group (14 capsulorhexes) performed with the manual technique; the 7.0-µJ group (14 capsulotomies) (LensAR laser system; Lensar, Inc., Orlando, FL); the 10-µJ group (14 capsulotomies) (LenSx laser system; Alcon Laboratories, Inc., Fort Worth, TX); and the 13.0-µJ group (14 capsulotomies) (LenSx laser system). All samples were stained for cellular apoptosis analysis (TUNEL assay) and cellular induced inflammation (NF-κB).RESULTS:One-way analysis of variance indicated a statistically significant difference in the percentage of NF-κB and TUNEL positive cells between the four groups, (F [3.52] = 14.717, One-way analysis of variance indicated a statistically significant difference in the percentage of NF-κB and TUNEL positive cells between the four groups, (F [3.52] = 14.717, P< .001) and (F [3.52] = 139.561, P< .001), respectively. Post-hoc analysis indicated a statistically significant difference in the percentage of NF-κB positive cells between the 13.0-µJ group and the manual, 7.0-µJ, and 10-µJ groups (P< .001, = .037, and < .001, respectively). Post-hoc analysis of differences in TUNEL positive cells indicated a significant difference between the 7.0-µJ and 10-µJ groups (P<.017) and between the 13.0-µJ group and the manual, 7.0-µJ, and 10-µJ groups (P< .001, < .001, and < .001, respectively).CONCLUSION:The results show a higher percentage of NF-κB and TUNEL positive cells in the 13.0-The results show a higher percentage of NF-κB and TUNEL positive cells in the 13.0-µJ group compared to the 7.0-µJ, 10-µJ, and manual groups. Therefore, inflammatory response and cell death increased at increasing energies. An effective capsulotomy in femtosecond laser-assisted cataract surgery with minimal detrimental apoptotic and inflammatory effects is possible if the laser system is set to use the minimum energy level.[[J Refract Surg.2015;31(5):290–294.]

BACKGROUND AND OBJECTIVE:To evaluate the effect of navigated retinal laser photocoagulation on visual acuity (VA) and retinal sensitivity in eyes with acute central serous chorioretinopathy (CSC).PATIENTS AND METHODS:Prospective, noncomparative, interventional case series of 30 eyes of 29 patients with acute CSC were treated using navigated photocoagulation. Patients were monitored for 180 days.RESULTS:Mean VA improved from 0.3 ± 0.1 to 0.1 ± 0.1 logMAR (Mean VA improved from 0.3 ± 0.1 to 0.1 ± 0.1 logMAR (P< .001). Mean retinal sensitivity within central 8° and 4° improved from 9.4 ± 4.7 dB to 14.9 ± 3.6 dB and from 9.0 ± 5.6 dB to 14.6 ± 4.2 dB respectively (P< .001). In all cases, a decrease in mean central retinal thickness of −50.6 ± 2.9 µm (P< .001) and in mean subretinal fluid thickness of −52.0 ± 3.3 µm (P< .001) was observed during follow-up.CONCLUSION:Navigated retinal laser photocoagulation demonstrated safety and accuracy for the treatment of acute CSC. VA and retinal sensitivity evaluations showed a significant improvement associated with resolution of the subretinal fluid during follow-up.[[Ophthalmic Surg Lasers Imaging Retina. 2015;46:349–354.]

Purpose Retinal structural changes in a case of spontaneous resolution of vitreomacular traction (VMT) syndrome were followed by means of multimodal retinal imaging approach.Methods Confocal scanning laser ophthalmoscopy (cSLO) including digital infrared and blue reflectance (BR) imaging and spectral-domain optical coherence tomography (SD-OCT) were performed in a young man with VMT syndrome.Results At the time of diagnosis, multimodal retinal imaging documented outer retina abnormalities linked to VMT. At 1 month follow-up visit, improvement of best-corrected visual acuity and resolution of metamorphopsia were accompanied by documentation of VMT resolution and outer retina restoration.Conclusions Both cSLO and SD-OCT imaging, particularly BR and en face OCT adapted to the outer plexiform layer contour, allowed to depict outer retina changes in the course of VMT resolution. A strict correlation between topographic BR images and en face OCT scans was evident.

PURPOSE:To compare functional and morphological outcomes of femtosecond laser clear corneal incision (CCI) versus manual CCI during cataract surgery.METHODS:Sixty eyes of 60 patients who underwent CCI during cataract surgery were randomized into two groups: femtosecond laser CCI (30 eyes) and manual CCI (30 eyes).RESULTS:There were no significant between-group differences in uncorrected distance visual acuity, corrected distance visual acuity, surgically induced astigmatism, and corneal aberrations. Keratometric astigmatism was significantly lower in the femtosecond laser CCI group compared to the manual CCI group at 30 and 180 days (There were no significant between-group differences in uncorrected distance visual acuity, corrected distance visual acuity, surgically induced astigmatism, and corneal aberrations. Keratometric astigmatism was significantly lower in the femtosecond laser CCI group compared to the manual CCI group at 30 and 180 days (P< .05). Central endothelial cell count was significantly higher in the femtosecond laser CCI group compared to the manual CCI group at 7 and 30 days postoperatively (P< .05). A lower increase of corneal thickness at the incision site was observed at 30 and 180 days postoperatively in the femtosecond laser CCI group compared to the manual CCI group (P< .05). In addition, femtosecond laser CCI showed a better morphology (lower percentage of endothelial and epithelial gaping and endothelial misalignment) compared to manual CCI at different time points. Total phacoemulsification time was significantly lower in the femtosecond laser CCI group (P< .05).CONCLUSIONS:The femtosecond laser procedure was safe, efficient, and less damaging, as evidenced by lower central endothelial cell loss, lower increase of corneal thickness at the incision site, and better tunnel morphology compared to the manual technique.[[J Refract Surg.2014;30(1):27–33.]

Purpose To report a case of macular pseudohole (MPH) development after sustained-release dexamethasone intravitreal implant for chronic macular edema due to central retinal vein occlusion (CRVO).Methods A 70-year-old man with cystoid macular edema (CME) due to CRVO underwent sustained-release dexamethasone intravitreal implant. En face optical coherence tomography (OCT) was performed before and after treatment.Results One month after dexamethasone intravitreal implant, best-corrected visual acuity (BCVA) improved from 1.0 to 0.5 logMAR. At 2 months, BCVA decreased from 0.5 to 1.3 logMAR. En face OCT detected the development of MPH due to exacerbation of centripetal vitreomacular transverse tractional forces on the overlying retina.Conclusions Macular pseudohole seems to be a complication of intravitreal therapy in patients with coexisting vitreomacular traction. En face OCT gives useful information to understand the mechanism of MPH development after sustained-release dexamethasone intravitreal implant.

PURPOSE:To evaluate astigmatism correction, visual performance, intraocular lens (IOL) position, and wavefront error after implantation of toric IOLs in patients with cataract.METHODS:This prospective study comprised 30 eyes of 30 patients with cataract who were candidates for phacoemulsification and implantation of the AcrySof toric IOL (Alcon Laboratories, Inc., Fort Worth, TX). Mean preoperative corneal keratometric and subjective refractive cylinder were 2.10 ± 0.47 and 2.17 ± 0.41 diopters (D), respectively.RESULTS:The refractive cylinder decreased significantly from 2.17 ± 0.41 to 0.73 ± 0.45 D (The refractive cylinder decreased significantly from 2.17 ± 0.41 to 0.73 ± 0.45 D (P= .001) at 180 days postoperatively. The difference between preoperative corneal astigmatism and postoperative refractive astigmatism was statistically significant (P< .05). At 180 days postoperatively, the uncorrected distance visual acuity was 0.20 logMAR (Snellen 20/32) in 100% of patients and 0.0 logMAR (Snellen 20/20) in 64% of patients. The root mean square of internal coma and trefoil aberrations showed a trend toward reduction; internal spherical aberration significantly decreased, whereas corneal trefoil aberration significantly increased (P< .05). A low amount of IOL decentration and tilt were detected at 30 and 180 days postoperatively, respectively.CONCLUSIONS:Toric IOL implantation is an effective procedure for correction of preexisting corneal astigmatism, improving visual performance, and inducing a low amount of higher-order aberrations. Moreover, the toric IOLs is well positioned early after surgery and stable over time.[[J Refract Surg.2013;29(7):476–483.]

Purpose To evaluate visual performance and wavefront error after multifocal intraocular lens (MIOL) implant with or without capsular tension ring (CTR).Methods Sixty eyes of 60 candidates for phacoemulsification and MIOL implantation were included in the study and were randomly divided into 2 groups. Thirty eyes (group 1) were implanted with the AcrySof ReSTOR®SN60D3 MIOL and Corneal®ACPI 11 CTR and 30 eyes (group 2) received the same MIOL with no CTR.Results Twenty days and at 360 days after surgery, the uncorrected and corrected distance visual acuity at high and low contrast were not significantly different between the 2 groups. The root mean square (RMS) of ocular and internal wavefront error was significantly different in the 2 groups early after surgery and did not modify significantly over the 1-year follow-up period. The RMS of total and internal high-order aberrations and ocular and internal trefoil and coma aberrations were significantly lower in group 1 compared to group 2 (p<0.05). Ocular, corneal, internal modulation transfer function at high and low spatial frequencies and ocular, corneal, internal Strehl ratio were not significantly different between the groups. The IOL decentration and tilt were higher in group 1 compared to group 2.Conclusions ReSTOR MIOL was effective in improving visual performance and provided a good quality of vision due to a significant reduction of high-order spherical aberration. The implant of CTR additionally reduced the ocular wavefront error related to a reduction of third-order aberration related to better IOL position.

PURPOSE:To evaluate visual and aberrometric outcomes and position of the AcrySof Cachet (Alcon Laboratories Inc) angle-supported phakic intraocular lens (PIOL) for correction of myopia in adults.METHODS:This prospective study included 36 consecutive eyes with moderate to high myopia in which an AcrySof Cachet PIOL was implanted to minimize refractive error. Follow-up was up to 1 year.RESULTS:Mean manifest spherical equivalent refraction reduced significantly from −14.90±0.90 diopters (D) to −0.29±0.30 D at 1 month and remained stable at 1 year (Mean manifest spherical equivalent refraction reduced significantly from −14.90±0.90 diopters (D) to −0.29±0.30 D at 1 month and remained stable at 1 year (P<.001). Mean uncorrected distance visual acuity was ⩾0.1 logMAR (20/20 Snellen) in 56% of patients and ⩾0.3 logMAR (20/25 Snellen) in 100% of patients. Corrected distance visual acuity was ⩾0.1 logMAR (20/20 Snellen) in 78% of patients and ⩾0.3 logMAR (20/25 Snellen) in 100% of patients. Mean endothelium–PIOL distance and mean PIOL–crystalline distance were within recommended values at all postoperative evaluations. Statistically significant variations for these variables were not observed. Anterior chamber depth, safety center distance, and vault center distance showed significant reduction after accommodation (P<.01). Anterior chamber depth and safety center distance significantly increased after pupil dilation (P⩽.01). Mean percentage of endothelial cell loss was 4.04% at 1 year. The root-mean-square of total higher order aberrations and spherical, coma, and trefoil aberrations did not change significantly from pre- to postoperatively.CONCLUSIONS:The AcrySof Cachet PIOL was effective in the correction of moderate to high myopia and provided excellent visual performance with no modification of physiologic ocular wavefront error. Adequate distance from the cornea and crystalline lens was maintained with no significant change during follow-up and under different environmental conditions.

Background and Objective:To compare functional and morphological outcomes of 1.8-mm versus 2.2-mm microincision coaxial cataract surgery (MCCS).Patients and Methods:Thirty eyes of 30 patients that underwent MCCS were randomized to two groups: 1.8-mm MCCS (group 1: 15 eyes) and 2.2-mm MCCS (group 2: 15 eyes).Results:There were no significant between-group differences in uncorrected visual acuity, best-corrected visual acuity, keratometric astigmatism, and endothelial cell count. One day postoperatively, a greater increase of corneal thickness at the incision site was observed in group 1 compared to group 2 using anterior segment optical coherence tomography with no significant differences in tunnel morphometric features and confocal microscopy showed more tunnel edema in group 1 versus group 2 that resolved in both groups.Conclusion:Both 1.8- and 2.2-mm torsional MCCS were safe and efficient with easy surgical maneuvers and excellent functional and morphological results; 1.8-mm MCCS induced slightly greater tunnel edema shortly after surgery that resolved in the medium term.

Purpose To evaluate the control of diurnal intraocular pressure (IOP) and the safety profile of bimatoprost in pseudoexfoliative glaucoma (PXG) compared to primary open angle glaucoma (POAG).Methods A prospective, observer-masked, nonrandomized study was performed. Seventy consecutive patients with either POAG (35 eyes) or PXG (35 eyes) drug-naive for glaucoma were assigned to receive bimatoprost 0.03% once daily for 12 weeks. Diurnal IOP was measured at baseline and after 12 weeks at three time points (8 AM, noon, and 4 PM). Main outcomes were diurnal IOP control and achievement of target IOP (CIGTS criteria). Mean diurnal IOP, hour-by-hour IOP measurements, and safety, including serious adverse events, were also evaluated.Results A significant IOP reduction from baseline was found in both groups (p<0.001). Mean and hour-by-hour IOP differences between groups were not statistically significant (NS). The observed IOP values and percentages of IOP reduction were 17.0 mmHg (31.5%) and 16.4 mmHg (31.9%) in PXG and POAG eyes, respectively; the differences were not statistically significant. Six eyes (1 POAG and 5 PXG, respectively) responded with a <20% IOP reduction (NS). Twenty-seven POAG (77.1%) and 23 PXG (65.7%) eyes achieved target IOP. Consequently, 20 eyes (8 POAG and 12 PXG, respectively) were classified as unable to achieve the IOP target values (NS).Conclusions Bimatoprost was effective and safe in lowering IOP both in open angle and pseudoexfoliative glaucoma, achieving target pressure in most patients. However, long-term efficacy in PXG must be evaluated.

To evaluate the longterm efficacy of 1?CU®accommodative intraocular lenses (IOLs) to restore near visual performance.

BackgroundThe implant of intraocular lenses (IOLs) following cataract surgery induces a foreign-body reaction to the IOL and a response on the part of the lens epithelial cells (LECs). The purpose of this study was to compare these aspects after the implantation of two different IOL materials.MethodsThirty-six cataract patients were randomised to receive two different foldable lens: an acrylic hydrophobic IOL (Acrysof MA30BA) and a heparin surface-modified (HSM) polymethylmethacrylate IOL (Pharmacia & Upjohn 809C) after phacoemulsification. Slit-lamp biomicroscopy with specular technique was used to assess the inflammatory cell adhesion on the anterior IOL surface, anterior capsule opacification (ACO) and membrane growth from the rhexis edge at 7, 30, 90, 180 and 360 days after surgery.ResultsThe 809C group showed a higher percentage of patients with slight inflammatory cell adhesion on the anterior cell surface and a higher small cellular density during the whole follow-up period. The epithelioid cell response was greater in the 809C group than the Acrysof group but the difference between the two groups was not statistically significant. The ACO increased during the follow-up in both groups but was significantly higher in the 809C group.ConclusionAcrysof lenses are more biocompatible than HSM IOLs, showing a lower grade of inflammatory cell adhesion and ACO. The implantation of these lenses may be particularly indicated in patients with pathologies predisposing to blood–aqueous barrier damage.

AbstractAims:To report 6 cases in which indocyanine green angiography (ICGA) failed to convert occult choroidal neovascularization (CNV) into well-defined CNV in adult-onset foveomacular vitelliform dystrophy (AOFVD). Methods:Patients with AOFVD observed from 1993 to 1999 were prospectively followed up. Whenever the development of CNV was suspected, ICGA was performed to detect the precise location and extension of CNV by means of the IMAGEnet System. Results:Six out of 51 patients (11.7) developed CNV during the follow-up. The CNV was of the occult type, with an associated detachment of the pigment epithelium in 1 eye. On ICGA, a large hyperfluorescent lesion appeared after about 10 min, irregularly increasing with time, without a clear visualization of site and extension of CNV. Conclusions:In AOFVD, ICGA may fail to convert occult CNV into well-defined CNV, which is amenable to laser treatment, since hyperfluorescence caused by the probably vitelliform material binding to the ICG molecule and the CNV-induced hyperfluorescence cannot be angiographically distinguished from each other.Copyright © 2001 S. Karger AG, Basel