Search

Objective: Evaluation of ophthalmologic safety with focus on retinal safety in patients with spinal muscular atrophy (SMA) treated with risdiplam (EVRYSDI®), a survival of motor neuron 2 splicing modifier associated with retinal toxicity in monkeys. Risdiplam was approved recently for the treatment of patients with SMA, aged ≥ 2 months in the United States, and is currently under Health Authority review in the EU., Methods: Subjects included patients with SMA aged 2 months-60 years enrolled in the FIREFISH, SUNFISH, and JEWELFISH clinical trials for risdiplam. Ophthalmologic assessments, including functional assessments (age-appropriate visual acuity and visual field) and imaging (spectral domain optical coherence tomography [SD-OCT], fundus photography, and fundus autofluorescence [FAF]), were conducted at baseline and every 2-6 months depending on study and assessment. SD-OCT, FAF, fundus photography, and threshold perimetry were evaluated by an independent, masked reading center. Adverse events (AEs) were reported throughout the study., Results: A total of 245 patients receiving risdiplam were assessed. Comprehensive, high-quality, ophthalmologic monitoring assessing retinal structure and visual function showed no retinal structural or functional changes. In the youngest patients, SD-OCT findings of normal retinal maturation were observed. AEs involving eye disorders were not suggestive of risdiplam-induced toxicity and resolved with ongoing treatment., Interpretation: Extensive ophthalmologic monitoring conducted in studies in patients with SMA confirmed that risdiplam does not induce ophthalmologic toxicity in pediatric or adult patients with SMA at the therapeutic dose. These results suggest that safety ophthalmologic monitoring is not needed in patients receiving risdiplam, as also reflected in the United States Prescribing Information for risdiplam., (© 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Objective: To evaluate holding security of 4 friction knots created with various monofilament and multifilament sutures in a vascular ligation model., Sample: 280 friction knot constructs., Procedures: 10 friction knots of 4 types (surgeon's throw, Miller knot, Ashley modification of the Miller knot, and strangle knot) created with 2-0 monofilament (polyglyconate, polydioxanone, poliglecaprone-25, and glycomer-631) and braided multifilament (silk, lactomer, and polyglactin-910) sutures were separately tied on a mock pedicle and pressure tested to the point of leakage. Linear regression analysis was performed to compare leakage pressures among suture materials (within friction knot type) and among knot types (within suture material)., Results: Mean leakage pressure of surgeon's throws was significantly lower than that of all other knots tested, regardless of the suture material used. All the other knots had mean leakage pressures considered supraphysiological. Significant differences in mean leakage pressure were detected between various friction knots tied with the same type of suture and various suture types used to create a given knot. Variability in leakage pressure among knots other than the surgeon's throw was greatest for poliglecaprone-25 and lowest for polydioxanone., Conclusions and Clinical Relevance: Most differences in knot security, although statistically significant, may not have been clinically relevant. However, results of these in vitro tests suggested the surgeon's throw should be avoided as a first throw for pedicle ligation and that poliglecaprone-25 may be more prone to friction knot slippage than the other suture materials evaluated.

Cerebral amyloid angiopathy (CAA) is one of the major types of cerebral small vessel disease, and a leading cause of spontaneous intracerebral hemorrhage and cognitive decline in elderly patients. Although increasingly detected, a number of aspects including the pathophysiology, the clinical and neuroradiological phenotype, and the disease course are still under investigation. The incomplete knowledge of the disease limits the implementation of evidence-based guidelines on patient's clinical management and the development of treatments able to prevent or reduce disease progression. The SENECA (SEarchiNg biomarkErs of Cerebral Angiopathy) project is the first Italian multicenter cohort study aimed at better defining the disease natural history and identifying clinical and neuroradiological markers of disease progression. By a multidisciplinary approach and the collection of a large and well-phenotyped series and biorepository of CAA patients, the study is ultimately expected to improve the diagnosis and the knowledge of CAA pathophysiological mechanisms.

Objective: To describe the use of a bipolar sealing device (BSD) for partial cystectomy in dogs undergoing excision of bladder tumors., Study Design: Multicenter, prospective, clinical pilot study., Sample Population: Seven client-owned dogs with nontrigonal urinary bladder lesions., Methods: Dogs underwent a sealed partial cystectomy with a BSD, with or without cystoscopic guidance of the resection. The sealed cystectomy site was oversewn with a single-layer simple continuous pattern with monofilament absorbable suture., Results: Sealed partial cystectomy was successfully performed in all dogs, with a median surgical duration of 69 minutes (range, 50-120). Lesions were located at the apex in six dogs and on the ventral midbody of the bladder in one dog. No urine leakage from the BSD luminal seal was visible prior to suture closure in three dogs, while varying amounts of urine leaked from the sealed site in four dogs. Suture was placed over the seal in grossly normal bladder tissue in six dogs and in the BSD peripheral thermal effect zone in one dog; in this latter dog, revision cystorrhaphy was required 3 days later because of uroabdomen. The other six dogs had no clinical evidence of urinary bladder healing complications., Conclusion: The integrity of the seal generated by the BSD tested here on partial cystectomies varied between dogs and was unpredictable., Clinical Significance: Sealed partial cystectomy with a BSD may reduce exposure of urinary bladder luminal contents to the surgical site. However, the placement of sutures over the seal and through grossly normal bladder tissue is recommended to prevent postoperative uroabdomen., (© 2020 The American College of Veterinary Surgeons.)

Objective: To compare mechanical properties (stiffness, yield load, failure load, and deformation at failure) of 2 pearl-type locking plate system (PLS) constructs (PLS 1 and PLS 2) in a simulated fracture gap model and to compare screw push-out forces of the 2 PLSs with and without plate contouring., Sample: 40 PLS constructs., Procedures: Mechanical properties of uncontoured PLS 1 (n = 8) and PLS 2 (8) constructs were evaluated in synthetic bone-plate models under axial compression. Screw push-out forces were evaluated in 6 uncontoured and 6 contoured PLSs of each type. Variables of interest were compared between PLS groups and between contoured and uncontoured plates by statistical methods., Results: Yield and failure loads were higher in the PLS 1 group than in the PLS 2 group, but stiffness did not differ significantly between groups. All constructs failed by plate bending, with greater deformation in the PLS 2 group. Push-out force to screw-plate uncoupling was higher in the PLS 2 group than in the PLS 1 group for uncontoured and contoured plates. Locking mechanism failure of PLS 1 specimens was through screw-thread stripping. The PLS 2 specimens failed by node deformation followed by screwhead stripping., Conclusions and Clinical Relevance: Distinct mechanical differences were identified between the 2 PLSs. The clinical relevance of these differences is unknown. Further research including cyclic fatigue testing is needed to reveal more clinically pertinent information.

Background: The purpose of the study is to evaluate the utility of acoustic radiation force impulse (ARFI) on pancreatic tissue as a preoperative predictor of postoperative pancreatic fistula (POPF). Studied patients underwent exclusively to pancreaticoduodenectomy (PD) surgery., Methods: Shear wave velocity of pancreas was measured using ARFI in 71 patients scheduled for PD. An intraoperative pancreas palpation was made by surgeons. A postoperative clinical evaluation to detect occurrence of POPF was performed. Sensitivity, specificity, positive and negative predictive values together with the accuracy of the method were investigated., Results: Incidence of fistula observed in 17 patients with soft pancreas was approximately 53% vs. 47% without fistula. Percentage of patients without fistula was higher (66%) among 24 patients with medium parenchymal texture values, and was even higher (69%) in 26 patients with hard pancreas. Comparing ARFI and intraoperative pancreatic palpation, low wave velocity values (≤1.40 m/s) match 60% with soft parenchyma assessed by palpation and high values (>2 m/s) match 59% with hard pancreas on palpation., Conclusions: This study shows that ARFI elastography may be clinically useful as a preoperative predictor of pancreatic fistula following PD., (© 2017 S. Karger AG, Basel.)

OBJECTIVE To compare stiffness and resistance to cyclic fatigue of two 3.5-mm locking system plate-rod constructs applied to an experimentally created fracture gap in femurs of canine cadavers. SAMPLE 20 femurs from cadavers of 10 mixed-breed adult dogs. PROCEDURES 1 femur from each cadaver was stabilized with a conical coupling plating system-rod construct, and the contralateral femur was stabilized with a locking compression plate (LCP)-rod construct. An intramedullary Steinmann pin was inserted in each femur. A 40-mm gap then was created; the gap was centered beneath the central portion of each plate. Cyclic axial loading with increasing loads was performed. Specimens that did not fail during cyclic loading were subjected to an acute load to failure. RESULTS During cyclic loading, significantly more LCP constructs failed (6/10), compared with the number of conical coupling plating system constructs that failed (1/10). Mode of failure of the constructs included fracture of the medial or caudal aspect of the cortex of the proximal segment with bending of the plate and pin, bending of the plate and pin without fracture, and screw pullout. Mean stiffness, yield load, and load to failure were not significantly different between the 2 methods of stabilization. CONCLUSIONS AND CLINICAL RELEVANCE Both constructs had similar biomechanical properties, but the conical coupling plating system was less likely to fail than was the LCP system when subjected to cyclic loading. These results should be interpreted with caution because testing was limited to a single loading mode.

Although the pathogenesis of diabetic retinopathy (DR) is still insufficiently understood, new evidences indicate 'retinal inflammation' as an important player in the pathogenesis of the complication. Accordingly, common sets of upregulated inflammatory cytokines are found in serum, vitreous and aqueous samples obtained from subjects with DR, and these cytokines can have multiple interactions to impact the pathogenesis of the disease. Thus, based on previously published data, we investigated the effects of Palmitoylethanolamide (PEA), an endogenous lipid amide that belongs to the N-acyl-ethanolamines family, on DR in streptozotocin (STZ)-induced diabetic rats. PEA (10mg/kg) was administered orally daily starting 3 days after the iv administration of STZ. The rats were killed 15 and 60day later and eyes were enucleated to evaluate, through immunohistochemical analysis, the key inflammatory events involved in the breakdown of blood retinal barrier (BRB). Immunohistochemical analysis confirmed the presence of VEGF, ICAM-1, nitrotyrosine (a marker of peroxynitrite), and tight junctions in the retina of STZ-treated rats. Of interest, the extent of injury was significantly reduced after treatment with PEA. Altogether, this study provides the first evidence that PEA attenuates the degree of inflammation while preserving the blood-retinal barrier in rats with experimental DR., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The canine knee is morphologically similar to the human knee and thus dogs have been used in experimental models to study human knee pathology. To date, there is limited data of normal canine 3D knee kinematics during daily activities. The objective of this study was to characterize 3D in-vivo femorotibial kinematics in normal dogs during commonly performed daily activities. Using single-plane fluoroscopy, six normal dogs were imaged performing walk, trot, sit, and stair ascent activities. CT-generated bone models were used for kinematic measurement using a 3D-to-2D model registration technique. Increasing knee flexion angle was typically associated with increasing tibial internal rotation, abduction and anterior translation during all four activities. The precise relationship between flexion angle and these movements varied both within and between activities. Significant differences in axial rotation and coronal angulation were found at the same flexion angle during different phases of the walk and trot. This was also found with anterior tibial translation during the trot only. Normal canine knees accommodate motion in all planes; precise kinematics within this envelope of motion are activity dependent. This data establishes the characteristics of normal 3D femorotibial joint kinematics in dogs that can be used as a comparison for future studies., (© 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

Purpose: To verify the effect of vasostatin-1 (VS-1), an anti-angiogenic fragment of chromogranin A, in the prevention of choroidal neovascularization (CNV) in an established mouse model of laser-induced ocular neovascularization., Methods: Bruch's membrane, the innermost layer of the choroid, was broken by laser photocoagulation in C57/Bl6 mice, to induce CNV. Mice were then treated daily for 14 days by intraperitoneal injection of VS-1 or vehicle (6 mice/group). CNV and vascular leakage were measured at three time-points (day 0, 7 and 14) in vivo by spectral domain optical coherence tomography (OCT) and fluorescein angiography (FA). Ex vivo analysis of CNV was also performed at day 14 by confocal microscopy analysis of dextran-perfused choroidal flat-mounts., Results: In vivo analyses showed that VS-1 significantly reduced CNV at day 14 (p = 0.03) and vascular leakage at day 7 (p = 0.01) and 14 (p = 0.04). Ex vivo confocal microscopy analysis of CNV performed on dextran-perfused choroidal flat-mounts at day 14 confirmed the protective activity of VS-1 (p = 0.01). A significant correlation between the results of in vivo and ex vivo analyses of CNV was also observed (p = 0.001, R(2) = 0.81)., Conclusion: The results indicate that VS-1 can prevent CNV and vascular leakage in a mouse model of ocular neovascularization, suggesting that this polypeptide might have therapeutic activity in human ocular diseases that are complicated by neovascularization or excessive vascular permeability., (© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Objective: To evaluate magnitude and mode of acute load to failure of the Zurich Cementless acetabular cup prosthesis in cadaveric specimens with and without 50% dorsal acetabular rim loss., Study Design: In vitro mechanical study., Sample Population: Cadaveric hemipelves of adult dogs (n = 8)., Methods: Each pair of hemipelves was prepared by dissection of surrounding musculature and implantation of a Zurich Cementless acetabular cup prosthesis. One hemipelvis had the dorsal rim left intact (group 1) and the contralateral hemipelvis had 50% of the dorsal rim excised (group 2). Each hemipelvis underwent acute load to failure with an axial load applied through a prosthetic femoral head. Load at failure was compared between hemipelves with and without dorsal rim loss with a paired t-test; P < .05 was considered significant., Results: Mean failure load was not significantly different between group 1 (3,713 ± 362 N) and group 2 (3,640 ± 751 N; P = .8). Bone fracture (n = 6), ventroversion of the cup (1), and absolute failure unreached at 6,000 N (1) occurred in group 1 and bone fracture (6), ventroversion of cup (1), and cup loosening (1) occurred in group 2., Conclusions: Zurich Cementless acetabular cup stability does not appear to be compromised by 50% acetabular rim loss at normal physiologic weight bearing loads. Thus, for this system, modifying procedures such as augmentation of the dorsal acetabular rim or deeper reaming for acetabular bed preparation may not be necessary with up to 50% dorsal rim loss with the Zurich Cementless acetabular cup., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Objective: To compare accuracy of a noninvasive single-plane fluoroscopic technique with radiostereometric analysis (RSA) for determining 3-D femorotibial poses in a canine cadaver with normal stifle joints., Sample: Right pelvic limb from a 25-kg adult mixed-breed dog., Procedures: A CT scan of the limb was obtained before and after metal beads were implanted into the right femur and tibia. Orthogonal fluoroscopic images of the right stifle joint were acquired to simulate a biplanar fluoroscopic acquisition setup. Images were obtained at 5 flexion angles from 110° to 150° to simulate a gait cycle; 5 cycles were completed. Joint poses were calculated from the biplanar images by use of RSA with CT-derived beaded bone models and compared with measurements obtained by use of CT-derived nonbeaded bone models matched to single-plane, lateral-view fluoroscopic images. Single-plane measurements were performed by 2 observers and repeated 3 times by the primary observer., Results: Mean absolute differences between the single-plane fluoroscopic analysis and RSA measurements were 0.60, 1.28, and 0.64 mm for craniocaudal, proximodistal, and mediolateral translations, respectively, and 0.63°, 1.49°, and 1.58° for flexion-extension, abduction-adduction, and internal-external rotations, respectively. Intra- and interobserver repeatability was strong with maximum mean translational and rotational SDs of 0.52 mm and 1.36°, respectively., Conclusions and Clinical Relevance: Results suggested that single-plane fluoroscopic analysis performed by use of CT-derived bone models is a valid, noninvasive technique for accurately measuring 3-D femorotibial poses in dogs.

Objective: To validate use of stress MRI for evaluation of stifle joints of dogs with an intact or deficient cranial cruciate ligament (CrCL)., Sample: 10 cadaveric stifle joints from 10 dogs., Procedures: A custom-made limb-holding device and a pulley system linked to a paw plate were used to apply axial compression across the stifle joint and induce cranial tibial translation with the joint in various degrees of flexion. By use of sagittal proton density-weighted MRI, CrCL-intact and deficient stifle joints were evaluated under conditions of loading stress simulating the tibial compression test or the cranial drawer test. Medial and lateral femorotibial subluxation following CrCL transection measured under a simulated tibial compression test and a cranial drawer test were compared., Results: By use of tibial compression test MRI, the mean ± SD cranial tibial translations in the medial and lateral compartments were 9.6 ± 3.7 mm and 10 ± 4.1 mm, respectively. By use of cranial drawer test MRI, the mean ± SD cranial tibial translations in the medial and lateral compartments were 8.3 ± 3.3 mm and 9.5 ± 3.5 mm, respectively. No significant difference in femorotibial subluxation was found between stress MRI techniques. Femorotibial subluxation elicited by use of the cranial drawer test was greater in the lateral than in the medial compartment., Conclusions and Clinical Relevance: Both stress techniques induced stifle joint subluxation following CrCL transection that was measurable by use of MRI, suggesting that both methods may be further evaluated for clinical use.

Objective: To compare biomechanical properties of (1) 4.5 mm cortical screws and Fitz Fenestrated Tubular Transcondylar (F2T2) screws; (2) normal humeri and humeri with an intracondylar osteotomy; and (3) humeri with an intracondylar osteotomy stabilized with either a 4.5 mm cortical screw or a F2T2 screw., Study Design: Cadaveric biomechanical assessment., Sample Population: 4.5 mm cortical screws (n = 10), 5.85 mm F2T2 screws (n = 10), and paired dog humeri (n = 40)., Methods: Cortical and F2T2 screws were loaded to failure in 3-point bending. Ten pairs of humeri with or without an intracondylar osteotomy were axially loaded to failure. Ten additional pairs of humeri with an intracondylar osteotomy were alternately stabilized with a positional cortical or F2T2 screw and axially loaded to failure., Results: Mean stiffness, yield load, and failure load was significantly greater (P < .001) for the F2T2 screws compared with cortical screws as well as for intact humeri compared with humeri with an intracondylar osteotomy (P < .001). There were no significant differences in mean stiffness (P = .59), yield load (P = .31), or failure load (P = .24) between humeri with stabilized intracondylar osteotomy., Conclusion: Isolated F2T2 screws have superior mechanical properties to 4.5 mm cortical screws when loaded in 3-point bending. Intracondylar osteotomy adversely affected humeral mechanical integrity. Osteotomized humeri stabilized by either screw had comparable mechanical properties.

Persistent right aortic arch (PRAA) in cats is an uncommon vascular anomaly with clinical signs referable to oesophageal obstruction. To our knowledge no reports of axial skeletal malformations concomitant to PRAA have been reported in cats. The aim of this study is to depict a new clinical feature in cats affected by PRAA. In the study six cats with a diagnosis of vascular ring anomaly were enrolled. A complete physical examination, a neurological examination and a total body radiograph were performed on each animal. Four of the six cats showed contemporary PRAA and skeletal malformations. Additionally, for the first time, a genetic test was performed on one subject to detect DNA alterations in the homologous DiGeorge region of cat. The percentage of skeletal malformations reported in the normal population was compared with animals with PRAA and showed a higher frequency. Genetic testing failed to demonstrate a correlation between PRAA and DiGeorge genomic deletion. A review of veterinary and human diseases that presented both conditions was assessed. The few animals enrolled do not allow definitive conclusions. Further studies are required to corroborate the correlation between PRAA and axial skeletal malformations in cats.

Endothelial progenitor cells (EPCs) enter the systemic circulation in response to cues related to vascular damage and need for neovascularization. Thus, EPCs could become readily accessible informers of vascular status and enable the survey of vascular pathologies during preclinical stages. To identify EPC changes with biomarker potential, we investigated whether discrete EPC abnormalities were associated with early nonproliferative diabetic retinopathy (NPDR). Two EPC subtypes with different functions have been characterized to date-one solely committed to the endothelial lineage and the other carrying both endothelial and monocytic markers. We found that only the latter, colony-forming units (CFU)-Hill cells, manifested abnormalities in type 1 diabetic patients with NPDR compared with control subjects. The abnormalities consisted in an increased number of colonies formed in vitro and downregulation of the molecules that facilitate homing at sites of vascular injury. The abnormalities were absent in type 1 diabetic patients free of retinopathy and other complications, despite long diabetes duration, but were detected in some of the patients without clinical retinopathy after short diabetes duration. CFU-Hill cells are potential informers of diabetic microangiopathy but may be preempted from carrying out reparative functions if the molecular abnormalities compromise interactions with the damaged vascular wall.

Although cellular and molecular bases of proliferative diabetic retinopathy are only partially understood, it is evident that this complication of diabetes is characterized by the formation of new vessels inside the retina showing abnormal architecture and permeability. This process, if not controlled by selective laser photocoagulation, leads to irreversible retinal damages and loss of vision. Angiogenesis, that is, the condition characterized by the growth of new blood vessels originated from preexisting ones, was shown to have a major role in the pathogenesis of proliferative retinopathy and, as a consequence, intravitreal antiangiogenic injection was suggested as a feasible treatment for this disease. Here, we describe the different antiangiogenic approaches used to treat this disease along with the respective advantages and limitations when compared to laser treatment. Altogether, even though further and longer studies are still needed to clarify the best possible therapeutic protocol, the antiangiogenic treatment will reasonably have a future role in the therapy and prevention of proliferative diabetic retinopathy.

Purpose: To identify by noninvasive means early retinal abnormalities that may predict diabetic macular edema., Methods: The authors analyzed retrospectively data from consecutive patients with Type 1 (n = 16) or Type 2 (n = 23) diabetes who presented for routine follow-up of early retinopathy, had no clinical signs or symptoms of diabetic macular edema, and were evaluated with spectral-domain optical coherence tomography. Age- and gender-matched nondiabetic subjects provided normative data., Results: Spectral-domain optical coherence tomography revealed in the macular region of diabetic patients small hyporeflective areas (median diameter, 55 μm) contained within discrete retinal layers that we named micropseudocysts (MPCs). Micropseudocysts are associated with vascular leakage. The patients showing MPCs had more frequently systemic hypertension and increased central foveal thickness than those without MPCs. The association with increased central foveal thickness was only in the patients with Type 2 diabetes., Conclusion: Macular MPCs in patients with mild diabetic retinopathy appear to reflect leakage and can precede macular thickening. The association of MPCs with increased central foveal thickness in patients with Type 2 diabetes, but not in patients with Type 1 diabetes, points to a greater tendency to retinal fluid accumulation in patients with Type 2 diabetes. Studies in larger cohorts will determine the usefulness of MPCs in strategies to abort diabetic macular edema.

During the last few years, the incidence of microvascular complications in diabetes mellitus has rapidly increased as a consequence of both an increase in incidence of type 2 and type 1 diabetes mellitus. The pathogenesis of diabetic microvascular complications is still largely unknown. Among the many hypotheses, a dysfunction in angiogenesis has been suggested as a common origin for retinopathy, nephropathy, and neuropathy. Based on this hypothesis, inhibition of vascular endothelial growth factor (VEGF) has been tested as a potential therapeutic approach to prevent and cure diabetic microvascular complications. Several VEGF inhibitors are currently under evaluation or are approved for the treatment of wet age-related macular degeneration and macular edema. These include inhibitors of intracellular transcription of VEGF (e.g. bevasiranib), inhibitors of extracellular VEGF (e.g. pegaptanib), inhibitors of VEGF receptor expression (e.g. aflibercept [VEGF-TRAP]) and inhibitors of the intracellular signaling cascade activating VEGF (e.g. midostaurin). According to the existing evidence base, although inhibition of VEGF results in a better outcome in the case of diabetic retinopathy and also, despite some discrepant results, in the case of diabetic nephropathy, there is no final confirmation that VEGF inhibition is a valid approach for diabetic neuropathy. The latter complication actually, in line with other chronic neuropathies, seems to improve with stimulation of angiogenesis through increased expression of VEGF.

Purpose: To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD)., Methods: Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA)., Results: RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70. 7%]). All eyes had either no or only a low-reflecting OCTsignal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization., Conclusions: OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.

Purpose: The purpose of this article is to analyze cross-sectional images of a subretinal macular lesion, using optical coherence tomography (OCT) in eyes with adult-onset foveomacular vitelliform dystrophy (AOFVD), to compare thickness of the neurosensory retina over the lesion with best-corrected visual acuity (BCVA) of each eye, and to compare OCT tomograms of AOFVD patients with OCT of Best disease., Design: Observational case series., Methods: This is a retrospective study which took place in a clinical practice. Forty-three patients (72 eyes) with AOFVD and 12 patients (24 eyes) with Best's disease were studied. The observation procedures used were biomicroscopic fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). The main outcome measures were a description of the typical picture of AOFVD in OCT tomograms, the relationship between the neurosensory retinal thickness over the lesion, the BCVA expressed in decimal terms, and a comparison with description of OCT in Best disease., Results: Of the 43 patients affected by AOFVD, 29 had bilateral macular lesions. Fluorescein angiography showed a central hypofluorescent spot surrounded by an irregular hyperfluorescent ring in 65 of the 72 eyes. Indocyanine green angiography demonstrated a central nonfluorescent spot and a hyperfluorescent area surrounding the central spot in 22 of 27 eyes examined. In all 72 eyes of 43 patients, OCT showed a well-defined central region of thickening in the reflective band representing the retinal pigment epithelium (RPE). The relationship between the thickness of neurosensory retina over the lesion and BCVA was significant (P =.001, r(2) = 0.61). Optical coherence tomography in all 24 eyes with Best disease showed a well-defined central serous retinal detachment., Conclusion: In the 72 eyes with AOFVD, FA and ICGA presented different features. Instead, OCT tomograms showed a well-defined subretinal thickening of the RPE in all the eyes. The lack of difference in OCT patterns between cases with or without the hypofluorescent spot on angiography was useful for confirming the diagnosis of AOFVD. Moreover, a reduced visual acuity was evident in patients with a thinner neurosensory retinal layer over AOFVD lesion. Finally, OCT images were also useful for distinguishing AOFVD from Best disease.

Residual vitreous base after vitreoretinal surgery was evaluated by ultrasound biomicroscopy (UBM). Twenty aphakic and pseudoaphakic patients (20 eyes) undergoing surgery for different vitreoretinal diseases were evaluated by high-frequency (50 MHz), high-resolution (50 microm) UBM, performed the day before surgery, weekly up to 1 month after surgery and then monthly. One week after surgery, the vitreous remnants were 'hardly visible' in 3 cases, 'visible' in 6 cases and 'highly visible' in 11. At the end of the follow-up (2.2 months), the 'hardly visible' cases increased to 6 and the 'visible' cases to 12, while the 'highly visible' cases decreased to 2. UBM demonstrated that vitreous base remnants were present in spite of accurate surgery; a spontaneous volume reduction of vitreous was observed during the follow-up., (Copyright 2002 S. Karger AG, Basel)