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Purpose To evaluate the effects of pneumatic trabeculoplasty (PNT) in ocular hypertension and glaucoma subjects.Methods A total of 63 consecutive subjects, either treated (79%) or untreated (21%), with intraocular pressure (IOP) between 20 and 25 mmHg were enrolled; the eye with higher IOP (or, in case of identical IOP, worse visual field) was treated with PNT, with the fellow eye used as control. Subjects underwent a baseline evaluation the day before treatment, two PNT treatments at day 0 and 7, visits at day 1, 8, 14, and at each month until the end of the study, which lasted 6 months. Safety was addressed at all visits; an IOP curve (at 8 and 10 AM, 2 and 4 PM) was obtained at baseline and during monthly visits.Results In PNT eyes, baseline IOP was 22.2±1.6 mmHg. Following PNT a statistically significant reduction of IOP occurred at all visits (p<0.0001), with a mean decrease ranging from −2.7±2.5 (-11.9±10.8%) to −3.6±2.6 mmHg (-16.0±11.6%); mean reduction was 12.8±11.5%. Although IOP diminished also in the control eyes after baseline (p<0.05), the change in IOP was significantly higher in PNT group at each visit (p<0.05). Mild side effects were experienced by 76% of subjects and they all resolved without sequelae.Conclusions The results suggest the effect of this procedure in reducing IOP in glaucoma and ocular hypertensive subjects.

Purpose To provide an in vivo confocal microscopy (IVCM) and impression cytology analysis of preserved- and unpreserved levobunolol-induced changes of conjunctival epithelium.Methods 27 eyes of 27 patients were consecutively randomized to receive preserved or unpreserved levobunolol; all patients had a recent diagnosis of primary open angle glaucoma (POAG) or ocular hypertension and were not previously treated with topical medications. IVCM and impression cytology were performed before and after six months of therapy. Goblet cells density and a conjunctival epithelium regularity index were considered in the IVCM analysis, whereas impression cytology specimens were graded and scored in accordance with Nelson's method.Results After six months of therapy, IVCM and impression cytology parameters showed significant differences with respect to baseline in both groups (p<0.001); significant differences were also found between the two groups (p<0.001). The IVCM analysis showed a goblet cells density reduction (61% and 17% from baseline, respectively in group 1 and 2) (p<0.001) and an higher index of epithelial regularity (p<0.001) in both groups; the impression cytology analysis showed an higher score in both groups (p<0.001).Conclusions All the IVCM and impression cytology parameters correlated well with the conjunctival modifications induced by the topical therapy, suggesting the less toxicity of unpreserved drugs

Purpose The aim of the study was to evaluate the fixation patterns of microstrabismic children previously treated for unilateral amblyopia.Methods Thirty-three children (mean age 7.3±1.5 years) were included in the study. Visual acuity (VA) was measured using the Early Treatment of Diabetic Retinopathy Study charts. Fixation was assessed by MP-1 microperimeter. Differences in position and stability of fixation between the fellow and the microstrabismic eyes were calculated by using the percentage of the preferred fixation points within central fixation and the percentage of the fixation points within target fixation, respectively. For statistical analysis Mann-Whitney test was used. To evaluate the influence of age and duration of anti-amblyopic treatment on microstrabismic eyes fixation, linear regression analysis was performed.Results In the microstrabismic eyes VA was significantly reduced when compared to the fellow eyes (0.1236±0.0204 vs 0.0042±0.0032 logMAR; p<0.001). Position and stability of fixation were significantly better in the fellow eyes (93.21±0.65% vs 70.91±4.80%; p=0.002, and 89.88±0.94% vs 71.73±2.94%; p<0.001, respectively). A significant correlation was found between fixation stability and both the duration of anti-amblyopic treatment and pretreatment VA (p=0.024 and p=0.009, respectively) and between fixation centrality and pretreatment VA (p<0.001).Conclusions VA, centrality, and stability of fixation were significantly impaired in the microstrabismic eyes. Pretreatment VA was a risk factor for fixation impairment. The severity of fixation stability impairment was linked to the duration of anti-amblyopic treatment.

Purpose To report pre- and post-operative macular optical coherence tomography (OCT) and immunohistochemical findings in a case of long-lasting silicone oil tamponade followed by silicone oil removal and epimacular membrane peeling.Methods A 69-year-old man with long-standing silicone oil tamponade and an epiretinal membrane at the posterior pole in his right eye (RE) underwent silicone oil/BSS exchange with epiretinal membrane peeling. Preoperatively RE best-corrected visual acuity was 20/200 and macular OCT examination revealed a small increase in foveal thickness (250 μm) with the appearance of a linear hyper-reflective signal at the foveal vitreoretinal interface and a thicker (440 μm) hyperreflective finding causing posterior shadowing at the vitreoretinal interface inferiorly to the fovea. Histopathologic and immunohistochemical study of the specimen including the epiretinal membrane was performed.Results Light microscopy revealed extensive rounded empty spaces interpreted as silicone oil bubbles in the preretinal membrane. Macrophages marker (CD68) positive staining cells were found surrounding the empty spaces within the preretinal membrane and several empty spaces were observed intracellularly within macrophage cytoplasm. Thirty days after surgery best-corrected visual acuity was 20/60 and OCT examination showed an evident decrease in foveal thickness (220 μm) with the disappearance of any hyper-reflective signal at the vitreoretinal interface referable to an epiretinal membrane.Conclusions The immunohistochemical study showed both silicone oil droplets and macrophagic cells embedded in the epiretinal membrane. Postoperative OCT demonstrated retinal recovery after silicone oil removal and epiretinal membrane peeling, thus justifying an unexpected visual acuity recovery despite the very long term tamponade.

Purpose To investigate whether topical nonsteroidal anti inflammatory drugs (NSAIDs) are useful, in the absence of concomitant corticosteroid therapy, in limiting postoperative inflammation after uncomplicated cataract surgery.Methods A total of 328 patients were enrolled in a prospective, randomized, double-masked, parallel-group, active-controlled study. Anterior chamber inflammation (ACI) was evaluated as the primary efficacy parameter. Only patients with moderate inflammation (ACI score of ≤4) the day after surgery were randomized and treated with NSAIDs. A novel topical formulation containing 0.2% sodium naproxen was compared with 0.1% diclofenac. Both were administered three times a day for 14 consecutive days. Ocular inflammation was measured after 7 and 14 days by using slit-lamp biomicroscopy. Safety parameters were also evaluated at the same time.Results Both treatments were equally effective in controlling postsurgical inflammation. No statistically significant differences between treatment groups were observed for the safety variables. No serious adverse events (AEs) occurred during the course of the study. The most frequent AE reported with naproxen was eye redness.Conclusions NSAIDs can effectively be used without concurrent administration of corticosteroids to control postoperative inflammation after uncomplicated cataract surgery. In addition, naproxen ophthalmic solution may be considered a suitable alternative to the currently available NSAIDs.

Purpose To evaluate variability of retinal nerve fiber layer (RNFL) thickness measurements in normal eyes and their correlation with optic disc diameter by using two different scan options of the ultimate commercial optical coherence tomography (OCT) unit (STRATUS OCT™, Carl Zeiss Meditec, Inc., Dublin, CA).Methods In this observational case series and instrument validation study 30 eyes of 30 normal subjects were enrolled. Each eye underwent optic disc vertical diameter measurement by means of both stereoscopic photography and planimetry and OCT; RNFL thickness measurements were performed using OCT. Three repetitions of two series of scans were performed. Each eye was scanned at two different options (RNFL thickness 3.4 and Nerve Head Circle). For each option descriptive statistics, analysis of variance, intraclass correlation coefficients (ICCs), and coefficients of variation (COVs) were calculated. To verify the correlation between the two methods of optic disc diameter assessment and to study the influence of optic disc diameter on RNFL measurement using the two different OCT options, Pearson's correlation coefficients were calculated.Results Optic disc diameter length ranged from 1.47 to 2.04 mm (mean 1.709 mm, SD ± 0.147) with stereoscopic photographs, and from 1.47 to 2.02 mm (mean 1.703 mm, SD ± 0.143) with OCT (Pearson correlation coefficient 0.999, p<0.001). Mean RNFL thickness was 89.29 mm (SD ± 10.80 mm) using the RNFL thickness 3.4 scanning option and 89.88 mm (SD ±1.72 mm) using the Nerve Head Circle protocol (Pearson correlation coefficient 0.065, p=0.734). The intersubject variance is higher using the RNFL thickness 3.4 option than using the NHC protocol (sum of square: 10147,60 vs. 257,41) (p<0.001); the intrasubject variance is very similar in the two groups (23,72 vs 23,60) (p=NS). The ICC is 99.89% when using the RNFL thickness 3.4 option, 95.62% with the NHC protocol (p=NS). COVs were 12.10% and 1.91 % by using RNFL thickness 3.4 and Nerve Head Circle option, respectively. Pearson's correlation coefficient was 0.988 (p<0.001) when comparing optic disc diameter and RNFL thickness by using the RNFL thickness 3.4 option and −0.016 (p=0.932) when comparing optic disc diameter and RNFL thickness by using the Nerve Head Circle option.Conclusions These results suggest that both scan options give good RNFL thickness measurement reproducibility; the use of the Nerve Head Circle option leads to less interindividual variability and can minimize the effect of differences in optic disc diameter on RNFL thickness measurements in normal subjects.

Purpose To report a case of spontaneous closure of traumatic macular hole in a young patient followed using optical coherence tomography (OCT) and fundus microperimetry.Methods/Results In the right eye of a 10-year-old child, a traumatic macular hole was observed to spontaneously resolve 18 weeks after blunt trauma. Initially, visual acuity in the right eye was 20/200 and OCT examination showed a 200üm-diameter full-thickness macular hole with perifoveal edema. Fundus microperimetry examination showed an evident decrease in retinal sensitivity within the macular hole and in the upper macular region where an area of commotio retinae was clearly visible. During follow-up OCT demonstrated the appearance of a band of tissue linking the inferior edge of the hole to the foveal retinal pigment epithelium and at the bottom of the hole the presence of hyperreflective (glial) material. Eighteen weeks after trauma right eye visual acuity had improved to 20/25, OCT examination showed a restored foveal depression, and fundus microperimetry demonstrated an increase in foveal sensitivity.Conclusions Both OCT and fundus microperimetry were useful tools for following the favorable course in a case of spontaneous closure of traumatic macular hole in a young patient. During follow-up OCT examinations were able to demonstrate the course of macular hole closure.

Purpose To report a case of surgical resolution of bilateral vitreomacular traction syndrome related to incomplete posterior vitreoschisis as documented by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Dublin, CA).Case Report In both eyes of a 72-year-old man with bilateral blurred vision, OCT examination disclosed a relevant increase in mean foveal thickness (right eye = 714 μm; left eye = 757 μm) due to a vitreomacular traction syndrome. At the edges of the most highly elevated area of vitreo-macular traction, OCT scans showed a characteristic splitting of the hyperreflective signal in both eyes, usually identified as posterior vitreous cortex. Both eyes underwent vitrectomy with epiretinal membrane peeling. Postoperative OCT examination showed vitreomacular traction resolution in both eyes with an evident decrease in mean foveal thickness (right eye = 364 μm; left eye = 335 μm). Right visual acuity improved from 20/200 to 20/50; left visual acuity changed from 20/150 to 20/40.Conclusions OCT was a useful tool in identifying an unusual case of bilateral vitreomacular traction syndrome linked to incomplete posterior vitreoschisis and following a favorable course after surgical management.

Purpose To report optical coherence tomography (OCT) and retinal thickness analyzer (RIA) findings in a case of spontaneous resolution of vitreomacular traction syndrome.METHODS Qualitative and quantitative analysis of the macular region was performed with OCT and RTA.Results In the left eye of a 34-year-old woman with blurred vision, OCT and RTA examination showed a discrete linear signal anterior to the retina with attachment at the macula and secondary cystoid macular changes. OCT and RTA examination showed an increase in macular thickness (350 μm). Six months later the patient showed a spontaneous complete recovery of visual acuity. Vitreomacular traction and cystoid changes were no longer detectable at OCT and RTA examination; retinal thickness was normal (205 μm) and a posterior vitreous detachment was visible.CONCLUSIONS Both OCT and RTA were useful tools for making the diagnosis of vitreomacular traction syndrome and demonstrating the effect of spontaneous vitreomacular traction release with resolution of cystoid macular changes.

Background/aims Fellow eye prophylaxis for retinal detachment (RD) is still a controversial issue since opinions are not unanimous regarding the kind of lesions to be treated or the method of treatment. This prospective clinical study aimed to follow the course of vitreoretinal conditions in 150 high risk fellow eyes. Methods 150 consecutive patients with unilateral rhegmatogenous RD were included in this study. Inclusion criteria were good explorability of fellow eye retinal periphery and one of the following conditions in the fellow eye--aphakia, pseudophakia with capsulotomy, high myopia (>-6D), contralateral eye to a giant retinal tear. Prophylactic treatment (photocoagulation or scleral buckling) was performed in the presence of retinal tears and lattice degenerations. The state of the vitreous body was determined at the beginning of the study and at the end, when RD occurred. Results Follow up ranged from 36 to 132 months. 95 fellow eyes were subjected to laser treatment; five eyes underwent prophylactic surgical treatment. Initially, in the treated group posterior vitreous detachment (PVD) was present in 100 eyes (100% of cases), but as a complete PVD only in 42 of them (42%). 10 eyes in the treated group developed RD during the follow up period. In five of these cases the partial PVD had progressed and a retinal tear in a previously healthy area was the cause of the retinal detachment. In the other five eyes RD apparently developed from previously treated lesions. Progression of PVD was evident in four out of these five eyes. The untreated eyes had no visible degenerative lesions. During follow up eight eyes developed RD. These eyes had no PVD at the beginning of the study, but showed a partial PVD at the time of the diagnosis of RD. Conclusion Fellow eyes with pre-existing retinal tears and PVDs can go on to retinal detachment in spite of laser prophylactic treatment. When PVD is not detectable or a partial PVD is present, the progression of posterior vitreous separation can account for retinal tears and RDs arising in formerly healthy areas.

Abstract: In this paper we exhibit a representation of the data structures allowing the automatic construction of the generating form of a family starting from its description by nieans of words. The generating form of a family of data structures is useful in the proof of structure properties and of one-one and many-one mappings between structures. Some examples of this use are given. At last this paper contains a generative extension of the Plya theorem, i. e. a theorem which allows one to write the generating function of thefamily of distinct confignrations, with respect to a given permutation group, which can be built on a finite set of figures.

Abstract: The aim of this paper is to analyze a representation of information structures which minimizes the storage employed for their memorization. These structures must belong to a family satisfying given conditions. This representation is realized by constructing alisting, which is a one-one correspondence between the family of information structures and the setDof non-negative integers. The listing algorithm presented in this paper is an extension of that one given in [5].The run time of both these listing algorithms and the resulting saving of storage are analyzed.As examples of application of the extended listing method, the listings of the family of structured programs according to [1] and of the families of ordered and non-ordered forest structures are treated extensively.

In the present paper we propose a new type assignment for λ-terms whose motivation is to introduce a system with simple inferential rules to study termination (i.e. the property of having a normal form) of λ-terms. The main results that will be proved in this paper are:a)all λ-terms in normal form possess a type,b)all λ-terms which possess a type reduce to normal form.

Purpose Rupture of the sclera occurring during retinal detachment surgery is generally associated with unfavourable anatomic and visual outcomes. Re-operation after a failed scleral buckle procedure and pre-existing scleral thinning are considered the main risk factors for scleral rupture.Case Report We describe the management and the favourable outcome of a case of scleral rupture in a 71-year-old woman during re-operation for retinal detachment.Conclusions We managed this case of scleral rupture in accordance with current indications concerning the anatomical recovery, by scleral suture and patch graft, restoring IOP by gas tamponade. The positive outcome was partly related to the prompt closure of the retinal hole which led to reattachment, and partly to favourable events such as the moderate intensity of vitreous hemorrhage and the lack of any more serious intraoperative and postoperative complications.

In this study concerning the prevalence of myopia in patients with open angle glaucoma, its distribution was analyzed within the sample tested in relation to the refraction defect size, compared with a control group of non-glaucomatous myopic subjects.The overall myopic rate was 17.2% of the glaucomatous patients; high myopia was more frequent in the subjects with open angle glaucoma (p<0.001) than in the myopic patients, thus appearing as a possible risk factor for the development of glaucoma.

A cross-sectional study was undertaken to analyze the relation between the perfusion of the rim area and lamina cribrosa of the optic nerve head by means of SLDF and the mean defect of the visual field.

A cross‐over double‐blind study was performed to evaluate the effect of acute administration of brimonidine on the blue‐yellow perimetry. Thirty patients with primary open‐angle glaucoma were admitted. After brimonidine administration, IOP and pupil diameter showed a significant reduction (p<0.01) without modification in systolic and diastolic blood pressure. Blue‐on‐yellow perimetry showed a significant reduction in CPSD from 3.81 ±1.60 to 2.71 ±1.92 (p<0.05). This result suggests that brimonidine improves ocular perfusion via a reduction of IOP.