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Purpose To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs). Methods This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patientsʼ satisfaction, and spectacle independence. Results All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification. Conclusion MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence.

Purpose: To evaluate the safety and efficacy of dexamethasone intravitreal implant (Ozurdex, DEX implant) 0.7 and 0.35 mg in the treatment of patients with diabetic macular edema (DME).Design: Two randomized, multicenter, masked, sham-controlled, phase III clinical trials with identical protocols were conducted. Data were pooled for analysis.Participants: Patients (n = 1048) with DME, best-corrected visual acuity (BCVA) of 20/50 to 20/200 Snellen equivalent, and central retinal thickness (CRT) of ≥300 μm by optical coherence tomography.Methods: Patients were randomized in a 1:1:1 ratio to study treatment with DEX implant 0.7 mg, DEX implant 0.35 mg, or sham procedure and followed for 3 years (or 39 months for patients treated at month 36) at ≤40 scheduled visits. Patients who met retreatment eligibility criteria could be retreated no more often than every 6 months.Main Outcome Measures: The predefined primary efficacy endpoint for the United States Food and Drug Administration was achievement of ≥15-letter improvement in BCVA from baseline at study end. Safety measures included adverse events and intraocular pressure (IOP).Results: Mean number of treatments received over 3 years was 4.1, 4.4, and 3.3 with DEX implant 0.7 mg, DEX implant 0.35 mg, and sham, respectively. The percentage of patients with ≥15-letter improvement in BCVA from baseline at study end was greater with DEX implant 0.7 mg (22.2%) and DEX implant 0.35 mg (18.4%) than sham (12.0%; P ≤ 0.018). Mean average reduction in CRT from baseline was greater with DEX implant 0.7 mg (−111.6 μm) and DEX implant 0.35 mg (−107.9 μm) than sham (−41.9 μm; P < 0.001). Rates of cataract-related adverse events in phakic eyes were 67.9%, 64.1%, and 20.4% in the DEX implant 0.7 mg, DEX implant 0.35 mg, and sham groups, respectively. Increases in IOP were usually controlled with medication or no therapy; only 2 patients (0.6%) in the DEX implant 0.7 mg group and 1 (0.3%) in the DEX implant 0.35 mg group required trabeculectomy.Conclusions: The DEX implant 0.7 mg and 0.35 mg met the primary efficacy endpoint for improvement in BCVA. The safety profile was acceptable and consistent with previous reports.

Purpose. To report a case of unilateral optic neuritis following Measles-Mumps-Rubella (MMR) vaccination.Methods. A 30-year-old female developed unilateral optic neuritis five days after a Measles-Mumps-Rubella (MMR) booster vaccination. The patient displayed unilateral involvement, with severe visual loss. However, visual acuity improved significantly after four days of intravenous steroid therapy with 500 mg/day of methylprednisolone.Conclusions. Optic neuritis is one of the rare complications associated with the mumps, measles, and rubella vaccine. It may be a toxic reaction to the nonviral component of the vaccine, but the exact etiology is unknown. Postvaccination neuritis is generally bilateral and usually affects children. In adults, unilateral optic neuritis is usually correlated with multiple sclerosis (MS).

To validate the Catquest-9SF questionnaire in Italian, assess the change in visual disability with cataract surgery and determine the correlation between pre-operative Catquest-9SF scores and Lens Opacities Classification System (LOCS) III cataract grading. Prospective, questionnaire validation study. The Catquest-9SF questionnaire was forward and back translated and completed by 209 Italian patients before and three months following cataract surgery. Rasch analysis was used to assess its psychometric properties. The Italian Catquest-9SF demonstrated ordered response categories, unidimensionality (item fit statistics range: 0.73–1.34), adequate person separation (2.04), and no differential item functioning. Mistargeting was evident with a mean difference in item difficulty and person ability of 2.04 logits but improved with inclusion of pre-operative data only. There was a statistically significant (Friedman tests, p

To investigate optical coherence tomography (OCT) measurements following implantation of the LENTIS Mplus multifocal IOL, compared with a control group. OCT scans were performed on 50 eyes with the Topcon 3D OCT-1000 in two groups of patients. The first group consisted of patients following implantation of the LENTIS Mplus, and a second group of age-matched control eyes following implantation of a monofocal aspheric IOL. Macular thickness and macular volume values were compared between groups and assessment for any onscreen visible artifacts. OCT scans were successfully performed in all 50 eyes with no visible artifacts in either group during scan acquisitions. There were no statistically significant differences (p > 0.05) in any measured or calculated macular thickness or volume values between the two groups. OCT measurements with the Topcon 3D OCT-1000 is possible and free from visible artifacts in eyes which have had the LENTIS Mplus multifocal IOL implanted. Macular thickness and volume values were similar to those of an age-matched control group of monofocal aspheric IOLs.

Purpose: The aim of this study is to evaluate whether optical coherence tomography (StratusOCT) may detect early changes in perimetrically unaffected (PU) fellow eyes of glaucomatous patients by assessing retinal nerve fibre layer (RNFL) thickness parameters. Methods: Thirty-seven glaucomatous patients with unilateral field loss and 34 age-matched controls were recruited. In glaucoma patients, PU and perimetrically affected fellow eyes were analysed separately. For each group, mean values (±SD) of RNFL thickness parameters were calculated and comparisons between fellow eyes of glaucoma patients and between healthy and PU eyes of glaucoma patients conducted with paired t-test and Mann–Whitney U-test, respectively. Proportion of clock-hour sectors flagged with probability

Glaucoma is a leading cause of irreversible blindness worldwide. Retinal ganglion cells and their axons represent the selective target of the disease. When visual function is still intact on standard automated perimetry and optic disc appearance is suspicious, an early diagnosis may be supported by the identification of a retinal nerve fibre layer (RNFL) defect in the peripapillary area. At present days, computer-based, real-time imaging of the peripapillary RNFL is available through instruments of easy use and with high levels of accuracy and reproducibility. Scanning laser polarimetry is performed by a confocal scanning laser ophthalmoscope with an integrated polarimeter (GDx-VCC). There is a considerable amount of scientific evidence about the role of this imaging technique for glaucoma diagnosis. The aim of this review is to describe the principles of operation, the examination procedure, the clinical role, the results of main diagnostic studies and the future development of the software for the scanning laser polarimetry.

BACKGROUND: To compare the effectiveness of subthreshold grid laser treatment (SGLT) with infrared micropulse diode laser alone or in combination with intravitreal triamcinolone injection (SGLT-IVTJ) for the treatment of macular oedema (MO) secondary to branch retinal vein occlusion (BRVO).METHODS: Pilot randomised clinical trial including 24 patients (24 eyes) who were randomised either to the SGLT (13 eyes) or to SGLT-IVTJ (11 eyes). Complete ophthalmic examinations, including Early Treatment of Diabetic Retinopathy Study visual acuity, OCT and fluorescein angiography, were performed at the moment of the study entry and at 3-month intervals, with a planned follow-up of 12 months. Main outcome measures were the decrease in mean foveal thickness (MFT) on OCT, and the proportion of eyes that gained at least 10 letters (approximately two or more lines of visual acuity gain) at the 12-month examination. Secondary outcomes were the decrease in mean total macular volume on OCT, and the timing of MO resolution.RESULTS: The change in MFT from the initial values was statistically significant for the SGLT-IVTJ from the 3-month examination and for the SGLP from the 6-month examination (p

Purpose: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for anterior segment neovascularizations (ASNVs) in patients affected by ischaemic form of central retinal vein occlusion (CRVO). Methods: Prospective non-comparative case series including 10 consecutive patients (10 eyes) affected by ischaemic CRVO. Main outcome measure was the obliteration of ASNV. Results: One month after PDT, biomicroscopic examination showed partial obliteration of iris new vessels and complete closure of angle neovascularization. Iris fluorescein angiography performed 1 week after treatment showed partial closure of the iris new vessels with no evidence of leakage in the late phases. During the subsequent examinations, a partial reopening of the iris and angle new vessels in association with dye leakage on fluorescein angiography was evident. In any case, the fluorescein leakage turned out to be still reduced with respect to the baseline aspects. Conclusions: Our results show that PDT with verteporfin can partially obliterate ASNVs in eyes affected by ischaemic CRVO preventing from the evolution towards advanced stages of neovascular glaucoma, but is not effective in cases with complete angle synechial closure.

PURPOSE To evaluate the effectiveness of macular grid laser photocoagulation (MGLP) in obtaining the reabsorption of exudative retinal detachment (ERD) in patients with ischemic branch retinal vein occlusion (BRVO). METHODS Prospective, randomized clinical trial including 31 patients with ERD secondary to ischemic BRVO, who were randomized either to MGLP or to observation. A complete ophthalmologic examination was performed within 7 days of treatment, and was arranged to be repeated regularly every 6 months for 24 months. MGLP was performed using a krypton laser with a spot size of 100 microm at 0.1 second. The main outcome measure was the number of eyes that had gained at least 15 letters at the 24-month examination in the two groups. RESULTS By the month 24 visit, 40% of the patients in the MGLP group had gained at least three lines of visual acuity as opposed to no patient in the control group. The mean best-corrected visual acuity passed from 20/160 to 20/125 Snellen equivalent in the MGLP group, and from 20/160 to 20/400 Snellen equivalent in the control group at month 24. The difference in the mean reabsorption time was statistically significant (P < 0.001) comparing the treated group with the controls (9.1 versus 15.8 months). CONCLUSION Natural history of ERD secondary to ischemic BRVO is poor, and MGLP is able to prevent visual acuity deterioration through a 24-month follow-up.

The idiopathic macular hole is a commonly observed retinal pathology. It had been generally considered an untreatable condition until 1991, when the first surgical successes were reported. Currently, the success rate of the surgical approach is very high. Surgical treatment includes pars plana vitrectomy, peeling of the internal limiting membrane, gas tamponade and face-down position. This approach is based on a better knowledge of the pathogenetic mechanisms underlying idiopathic macular hole formation. The aim of this review is briefly to describe the pathogenesis of the idiopathic macular hole, its natural history, the diagnostic approach and the current surgical treatment.

PURPOSE: To analyse the spectrum of angiographic features in patients monolaterally or bilaterally affected by pseudoexfoliation syndrome (PES), with and without glaucoma, and to evaluate the sensibility and specificity of these features in the diagnosis of glaucoma.METHODS: Sixty-eight patients affected by PES and 20 healthy subjects underwent iris fluorescein angiography (IFA) and iris indocyanine green angiography (IICGA). Angiographic features analysed were hypoperfusion, microneovascularizations, and anastomotic vessels.RESULTS: There was no statistically significant difference among unaffected, unilaterally affected, and bilaterally affected eyes. Patients affected by PES glaucoma showed a statistically significant difference with respect to the other groups for most of the variables. The results of qualitative variables revealed a gradual increase of the vascular involvement in the different groups. Peripupillary tufts, stromal tufts, and radial arterioles showed the best sensibility and specificity values on IFA, whereas radial arterioles and plexuses showed the highest sensibility and specificity values on IICGA. Considering all the parameters, the results were not associated with large effects on the post-test probability of disease. The values of likelihood ratio indicated that none of the examined variables was sufficiently able to discriminate patients affected by PSE glaucoma from the overall group.CONCLUSIONS: Patients clinically affected only monolaterally by PES show microvascular changes, which are similar in both eyes. Glaucoma PES represents a more advanced stage of the disease, with more pronounced alterations, even though no typical microvascular pattern can be identified by iris angiography.

Purpose To evaluate the effect of internal limiting membrane (ILM) peeling and other variables in hole closure and functional success rate after idiopathic macular hole surgery. Design Retrospective, multicenter, observational study. Methods The records of 1627 patients operated on for idiopathic macular hole were collected retrospectively from 28 surgeons. All patients underwent a single pars plana vitrectomy and were divided into 2 groups: with and without ILM peeling. Preoperative, intraoperative, and postoperative variables were evaluated. Results The overall rate of macular hole closure was 94.1% in the ILM peeling group and 89.0% in the no ILM peeling group ( P P P P Conclusions Internal limiting membrane peeling seems to improve hole closure for stage 3 and 4 holes and for long-lasting holes. Higher-stage macular holes and longer duration of symptoms are risk factors for surgical failure. In patients obtaining hole closure, there is no difference in functional results between pseudophakic peeled and not peeled patients, whereas in phakic patients, a better functional result in not peeled patients was seen.

Purpose: To evaluate whether a significant age-related thinning of the retinal nerve fibre layer (RNFL) is measurable by means of scanning laser polarimetry with variable corneal compensation (GDx-VCC) in a sample of healthy eyes. Methods: A sample of 324 eyes of 324 healthy subjects (mean age 56 ± 14 years, range 21–85 years) underwent a complete ophthalmic evaluation, standard automated perimetry and RNFL scan with the GDx-VCC. Temporal-superior-nasal-inferior-temporal (TSNIT), superior and inferior average (SA and IA) values provided on the printout were collected and their mean value averaged from all eyes and also after separating the eyes by gender and by age decades. The values of the three parameters were plotted against age and linear regression was calculated. Results: Ageing is associated with a significant RNFL thinning (0.08 µ, 0.16 µ and 0.12 µ per year for TSNIT, SA and IA, respectively; p

Purpose To evaluate the incidence of intraocular lens (IOL) decentration and posterior capsule opacification (PCO) after implantation of a three-piece posterior chamber silicone IOL in a series of eyes examined postmortem. Methods Twenty-three pseudophakic enucleated human cadaver eyes, implanted with AMO SI40NB IOLs after phacoemulsification, were analyzed. Eyes obtained postmortem were sectioned at the equatorial plane and the anterior segment photographed from a posterior view. Location of IOL optic and haptics, type of fixation, and centration of IOL was evaluated. PCO was graded and the presence of Nd:YAG laser posterior capsulotomy was noted. Results Mean age at the time of surgery was 77.83 years, mean time since implantation was 18.26 months. In all the eyes examined, IOL haptics were positioned in the capsular bag. Mean decentration was 0.20±0.16 mm. No correlation was found between IOL decentration and time since implantation. The degree of peripheral PCO ranged from none (13.0%) to mild (39.1%) to moderate (26.1%) to severe (21.7%). The degree of central PCO ranged from none (52.2%) to mild (30.4%) to moderate (4.3%). Three patients (13.0%) underwent Nd:YAG laser posterior capsulotomy. Conclusions A very good centration can be obtained when silicone AMOSI40NB IOLs are correctly implanted with the haptics inside the capsular bag. About half of the implants showed no central PCO while Nd:YAG laser posterior capsulotomy rates documented a relatively low PCO 18 months after surgery. A careful in the bag haptics placement is needed in order to reduce the IOL decentration and to prevent central PCO.

To evaluate the ability of scanning laser polarimetry with variable corneal compensation (GDx-VCC) in separating healthy from glaucomatous patients with early visual field (VF) loss.Sixty-two healthy and 48 glaucomatous age-matched patients with early glaucoma [mean deviation (MD): -1.74dB +/-1.69] underwent complete ophthalmological evaluation, automated achromatic perimetry (AAP) and retinal nerve fiber layer (RNFL) measurement with GDx-VCC. One randomly selected eye from each subject was considered. Glaucomatous VF defects had either Glaucoma Hemifield Test (GHT) outside normal limits or pattern standard deviation (PSD) outside 95% confidence limits. Mean (+/-SD) MD, PSD and GDx-VCC parameters in the two groups were compared by t-test. For each GDx-VCC parameter, area under receiver operating characteristics (AUROC) curve and sensitivity at predetermined specificityor =80% andor =95% were calculated. Moreover, the parameter with largest AUROC was evaluated by likelihood ratios (LRs).Mean values for MD, PSD and ten of 14 GDx-VCC parameters were significantly different between the two groups (P0.001). The three parameters with largest AUROCs were the nerve fiber indicator (NFI) (0.870), superior average (0.817) and normalized superior area (0.816) (P=0.08 for differences between AUROCs). NFI displayed sensitivity values of 80.2% and 60.4% for specificityor =80% andor =95%, respectively. At NFI cutoff value of 30, positive LR was 34.9 (95% CI: 4.9-247.6) and negative LR was 0.45 (95% CI: 0.32-0.61). Interval LRs showed large effect on post-test probability for NFI valuesor =18 oror =31.In our sample of eyes with early VF loss, GDx-VCC showed moderate-to-good discriminating ability. Among the best performing parameters, NFI had the largest AUROC, but several glaucomatous eyes (21, 43.8%) had NFI30. This suggests that algorithm for NFI calculation requires some refinement when eyes with early VF loss are evaluated.

Purpose: To assess if a polymorphism (PM) of the microsatellite (CA13–27) in the promoter region of Matrix Metalloproteinase 9 (MMP-9) was associated with the exudative form of age-related macular degeneration (AMD) and to its risk factors. Methods: In 107 patients with AMD (AMD Group) and 223 age- and gender-matched controls (Control Group) with cataract, demographic, clinical data, and MMP-9 PM have been compared. Results: The comparison of allelic frequencies showed a different pattern of CA repeats between AMD and Control Group (P < 0.00005), in particular the prevalence of longer microsatellites (≥ 22 CA repeats) was higher in AMD than in Control Group (O.R. 2.49, 95% CI 1.71 - 3.37, P < 0.001). Analyses of genetic frequencies gave similar results. Logistic regression confirmed that 22 or more CA repeats are associated to AMD. The only association between MMP-9 PM and other risk factors for AMD was with BMI (Spearman’s R = 0.298, P < 0.00005): all patients with both microsatellites ≥ 22 CA repeats were overweight or obese (χ2 test P < 0.0005, compared to other genotypes). Conclusions: Longer microsatellites in the promoter of MMP-9 are associated to the exudative form of AMD and to body mass index, a well-known risk factor for the disease.

Purpose To describe a technique for visualizing fluid turbulence and cavitational energy created by ultrasonic phaco tips. Setting University Eye Clinic of Trieste, Trieste, Italy. Methods Generation of cavitational energy by the phaco tip was visualized using an optical test bench comprising several components. The technique uses a telescope system to expand a laser light source into a coherent, collimated beam of light with a diameter of approximately 50.0 mm. The expanded laser beam shines on the test tube containing the tip activated in a medium of water or ophthalmic viscosurgical device (OVD). Two precision optical collimators complete the optical test bench and form the system used to focus data onto a charge-coupled device television camera connected to a recorder. Results Images of irrigation, irrigation combined with aspiration, irrigation/aspiration, and phacosonication were obtained with the tip immersed in a tube containing water or OVD. Conclusions Optical image processing enabled acoustic cavitation to be visualized during phacosonication. The system is a possible means of evaluating a single phaco apparatus power setting and comparing phaco machines and techniques.

Objective: To evaluate by means of a controlled clinical trial the effectiveness and the tolerance of prismatic correction in improving visual function in patients affected by advanced bilateral age-related macular degeneration. Setting: Department of Ophthalmology, Eye Clinic, University of Trieste. Subjects and interventions: Each patient underwent an ophthalmologic examination, complete with distance visual acuity measurement using the Standard Early Treatment Diabetic Retinopathy Study chart. Patients were then randomly assigned to the treatment or control group. The treatment group received spectacles lenses with a prismatic correction of low power (5–7 prismatic dioptres) in the better eye. Main measures: Visual acuity was measured at baseline and 1, 90, 180 and 360 days after prescription in both groups. Results: The treatment group consisted of 14 patients, while the control group was of 14 patients. The prismatic correction was well tolerated in 85.7% of cases. Visual acuity in the treatment group improved mostly at three-month follow-up, with a slight further improvement at the sixand 12-month follow-ups, showing a statistically significant difference in comparison with the control group. No visual acuity improvement was registered in the control group. Conclusion: Monolateral prismatic correction may be considered a viable means to improve visual function in patients affected by bilateral age-related macular degeneration at an advanced stage.

Purpose: To analyse the epidemiological and clinical characteristics of nasal branch retinal vein occlusion (NBRVO). Methods: Patients affected by branch retinal vein occlusion observed in the out-patient departments of the Eye Clinic of Trieste between January 1995 and January 1999 were enrolled. Results: Out of 144 patients with branch retinal vein occlusion, 128 (88.9%) were affected by temporal branch retinal vein occlusion (TBRVO), and 16 patients were affected by NBRVO (11.1%). The two groups did not differ as far as systemic hypertension, diabetes mellitus, glaucoma and ischaemic heart disease were regarded. NBRVO cases were characterized by better visual acuity and greater figures of capillary non-perfusion, retinal neovascularization and vitreous haemorrhage. Conclusions: NBRVO, even though infrequent, shares the same epidemiological characteristics as TBRVO. The higher prevalence of ischaemic cases in the NBRVO group could depend on a bias during the enrolment of patients, because especially symptomatic patients may have been examined in our out-patient departments. The relatively high percentage of epiretinal membrane formation after laser photocoagulation suggests particular caution, especially in cases presenting with vitreous haemorrhage.

Purpose To determine the influence of intraocular lens (IOL) material on anterior capsular opacification and membrane growth over the anterior IOL surface in patients who have undergone standardized small-incision cataract surgery and foldable IOL implantation in the capsular bag. Design Randomized controlled trial. Participants Eighty-eight cataract patients (88 eyes). Methods Patients were randomly assigned to receive one of four different foldable IOLs after phacoemulsification: Storz Hydroview H60M, Corneal ACR6D, AMO SI40NB, and Alcon AcrySof MA60BM. Examinations on days 7, 30, 90, 180, 360, and 720 after surgery included ophthalmologic examination, slit-lamp biomicroscopy, and photography using red reflex and focal illumination of the anterior IOL surface. Main outcome measures Best-corrected visual acuity was measured at each examination. In addition, the anterior capsule opacification and the membrane growth on the anterior IOL surface were graded according to a subjective method by the same researcher. Results The fibrosis of the anterior capsule was more frequently observed in the group using Corneal ACR6D and AMO SI40NB. The Hydroview and ACR6D groups showed a higher percentage of cases with membrane growth from the rhexis edge on the anterior IOL surface. AcrySof showed the lowest presence of fibrosis of the anterior capsule, and no membrane growth was noted. Conclusions Anterior capsule opacification is an index of IOL biocompatibility. The natural location of lens epithelial cells (LECs) precludes the possibility of the IOL's design influencing the anterior capsule behavior. The local response of LECs varies according to the IOL studied. This may be related to the chemical and physical properties of the materials used in the different IOLs.

Background: Photodynamic therapy with verteporfin (Visudyne; Novartis, Bulach, Switzerland) has been proposed for the treatment of subfoveal choroidal neovascularization secondary to pathologic myopia. We retrospectively evaluated the effects of verteporfin therapy of subfoveal recurrences of extrafoveal myopic CNV previously treated with thermal laser photocoagulation. Methods: Twelve eyes, previously treated with thermal laser photocoagulation for extrafoveal choroidal neovascularization, received photodynamic therapy with verteporfin for subfoveal recurrence of choroidal new vessels. Thirteen eyes that did not receive photodynamic therapy served as control group. Vision and fluorescein angiography outcomes were analyzed on all study visits (every 3 months) through month 12. Visual acuity was measured in Snellen lines. Results: On average, at the month 12 examination the verteporfin-treated group had gained 2 lines and the untreated group had lost 1 line of vision. Eleven eyes of the verteporfin-treated group compared with nine eyes of the untreated group lost fewer than 3 lines of vision, including four eyes versus none improving at least 1 line of vision. Conclusion: Photodynamic therapy with verteporfin might increase the chance of stabilizing or improving vision in patients with subfoveal recurrences of extrafoveal myopic CNV previously treated with thermal laser photocoagulation. A prospective, randomized study on larger series of patients is mandatory.

Malattia Leventinese (ML) is a dominant macular dystrophy characterized by drusen at the posterior pole. ML has been associated with a single mutation (R345W) in the EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP-1) gene, but also the EFEMP-2 gene, known to share genetic homology with EFEMP-1, is considered a candidate gene for this genetic disorder. We have characterized clinically and genetically seven members of a three-generation family affected by ML. Results showed that five family members were clinically affected but the DNA sequencing failed to reveal the typical R345W mutation. Furthermore, the linkage analysis to EFEMP-1 (using polymorphic markers D2S337 and D2S2368) and to EFEMP-2 (using D11S987 and D11S1314 markers) gave negative results. Therefore, our results suggest EFEMP-1 or EFEMP-2 genes cannot be excluded as being responsible for ML but other genes have to be considered in the pathogenesis of the disease.

Purpose: To evaluate the effect of indocyanine greenangiography (ICG)-guided laser photocoagulation in eyes withage-related macular degeneration (AMD) and occult choroidalneovascularization (O-CNV), appearing as a well-defined focalspot on ICG. Methods: Eyes with extrafoveal or juxtafovealfocal spot on ICG, either without PED (Group A) or with PED(Group B) at baseline, were selected. The hyperfluorescentarea was photocoagulated by krypton red laser within 24 hoursfrom diagnosis on ICG guide. At 1, 3, 6, 9 and 12 months fromtreatment, all eyes underwent clinical examination, FA and ICG.Parameters as best corrected visual acuity (BCVA), CNV closureand recurrence onset were analyzed. Results: 53 eyes wereenrolled in Group A and 33 in Group B. After 1 year from treatment,a stabilized (±1 Snellen line) or improved (2 or more Snellenlines) visual acuity was measured in 37 eyes (43%), 32 inGroup A and 5 in Group B. After 1 year, a complete resolution ofexudative signs was achieved with one or more laser sessions in41 eyes (48%), 34 in Group A and 7 in Group B. After 1 year, 50eyes (58%) had one or more episodes of recurrent CNV, appearingin 51% of eyes of Group A and in 70% of eyes of Group B. Mostof the recurrences (86%) occurred during the first trimesterafter photocoagulation. Conclusions: ICG-guided laserphotocoagulation for O-CNV appearing as a focal spot producedencouraging anatomical and functional outcome in eyes withoutPED at presentation. When focal CNV is associated with a PED,our treatment technique produced disappointing results.

A series of pits varying in depth and size appeared on the anterior surface of hydrogel intraocular lenses (IOLs) soon after they were implanted. In all cases, the pits increased in size but not in number during a 1 year follow-up. The origin of the pit defects is unknown and does not seem related to inflammatory or lens epithelial cell activity. Hydration of the IOL could be a cause even if a manufacturing defect were present. This IOL surface alteration did not seem to impair visual function or cause visual disturbances.

Purpose: The iris vasculature shows typical changes in pseudoexfoliation syndrome (PXS) revealed by iris fluorescein angiography (IFA), such as hypoperfusion, microneovascularisation, and anastomotic vessels. Iris indocyanine green angiography (IICGA) can visualize more precisely details of the iris vascular pattern, especially as regards hypoperfusion and capillary dilatations. The aim of the present study is to describe the angiographic features of PXS on IFA and IICGA, comparing eyes affected with those not affected by capsular glaucoma. Methods: In a prospective study 42 consecutive patients affected by PXS underwent a complete ophthalmologic examination including IFA and IICGA. Thirty-two eyes were affected by capsular glaucoma. IICGA was performed using IMAGEnet System H1024. Results: IFA can easily detect the microneovascularisation, whereas IICGA allows a better recognition of iris hypoperfusion and anastomotic vessels, and it can reveal iris pigment epithelium defects. While the degree of hypoperfusion was similar in the two subgroups, eyes affected by capsular glaucoma more frequently showed signs of both microneovascularisation (marked stromal tufts and marked plexi), and of anastomotic vessels (peripheral loop, lesser circle and oblique vessels), with statistically significant difference. A clear correlation between hypoperfusion, microneovascularisation, and anastomotic vessels as regards site and extent was not noticed. Conclusions: A different angiographic pattern can be detected in PXS eyes with capsular glaucoma in comparison with eyes without it. Further studies are needed to correlate angiographic features revealed by IFA and IICGA, with clinical features.

PURPOSE: To report a case showing adult-onset foveomacular vitelliform dystrophy (AOFVD), associated with vascularized pigment epithelial detachment.CASE REPORT: A 72-year-old female affected by AOFVD complained with blurred vision and metamorphopsia in her right eye, seven months after a routinary clinical examination. Visual acuity in right eye dropped from 0.6 to 0.3, and biomicroscopic fundus examination revealed a serous pigment epithelial detachment arising from the temporal margin of the pseudovitelliform lesion. Fluorescein angiography showed an uneven filling of the pigment epithelial detachment, suggesting the presence of a subfoveal choroidal neovascularisation, which was confirmed by indocyanine green angiography.DISCUSSION: The association between AOFVD and vascularized pigment epithelial detachment, supports the hypothesis that AOFVD may be a different subgroup of age-related macular degeneration with specific genetic predisposition.

Aim: Macular branch retinal vein occlusion (MBRVO) is a subgroup of branch retinal vein occlusion in which the occlusion is limited to a small venous vessel draining a sector of the macular region. The present study aims to evaluate the efficacy of grid laser treatment for macular edema in MBRVO. Methods: 77 Patients with MBRVO of recent onset were prospectively studied during a 24 month period. Eyes were randomly assigned to a grid laser treatment group and to a control group. Clinical parameters such as visual acuity, presence of macular edema and angiographic features were recorded during the follow-up period. Results: Visual acuity increased significantly in both groups after 3 months of follow-up (p

Purpose: To analyze and compare the light energy distribution generated by multifocal intraocular lenses (IOLs). Setting: Laser Laboratory of the Department of Electronics, Electrotechnics and Informatics, University of Trieste, Italy. Methods: An optic system to examine the division of a laser beam in the various focal spots of multifocal IOLs was developed. The model consists of a helium-neon laser and an optical system: a triangular optical bench with a precision collimator, a micropositionable immersion stage supporting the IOL to be measured, and a digital image-processing system. Four bifocal and three multifocal IOLs were studied. This system is able to expand the distance between foci, leading to a sharper separation of the focal spots. The resolution of the images makes it possible to analyze the distribution of total light energy among the foci. Results: Results showed the variation in light intensity of the focal spots of multifocal and bifocal IOLs, as well as their disposition in the dioptric range. Conclusion: Light distribution among various focal distances corresponded to the foci provided by monofocal, bifocal, and multifocal IOLs. The percentage of light energy distribution was related to the importance of each focus.

Background: Iris arteriovenous communication (IAVC) represents a quite rare congenital anomaly, consisting of abnormal vascular connection bypassing the iris capillary bed. The aim of the present study is to describe clinical and angiographic pattern of IAVC on iris fluorescein angiography (IFA) and on indocyanine green videoangiography (IICGV). Methods: During a mean follow-up period of 33.5 months, eight patients affected by IAVC underwent at least three ophthalmological examinations completed by IFA and IICGV. Results: IFA allows the detection of IAVC vascular structures, evidencing afferent and efferent branches, which show a rapid filling, without any evidence of leakage or iris hypoperfusion. IICGV shows more precisely the entire vascular pattern of IAVC, revealing also the presence of iris hypoperfusion in the sector in which the IAVC lay. One patient underwent cataract surgery; three months later, two neovascular tufts appeared in the hypoperfused area related to IAVC. In all other patients, periodical examinations did not reveal any clinical or angiographic changes. Conclusion: In IAVC, the clinical picture appears stable throughout the follow-up; both angiographic techniques seem able to precisely delineate the vascular pattern. Nevertheless, IICGV is superior in showing iris hypoperfusion surrounding the vascular abnormality. Particular care must be drawn to patients affected by IAVC who need cataract surgery.

Background: Macroaneurysms can represent common consequences of branch retinal vein occlusion(BRVO). The aim of the present study is to evaluate the clinical and angiographic aspects of 31 cases of branch retinal vein occlusions (BRVO) in which retinal macroaneurysms developed, in an attempt to analyze their pathogenic features. Methods: One hundred and sixty-one consecutive patients affected by BRVO were considered. Each patient underwent an ophthalmological examination including fluorescein angiography, at an average interval of two months (range: 1–4 months) from the onset of the disease, with a mean follow-up of 43months (range: 32–56 months). The macroaneurysms were subdivided according to size into small (from 100 to149 microns), medium (from 150 to 249 microns), and large (greater than 250 microns), and according to origin into arterial, venous, capillary and collateral-associated. Results: Thirty-one patients (19.3%) developed retinal macroaneurysms. The total number of detected macroaneurysms was 51; ten (19.6%) were large, 21(41.2%) were of medium-size and 20 (39.2%) were small in dimension. Three lesions were of arterial origin, 22 were capillary and 26 were from collateral vessels. In27 patients (87.1%) the lesions were located outside the macular region, and in 4 patients (12.9%) in the macular region. Patients with retinal macroaneurysms did not show a different prevalence of capillary non-perfusion when compared with others. With regard to the number of retinal venous collaterals patients with macroaneurysms developed fewer than other patients, and the difference was statistically significant (p < 0.001). Conclusion: The insufficient number of retinal venous collaterals can be considered the most contributory factor in the development of macroaneurysms secondary to BRVO.

Purpose To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery. Methods/Results A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry. Discussion This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.

AIMS/BACKGROUND: Iris fluorescein angiography (IFA) is not commonly used in clinical practice, although its value has been demonstrated especially in cases of diabetic disease. IFA is able to show neovascular tufts in order to guide the laser treatment, and it is highly recommended in diabetic patients who need cataract surgery or vitrectomy. Nevertheless, IFA fails to demonstrate the iris vascular pattern in heavily pigmented iris and conspicuous leakage cases. The aim of the study was to evaluate the feasibility of iris indocyanine green videoangiography (IICGV) and to correlate its findings with those of IFA in diabetic iridopathy. METHODS: Thirty six patients affected in varying degrees by diabetic retinopathy underwent an ophthalmic examination including retinal fluorescein angiography, IFA, and IICGV. IICGV was performed using IMAGEnet System H1024. RESULTS: The results demonstrated that IICGV allows precise visualisation of the iris vascular pattern, also in cases of heavily pigmented iris. CONCLUSIONS: Three main findings seemed to be evident: firstly, iris neovascularisations are detected with IFA far more easily than IICGV; secondly, capillary dilatations and iris hypoperfusion are identified far more clearly using IICGV; thirdly, there is no evident relation between capillary dilatation or iris hypoperfusion, and degree of diabetic retinopathy.

The mean area of the foveal avascular zone (FAZ) in normal subjects was reported as 0.231 mm2 to 0.405 mm2, using fluorescein angiography. The FAZ enlarges in vaso-occlusive diseases, especially diabetic retinopathy, sickle cell retinopathy, talc retinopathy and branch retinal vein occlusion. In the present study the FAZ of 20 patients affected by macular branch retinal vein occlusion (MBRVO) was compared with the FAZ of 41 control subjects. The FAZ mean area was 0.56 +/- 0.34 mm2 SD in the MBRVO group, while 0.26 +/- 0.07 mm2 SD in the control group, with a statistically significant difference (p0.001). The FAZ mean perimeter was 4.77 +/- 1.90 mm SD in the MBRVO group, and 2.36 +/- 0.32 mm SD in the control group, with a statistically significant difference (p0.001). Taking into account the MBRVO group, a statistical correlation was found between visual acuity impairment and FAZ enlargement (p = 0.02), but not between visual acuity impairment and macular edema (p = 0.41). In 14 cases (70%) secondary avascular microzones located in the macular sector correspondent to MBRVO were also evident. MBRVO causes an irregular enlargement of the FAZ which seems to represent the most important feature related to visual acuity impairment.

Objective: To investigate the effect of cataract surgery on subjective quality of vision. Methods: The Quality of Vision (QoV) questionnaire (Italian translation) was completed before and 3 months after cataract surgery in 4 groups of patients recruited from September through December 2010: first eye with ocular comorbidity, first eye without ocular comorbidity, second eye with ocular comorbidity, and second eye without ocular comorbidity. The questionnaire measures 3 aspects of quality of vision: frequency, severity, and bothersome nature of symptoms. The Lens Opacities Classification System (LOCS) III was used for cataract grading. Friedman and Kruskal-Wallis H tests were performed to compare QoV scores within and between groups. Spearman rank correlations (rs) were calculated to investigate the correlation between LOCS III and QoV symptoms. Results: Two hundred twelve patients (mean [SD] age, 74.2 [8.7] years) were recruited, and 212 eyes were included in the study. Improvements in QoV scores were found in all 4 groups (P < .05). There were no statistically significant (P > .05) differences among the 4 groups in the improvement in QoV scores or in the preoperative or postoperative scores. Blurred vision was correlated with posterior subcapsular cataract (rs = 0.420, P = .04). Conclusions: Cataract in one or both eyes causes a similar loss in subjective quality of vision, which is also irrespective of the presence of ocular comorbidity. Posterior subcapsular cataract causes the specific symptom “blurred vision.” Cataract surgery resulted in a large and comparable improvement in subjective quality of vision, regardless of ocular comorbidity and first or second eye surgery. Refereed/Peer-reviewed

PURPOSE: To measure the working frequency and the stroke dynamics of the phaco tip of 3 phacoemulsification machines. SETTING: University Eye Clinic of Trieste, Italy. DESIGN: Experimental study. METHODS: A video wet fixture was assembled to measure the working frequency using a micro camera and a micropulsed strobe-light system. A different video wet fixture was created to measure tip displacement as vectorial movement at different phaco powers using a microscopic video apparatus. RESULTS: The working frequency of the Infiniti Ozil machine was 43.0 kHz in longitudinal mode and 31.6 kHz in torsional mode. The frequency of the Whitestar Signature machine was 29.0 kHz in longitudinal mode and 38.0 kHz with the Ellips FX handpiece. The Stellaris machine had a frequency of 28.8 kHz. The longitudinal stroke of the 3 machines at different phaco powers was statistically significantly different. The Stellaris machine had the highest stroke extent (139 mm). The lateral movement of the Infiniti Ozil and Whitestar Signature machines differed significantly. No movement on the y-axis was observed for the Infiniti Ozil machine in torsional mode. The elliptical path of the Ellips FX handpiece had different x and y components at different phaco powers. CONCLUSIONS: The 3 phaco machines performed differently in terms of working frequency and stroke dynamics. The knowledge of the peculiar lateral and elliptical path strokes of Infiniti and Whitestar Signature machines may allow the surgeon to fully use these features for lens removal. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. J Cataract Refract Surg 2012; 38:333–342 Q 2012 ASCRS and ESCRS

Eyes with pseudoexfoliation syndrome have a greater risk of intraoperative and postoperative complications. Clinical and histopathological studies indicate that heparin-surface-modified intraocular lenses (HSM IOLs) can reduce postoperative anterior segment inflammation. Our study evaluated the blood-aqueous barrier permeability in eyes with pseudoexfoliation syndrome and implanted with an HSM IOL. We examined two groups of 20 patients, one comprising patients with pseudoexfoliation syndrome and one a sex- and age-matched control group with senile cataracts. Each group was divided into two subgroups of ten patients each. In one subgroup, an HSM IOL was implanted; in the other, a conventional poly(methyl methacrylate) IOL. We performed a complete ophthalmologic examination and iris angiography preoperatively and at 30, 90, and 180 days after surgery. Fluorophotometry was performed at the 90-day and 180-day postoperative examinations. The patients with pseudoexfoliation syndrome had a higher blood-aqueous barrier permeability than did the control group. Permeability decreased significantly three and six months after surgery, especially in the HSM IOL group.

Low or normal-tension glaucoma (NTG) is a rare clinical condition characterized by a glaucomatous cupping of the optic disk associated with the appearance of typical visual field defects, without ocular hypertension. According to several authors, NTG accounts for 5-15% of primary open angle glaucomas (POAG). In our open study we obtained a complete documentation of clinical and instrumental data-tonometric curve, computerized perimetry, pattern electroretinogram, pulsatile ocular blood flow (POBF) and retinography--on 10 consecutive patients (18 eyes) affected by NTG. We found that the NTG patients were similar to the controls as regards arterial systemic pressure and heart rate, but that POBF values were lower in the NTG patients.

OBJECTIVE: To determine whether the anterior capsulotomy shape (capsulorhexis or envelope) or the IOL design (polyHEMA, one-piece PMMA open and closed loops, three-piece polypropylene and PMMA loops) influence the lens decentration after intercapsular cataract surgery. STUDY DESIGN: Retrospective study of postoperative results 18 months after surgery. SETTING: University Eye Clinic of Trieste, Italy. PATIENTS: 150 patients divided into two groups: in 75 cases anterior circular continuous capsulorhexis (CCC) was performed and in 75 cases the envelope technique was used. Only patients with uncomplicated eyes and absence of posterior capsular opacification were included. MAIN OUTCOME MEASURES: Degree of IOL decentration was measured by projecting a slide of the anterior segment of the eye, taken after maximum dilatation, and calculating the distance between the circles formed by the corneoscleral limbus and the edge of the IOL. RESULTS: Including all IOLs, mean decentration was 0.28 ± 0.21 mm in the capsulorhexis group and 0.55 ± 0.32 mm in the envelope group; the difference is statistically significant ( P

A 78-year-old cataract patient with horizontal jerk nystagmus had phacoemulsification and intraocular lens (IOL) implantation in the capsular bag with continuous curvilinear capsulorhexis. One week postoperatively, the posterior capsule ballooned posteriorly, the anterior capsule opening was sealed to the IOL optic, and a transparent liquefied substance accumulated between the lens optic and the posterior capsule. The best corrected visual acuity was 0.6 with a myopic shift compared with the refraction after the first day. A neodymium:YAG laser posterior capsulotomy was performed, and the capsular block syndrome (CBS) resolved. The results confirm the experimental model proposed by Zacharias suggesting that saccadic eye movements contribute to CBS under certain anatomic conditions.

Daniele Tognetto, Eirini Skiadaresi, Paolo Cecchini, Giuseppe RavalicoEye Clinic, University of Trieste, Trieste, ItalyAbstract: We describe three cases of submacular hemorrhage that occurred two to four days after anti-VEGF intravitreal injection for occult choroidal neovascularisation in age-related macular degeneration and their management with 25 gauge pars plana vitrectomy with injection of subretinal recombinant tissue plasminogen activator (rTPA) followed by fluid-air exchange and postoperative prone position. Vitrectomy, subretinal rTPA injection and fluid-gas exchange apply as a safe and effective treatment in these cases. Functional results seem to be positive especially if surgical treatment is promptly performed.Keywords: vitrectomy, rTPA subretinal injection, gas tamponade, blood displacement

Purpose To assess the effects of subthreshold laser treatment (STLT) for retinal arterial macroaneurysms (RAM) associated with foveal exudative manifestations and visual acuity deterioration. Methods Patients with RAM associated with foveal exudative manifestations and best-corrected visual acuity (BCVA) worse than 20/80 Snellen equivalent underwent a ophthalmological examination, including ETDRS visual acuity, optical coherence tomography (OCT) and fluorescein angiography. The patients were prospectively observed for 4 months, and in absence of spontaneous improvement, they underwent STLT using an infrared diode laser. Results Primary outcome measures were a reduction in mean central point thickness (CPT) and BCVA changes at the 12-month examination. Secondary outcomes included changes in mean total macular volume (TMV) and central subfield thickness (CST). Nine patients were enrolled and prospectively followed up. The mean baseline values of BCVA, CPT, TMV and CST were 0.8 +/- 0.1 (logMAR +/- SD), 340 +/- 49 mu m, 7.14 +/- 0.05 mm(3) and 366 +/- 37 mm, respectively. At the 4-month examination following STLT, the mean BCVA improved to 0.6 +/- 0.2, whereas the mean CPT, TMV, and CST decreased to 274 +/- 29 mm, 6.87 +/- 0.11 mm(3) and 296 +/- 33 mu m. At the 12-month examination, the mean BCVA was 0.36 +/- 0.2, the mean CPT was 195 +/- 11 mu m, the mean TMV was 6.55 +/- 0.19 mm(3), and the mean CST was 239 +/- 14 mu m, respectively. No side-effects were noted. In particular, no sign of retinal thinning and underlying backscattering typical of conventional laser treatment could be detected at the site of the laser application on OCT. Conclusion The current pilot investigation of STLT for the treatment of symptomatic RAM revelas encouraging data. A randomised clinical trial is required to ascertain the real efficacy of this technique and the most appropriate settings to be employed.

Contrast sensitivity was measured in two groups of 20 patients each implanted with refractive and diffractive multifocal intraocular lenses and in two control groups of 20 patients each--the first group implanted with a monofocal IOL and the second phakic subjects. All cases had a postoperative follow-up of at least one year and a corrected visual acuity of 20/20- or better. We used two psychophysical tests, Pelli Robson test chart and Vistech 6500 test chart, and an objective test, visual evoked potentials (VEPs). There were no statistically significant differences in contrast sensitivity in the psychophysical tests between the two groups implanted with multifocal IOLs. The situation was different, however, when they were compared with the control group with monofocal IOLs and the group with phakic eyes: the Pelli-Robson test results were not significantly different, but the Vistech 6500 test showed a significant reduction in contrast sensitivity in both groups. The pattern VEPs objective test confirmed these results: no differences were noted between the two different multifocal IOLs, while there was a drop in contrast sensitivity when their results were compared with those of the control groups; the intermediate frequencies were particularly affected by this phenomenon. The contrast sensitivity in patients with multifocal IOLs is reduced despite high visual acuity and this can affect the quality of vision.

Purpose: To report a case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) in the course of Ulcerative Colitis (UC). Methods: A complete ophthalmologic evaluation, including fluorescein and indocyanine green angiography, was performed. Results: A patient with exacerbation of UC was referred to our department for sudden visual loss in RE. Ophthalmoscopy disclosed multifocal yellow-white placoid lesions typical of APMPPE in RE. There were no lesions in the fellow eye. On fluorescein angiography (FA), the active lesions showed early hypofluorescence, followed by late staining. Indocyanine green angiography (ICGA) revealed early and late hypofluorescence corresponding to the lesions observed clinically, and late anular staining surrounding a hypofluorescent lesion at the posterior pole. On LE ICGA revealed lesions not detected with ophthalmoscopy and FA. After corticosteroid therapy the lesions healed. Conclusion: Ulcerative Colitis may be responsible for the onset of AMPPPE by an immunological mechanism of delayed type hypersensitivity reaction.

To assess the relationship between pupillary diameter and focusing for distance and near vision with the refractive bifocal intraocular lens (IOL), we studied visual acuity for far and near distance, near point, and depth of focus with normal pupillary movements and after pharmacological miosis and mydriasis (pilocarpine 2% and phenylephrine 10% eyedrops, respectively) in 20 patients implanted with an IOLAB refractive bifocal IOL. Pharmacological miosis and mydriasis did not change far and near visual acuity values from the values with normal pupillary diameter. After pharmacological miosis, the near point position and the width of the depth of focus were unchanged. After pharmacological mydriasis, near point distance was unchanged but depth of focus dropped in a statistically significant manner (P < .01). We concluded that the pupillary diameter alone cannot produce distance or near vision focusing. The choice depends on the brain's preference. Pupillary diameter increases the quality of vision through the blur circles mechanism.