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Purpose: To evaluate the precision of the IcareONE rebound tonometer, which was developed for self-measuring intraocular pressure (IOP) and to compare IcareONE measurement with Goldmann applanation tonometry (GAT). Methods: Twenty-four healthy eyes and 81 glaucomatous eyes were enrolled. IOP measurements (three times per session) with IcareONE were made in a random order by an ophthalmologist (Icare(O)) and by the subject (Icare(S)). Intraclass correlation coefficients (CCs), kappa values and mean values of IOP were compared among the two types of Icare recordings and GAT. Bland–Altman analysis was used to assess agreement between methods. Multiple regression analysis was performed to identify the subject factors that influenced the discordant measurements between IcareONE and GAT. Results: The mean value of Icare(O) and Icare(S) measurements was 13.5 ± 5.2 and 13.5 ± 5.4 mmHg, respectively, neither of which was significantly different from GAT (13.8 ± 4.4). The intrarater CC of Icare(O) and Icare(S) was 0.968 and 0.885, respectively. The intermethod CC and weighted kappa between Icare(O) and Icare(S) were 0.907 and 0.684, respectively. All pairwise correlations between the two types of IOP measurement showed coefficients of determination >0.8. Bland–Altman analysis did not show any proportional biases. Multiple regression analysis revealed that the differences between GAT and Icare(O) or Icare(S) were positively correlated with central corneal thickness (CCT) and negatively correlated with age. Conclusions: Intraocular pressure measurements with IcareONE by a physician and by the subject showed excellent agreement with GAT measurements; IcareONE measurements between a physician and the subject had high intrarater reliability, and good agreement thicker CCT led IcareONE measurement to overestimate IOP, while higher age caused it to underestimate IOP compared with GAT.

Purpose: To investigate the effect of intravitreal ranibizumab on extrafoveal choroidal neovascularization secondary to age-related macular degeneration. Methods: Eighteen eyes affected by extrafoveal choroidal neovascularization secondary to age-related macular degeneration were prospectively enrolled in this study. After an initial intravitreal ranibizumab, all patients were reevaluated monthly over 12 months of follow-up. Further retreatments were performed on a pro re nata basis, depending on detection of any type of fluid on optical coherence tomography and/or the presence of leakage on fluorescein angiography. Primary outcome measures were mean changes in best-corrected visual acuity and the proportion of eyes gaining at least 15 letters (3 Early Treatment Diabetic Retinopathy Study [ETDRS] lines) at the end of the follow-up. Secondary outcome measures were central macular thickness variations and changes in choroidal neovascularization size. Results: Mean best-corrected visual acuity presented a significant improvement during the follow-up period, being 0.3 +/- 0.2 logMAR at baseline and 0.2 +/- 0.2 logMAR at the 12-month examination (P < 0.001). An improvement of at least 3 EDTRS lines was achieved by 6 eyes (33.3%), whereas 6 patients (33.3%) gained 1 to 2 lines. The mean central macular thickness at baseline was 314 +/- 87 mu m, changing to 268 +/- 65 mu m at the 12-month examination (P = 0.003). The mean lesion size was 1.4 +/- 1.4 mm(2) and remained stable throughout the follow-up, being 1.8 +/- 2.9 mm(2) at 12 months (P = 0.64). Conclusion: Intravitreal ranibizumab administered after a pro re nata regimen with monthly evaluation is a beneficial approach for the management of extrafoveal choroidal neovascularization secondary to age-related macular degeneration over 12 months of follow-up. Further studies are warranted to confirm our preliminary results.

Percutaneous drug-eluting stent (DES) implantation is commonly used in patients with unprotected left main (ULM) disease. As this procedure has been performed routinely in Turin Center since 2002, this article aimed to summarize a five year-experience in DES implantation in the ULM.Baseline, procedural and in-hospital outcome data of all patients with ULM undergoing percutaneous coronary intervention (PCI) with DES between July 2002 and October 2006 at Turin Center have been collected. Patients were randomized into four groups: A (patients treated between July 2002 and December 2003), B (treated in 2004), C (treated in 2005) and D (treated in 2006). The baseline surgical risk features was to be compared with the European System for Cardiac Operative Risk Evaluation, disease location in the ULM, and in-hospital major adverse cerebro-cardiovascular events (MACCE), defined as death, myocardial infarction, repeat percutaneous revascularization, coronary artery bypass grafting, stroke, or stent thrombosis.Out of a total of 4 432 coronary interventional procedures 198 patients treated with DES in the ULM were identified. There was a significant increase in the number of patients treated (P=0.00095), but no difference in EuroSCORE across groups (P=0.14). Conversely, there was a significant temporal trend in the incidence of bifurcational ULM being treated with DES (P=0.03). Intriguingly, despite this increase in adverse lesion characteristics, no significant increase was found in the rate of in-hospital MACCE (P=0.93).In this single-center study, the number of patients being treated with DES for ULM disease has risen across the years, although keeping a similar surgical risk profile. Distal ULM involvement is no longer considered an absolute contraindication to PCI, as testified by the increasing frequency of such lesion among patients undergoing DES implantation at this Institution, with remarkably low rates of adverse events.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is common even with concomitant multivessel disease. We aimed to investigate the impact of multivessel disease on long-term outcome after PCI for CTO.We collected baseline, procedural and follow-up data on patients undergoing successful PCI with stenting for CTO. We divided our population into three groups: patients with 1 vessel disease (1VD), those with 2-vessel disease (2VD) and subjects with 3-vessel disease (3VD). The primary end-point was the occurrence of major adverse cardiac events (MACE), i.e. death, myocardial infarction or target vessel revascularization.A total of 111 patients were included: 24 (21%) in group 1VD, 28 (25%) in group 2VD, and 59 (53%) in group 3VD. Clinical follow-up was available in 109 (98%) of them after a median of 27 months (range 6-68), yielding MACE rates of 1 (4%) in group 1VD, 5 (18%) in group 2VD, and 17 (29%) in group 3VD, respectively (P=0.03). No statistically significant difference was found comparing the 3 groups for the individual rates of death, myocardial infarction or target vessel revascularization (all P0.05). No case of definite or probable stent thrombosis was adjudicated, despite use of DES in 99 (89%) patients.Patients with diffuse coronary disease undergoing PCI for a CTO fare a significantly worse prognosis. Nonetheless, despite liberal use of DES, stent thrombosis is rare in this setting, without differences according to the initial severity of disease, thus supporting the long-term safety of DES, even if used in this "off-label" context.

The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.

Hypoxic ischemic encephalopathy is one of the major causes of neonatal death and neurological disability in the child, and represents the most common birth injury claim. Intrapartum asphyxia often leads to several long-term sequalae, such as cerebral palsy and/or developmental delay, epilepsy. Through the neuroimaging it's possible to identify and define the different lesioned pictures and provide useful elements to establish the moment in which the damage occurred; indeed, timing of injury is a key element in the legal arena. Magnetic resonance imaging (MRI) is emerging as one of the most important tools in identifying the etiologic of neonatal encephalopathy as well as in predicting long-term outcomes. The aim of this study is to evaluate all MRI tests performed in a group of infants and young patients with possible neonatal encephalopathy, in order to determine the role of MRI in perinatal hypoxic-ischemic damage and the specific patterns that can point towards a diagnosis of the time of the damage's onset. Another goal is to assess the role of MRI in cases subject to legal-medical ligation. Since the advent of hypothermic neuroprotection, new malpractice allegations have arisen, including the failure to initiate cooling in a timely manner. In all cases, documentation of the status of the baby at birth, including a thorough neurologic exam, can be extremely helpful to the later defence of a malpractice claim, which might occur years later.

Dear Editor:We read with interest the article by Vidne and colleagues entitled “Perfluorocarbon Liquid Vs. Subretinal Fluid Drainage during Vitrectomy for the Primary Repair of Rhegmatogenous Retin...

Purpose: To evaluate the effects of repeated intravitreal dexamethasone implant. Methods: We reviewed the charts of 12 patients with diabetic macular edema, who received at least 2 intravitreal Ozurdex (0.7 mg) on an "as needed" basis. Main outcome measures included changes in best-corrected visual acuity, central macular thickness, retreatment interval, and incidence of side effects. Results: A total of 15 eyes of 12 patients (6 men, 6 women; mean age 62 +/- 12 years) were included. Retreatment was judged necessary after mean of 7.8 +/- 4.1 months from the first Ozurdex (median, 6 months) (15 of 15 eyes), mean of 4.8 +/- 0.9 months from the second Ozurdex (median, 5 months) (7 of 15 eyes), mean of 5.3 +/- 1.5 months from the third Ozurdex (median, 5 months) (3 of 15 eyes), and mean of 5.6 +/- 2 months from the fourth Ozurdex (median, 5 months) (3 of 15 eyes). Mean baseline best-corrected visual acuity was 0.67 +/- 0.33 logMAR in the overall diabetic macular edema population; it significantly improved to 0.53 +/- 0.31 logMAR after mean of 40.9 +/- 18.2 days from the first Ozurdex (peaking efficacy) (P < 0.001), to 0.53 +/- 0.29 logMAR after mean of 34.4 +/- 9.0 days from the second Ozurdex (peaking efficacy) (P < 0.003), and stabilized to 0.62 +/- 0.26 logMAR after mean of 29.8 +/- 12.1 days from the third Ozurdex (peaking efficacy) (P = 0.05), to 0.5 +/- 0.26 logMAR after mean of 36.3 +/- 3.2 days from the fourth Ozurdex (peaking efficacy) (P = 0.2), and to 0.50 +/- 0.26 logMAR after mean of 37.0 +/- 2.6 days from the fifth Ozurdex (peaking efficacy) (P = 0.2). Mean baseline central macular thickness significantly decreased from 546 +/- 139 mu m to 292 +/- 43 mu m at 39.4 +/- 17.9 days from the first Ozurdex (peaking efficacy) (P < 0.001), to 297 +/- 47 mu m at 33 +/- 9.4 days from the second Ozurdex (peaking efficacy) (P < 0.001), to 293 +/- 22 mu m at 29.8 +/- 12.1 days from the third Ozurdex (peaking efficacy) (P = 0.01), and stabilized to 309 +/- 35 mu m at 36.3 +/- 3.2 days from the fourth Ozurdex (peaking efficacy) (P = 0.1), and to 295 +/- 7 mu m at 37.0 +/- 2.6 days from the fifth Ozurdex (peaking efficacy) (P = 0.1). No serious adverse events were observed; three eyes developed a transient intraocular pressure increase, and cataract was extracted in one eye. Conclusion: Repeated intravitreal Ozurdex on an "as needed" basis with a variable retreatment interval may produce long-term clinically meaningful benefits in the treatment of diabetic macular edema, without other significant side effects than expected after intraocular corticosteroid treatment. Purpose: To evaluate the effects of repeated intravitreal dexamethasone implant. Methods: We reviewed the charts of 12 patients with diabetic macular edema, who received at least 2 intravitreal Ozurdex (0.7 mg) on an "as needed" basis. Main outcome measures included changes in best-corrected visual acuity, central macular thickness, retreatment interval, and incidence of side effects. Results: A total of 15 eyes of 12 patients (6 men, 6 women; mean age 62 +/- 12 years) were included. Retreatment was judged necessary after mean of 7.8 +/- 4.1 months from the first Ozurdex (median, 6 months) (15 of 15 eyes), mean of 4.8 +/- 0.9 months from the second Ozurdex (median, 5 months) (7 of 15 eyes), mean of 5.3 +/- 1.5 months from the third Ozurdex (median, 5 months) (3 of 15 eyes), and mean of 5.6 +/- 2 months from the fourth Ozurdex (median, 5 months) (3 of 15 eyes). Mean baseline best-corrected visual acuity was 0.67 +/- 0.33 logMAR in the overall diabetic macular edema population; it significantly improved to 0.53 +/- 0.31 logMAR after mean of 40.9 +/- 18.2 days from the first Ozurdex (peaking efficacy) (P < 0.001), to 0.53 +/- 0.29 logMAR after mean of 34.4 +/- 9.0 days from the second Ozurdex (peaking efficacy) (P < 0.003), and stabilized to 0.62 +/- 0.26 logMAR after mean of 29.8 +/- 12.1 days from the third Ozurdex (peaking efficacy) (P = 0.05), to 0.5 +/- 0.26 logMAR after mean of 36.3 +/- 3.2 days from the fourth Ozurdex (peaking efficacy) (P = 0.2), and to 0.50 +/- 0.26 logMAR after mean of 37.0 +/- 2.6 days from the fifth Ozurdex (peaking efficacy) (P = 0.2). Mean baseline central macular thickness significantly decreased from 546 +/- 139 mu m to 292 +/- 43 mu m at 39.4 +/- 17.9 days from the first Ozurdex (peaking efficacy) (P < 0.001), to 297 +/- 47 mu m at 33 +/- 9.4 days from the second Ozurdex (peaking efficacy) (P < 0.001), to 293 +/- 22 mu m at 29.8 +/- 12.1 days from the third Ozurdex (peaking efficacy) (P = 0.01), and stabilized to 309 +/- 35 mu m at 36.3 +/- 3.2 days from the fourth Ozurdex (peaking efficacy) (P = 0.1), and to 295 +/- 7 mu m at 37.0 +/- 2.6 days from the fifth Ozurdex (peaking efficacy) (P = 0.1). No serious adverse events were observed; three eyes developed a transient intraocular pressure increase, and cataract was extracted in one eye. Conclusion: Repeated intravitreal Ozurdex on an "as needed" basis with a variable retreatment interval may produce long-term clinically meaningful benefits in the treatment of diabetic macular edema, without other significant side effects than expected after intraocular corticosteroid treatment.

Purpose Handheld laser pointer thermal injury affects primarily the retinal pigment epithelium (RPE). However, so far no study has reported on the possible effects of laser pointers in the deeper layers, beneath the RPE. Here, we describe the spectral-domain optical coherence tomography angiography findings in the choriocapillaris of a patient with laser maculopathy. Methods A 13-year-old boy presented to our department with decreased vision in the left eye 12 hours after having stared at the beam of a laser pointer. Results Structural optical coherence tomography (OCT) showed 2 focal hyperreflective columns at the fovea extending from the RPE, involving all outer retinal layers, and terminating at the outer plexiform layer. The patient also underwent OCT angiography (OCT-A), which in the choriocapillary segmentation revealed 2 hypointense lesions in correspondence of the focal hyperreflectivities detected on structural OCT. We hypothesize that the OCT-A findings could represent a rarefaction of the choriocapillaris. However, the choriocapillary OCT-A findings could also represent artifacts due to the overlaying hyperreflective lesions. Conclusions It is known that the RPE is primarily damaged by the laser injury. Our findings suggest that the thermal injury could involve also the choriocapillaris, and thus not limited to the RPE. Multimodal imaging in laser maculopathy including OCT-A may lead to a better comprehension of the pathogenesis of laser retinal damages.

Purpose: To evaluate demographic characteristics, clinical features, systemic disease associations, visual outcomes, and treatment modalities of patients with episcleritis and scleritis in an Italian tertiary care referral center. Methods: Data from 25 patients with episcleritis and from 85 patients with scleritis followed from 2003 to 2012 were retrospectively evaluated. The main outcome measures were demographics, ocular disease characteristics, presence of systemic associated disease, treatment regimen, and follow-up period. Results: Episcleritis and scleritis were found bilaterally in 24% and 31% of patients, respectively (p

Purpose To report 3 cases of ocular chorioretinal folds from different etiologies and their aspect with the new imaging technology of optical coherence tomography (OCT) angiography (OCT-A). Methods Baseline data, investigational process on etiology, and follow-up data of patients referred for chorioretinal folds to the Medical Retina & Imaging Unit of San Raffaele Hospital in the period January-March 2016 were collected. Multimodal imaging evaluation, comprehensive of infrared, fundus autofluorescence, multicolor, spectral-domain OCT, and OCT-A, was performed on all patients. Results Four eyes of 3 men, 65, 46, and 50 years of age, showed chorioretinal folds secondary to central serous chorioretinopathy, postoperative hypotony (after deep sclerectomy), and anisometropia with unilateral hyperopia, respectively. In all cases, OCT-A imaging showed a signal reduction in the choriocapillaris layer in correspondence of the folds. Due to this signal reduction, the en face reconstruction of choriocapillaris layer showed, in all cases, a peculiar tigroid aspect. The aspect of the folds at OCT-A remained unchanged during the 3-month follow-up in all patients. Conclusions Optical coherence tomography angiography shows a typical linear signal reduction in the choriocapillaris layer in correspondence of the fold with a tigroid pattern. We hypothesize this aspect could be explained by blood flow alteration at the choriocapillaris level in correspondence of the fold.

Aims: To investigate the short-term effects of intravitreal ranibizumab on retinal vessel functionality in patients with diabetic macular edema (DME) by Dynamic Vessel Analyzer (DVA). Methods: Patients presenting with DME were enrolled in the study. All patients underwent a complete ophthalmic evaluation, including optical coherence tomography and dynamic and static vessel analysis, using the DVA before (baseline), 1week and 1month after administration of intravitreal ranibizumab. DME subject were compared with diabetic retinopathy (DR) without DME subjects, and with normal non diabetic subjects (controls) matched for age and sex. Results: A total of 45 eyes of 45 subjects (15 eyes for each group) were included in the analysis. In DME patients, dynamic analysis showed a significant decrease in mean arterial dilation from baseline to 1week. Mean central retinal artery equivalent (CRAE) of DR patients without DME was significantly different from baseline and week 1 of DME eyes. In healthy control subjects, CRAE was significantly different from CRAE at baseline and 1week on DME patients, but not significantly different from DR patients without DME. Conclusions: Using DVA in patients with DME, dynamic analysis showed a significant decrease in mean arterial dilation from baseline to 1week in DME eyes. A significant reduction in arterial vessels could be demonstrated in DME patients compared to DR patients without DME and controls.

The vitreous is involved in multiple diseases when an incomplete posterior vitreous detachment (PVD) occurs. An incomplete PVD can lead to several pathological conditions. Such visually threatening conditions are traditionally of exclusive surgical interest. In contrast, pharmacological vitreolysis is the effort to reduce or eliminate the pathogenetic role of the vitreous solely by means of drug delivery. Here we aim to review and summarize the evidence available to date about this challenging new approach. (C) 2013 S. Karger AG, Basel

Purpose To analyze major retinal vessels in eyes with high myopia by means of the Dynamic Vessel Analyzer (DVA) in order to gather insight on retinal vascular functionality and better understand why these eyes are resistant to diabetes-related changes. Methods A total of 20 high-myopia eyes with pathologic myopia, 20 high-myopia eyes without pathologic myopia and 20 age- and sex-matched control subjects (without pathologic myopia) were included and compared. Results Dynamic analysis showed mean arterial dilation of 2.44 +/- 1.59 % in high-myopia eyes with pathologic myopia, 2.67 +/- 1.17 in high-myopia without pathologic myopia eyes, and 3.28 +/- 1.46 % in healthy eyes. Mean venous dilation was 3.45 +/- 1.82 %, 3.57 +/- 1.72, and 4.45 +/- 2.72 % respectively. Static analysis in high myopia eyes with pathologic myopia showed a mean central retinal artery equivalent (CRAE) of 171.6 +/- 24.3, a mean central retinal vein equivalent (CRVE) of 199.5 +/- 27.73, and a mean arteriovenous ratio (AVR) of 0.86 +/- 0.01. In patients with high myopia without pathologic myopia, we found a mean CRAE of 173 +/- 21.6, a mean CRVE of 198.2 +/- 18.8, and a mean AVR of 0.87 +/- 0.1. In control subjects, mean CRAE was 190.3 +/- 11.93, mean was CRVE 215.7 +/- 13.30, and mean AVR was 0.88 +/- 0.04. Conclusions Static and dynamic tests revealed that in high-myopia eyes, the vessels at the retinal posterior pole have reduced diameter, but are functionally comparable to control subjects. This supports the hypothesis of reduced oxygen consumption in high-myopia eyes. OI Corvi, Federico/0000-0002-2661-5500 Purpose To analyze major retinal vessels in eyes with high myopia by means of the Dynamic Vessel Analyzer (DVA) in order to gather insight on retinal vascular functionality and better understand why these eyes are resistant to diabetes-related changes. Methods A total of 20 high-myopia eyes with pathologic myopia, 20 high-myopia eyes without pathologic myopia and 20 age- and sex-matched control subjects (without pathologic myopia) were included and compared. Results Dynamic analysis showed mean arterial dilation of 2.44 +/- 1.59 % in high-myopia eyes with pathologic myopia, 2.67 +/- 1.17 in high-myopia without pathologic myopia eyes, and 3.28 +/- 1.46 % in healthy eyes. Mean venous dilation was 3.45 +/- 1.82 %, 3.57 +/- 1.72, and 4.45 +/- 2.72 % respectively. Static analysis in high myopia eyes with pathologic myopia showed a mean central retinal artery equivalent (CRAE) of 171.6 +/- 24.3, a mean central retinal vein equivalent (CRVE) of 199.5 +/- 27.73, and a mean arteriovenous ratio (AVR) of 0.86 +/- 0.01. In patients with high myopia without pathologic myopia, we found a mean CRAE of 173 +/- 21.6, a mean CRVE of 198.2 +/- 18.8, and a mean AVR of 0.87 +/- 0.1. In control subjects, mean CRAE was 190.3 +/- 11.93, mean was CRVE 215.7 +/- 13.30, and mean AVR was 0.88 +/- 0.04. Conclusions Static and dynamic tests revealed that in high-myopia eyes, the vessels at the retinal posterior pole have reduced diameter, but are functionally comparable to control subjects. This supports the hypothesis of reduced oxygen consumption in high-myopia eyes.

PURPOSE: To assess the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks (AS) in a 3-year follow-up study. DESIGN: Noncomparative, interventional, prospective case series. METHODS: Eighteen patients (18 eyes) with juxtafoveal/extrafoveal CNV secondary to AS were recruited. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on ETDRS chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections on the basis of detection of new hemorrhage, any type of fluid on OCT, and/or presence of FA leakage. Primary outcome measures were final mean changes in BCVA and proportion of eyes with 10 ETDRS letters improvement. Secondary outcomes were mean changes of central macular thickness (CMT) and foveal involvement. RESULTS: After a mean BCVA stabilization over the first year, a statistically significant BCVA worsening was registered at the 24-month (72.8 +/- 10.0 ETDRS letters, P = .03) and 36-month examinations (65.8 +/- 15.0 ETDRS letters, P = .02) in comparison with the 1-year visual outcomes (80.1 +/- 5.4 ETDRS letters); lastly, a substantial stabilization in the BCVA was observed at 36 months in comparison with the baseline value (77.9 +/- 10.0 ETDRS letters, P = .22). Two eyes (25%) with juxtafoveal CNV and no eye with extrafoveal CNV experienced a 10-letter improvement at the 3-year examination. Mean CMT at baseline was 220 15 mu m and 235 +/- 66 pm at 36 months (P = 1.00). During the first and second years of follow-up, 5 juxtafoveal CNVs and 3 extrafoveal CNVs showed foveal involvement. CONCLUSIONS: Intravitreal bevacizumab can be effective in the management of nonsubfoveal CNV secondary to AS, although monthly monitoring is required to control CNV recurrence or progression. (C) 2016 Elsevier Inc. All rights reserved.

To describe the morphological macular changes detected by spectral domain optical coherence tomography (SD-OCT) in eyes with retinitis pigmentosa (RP) and to analyze their correlation with the visual function. Twenty-two patients (44 eyes) patients affected by RP were recruited. The following structures were evaluated on SD-OCT: outer plexiform layer (OPL), outer nuclear layer (ONL), external limiting membrane (ELM), photoreceptor inner/outer segment (IS/OS) junction, photoreceptor outer segment/retinal pigmented epithelium (OS/RPE) junction, inner limiting membrane thickening (ILMT), ganglion cell complex (GCC), and cystoid macular edema (CME). The relation between each SD-OCT finding and BCVA was evaluated at uni- and multivariate analysis. Mean age and mean best-corrected visual acuity (BCVA) were 51 ± 17.5 years and 0.4 ± 0.5 LogMAR, respectively. Univariate linear regression model revealed a correlation between BCVA and the absence of ELM, IS/OS, ONL, and OS/RPE layers (R 2 values were, respectively, 0.51, 0.57, 0.48, and 0.68, with p values all

Background To correlate patterns in short-wavelength (SW) and near-infrared (NIR) fundus autofluorescence (FAF) with morpho-functional outcomes in eyes affected by Stargardt disease. Methods Fifty-four eyes of 27 patients were prospectively enrolled. All patients underwent a complete ophthalmologic examination including SW-FAF, NIR-FAF, microperimetry and spectral-domain optical coherence tomography (SD-OCT). The main outcome measures were identification of a correlation between NIR-FAF and SW-FAF patterns within the foveal region and best corrected visual acuity (BCVA) values. Secondary outcome measures were correlation of FAF patterns with SD-OCT findings and retinal sensitivity on microperimetry. Results Eyes showing a pattern of foveal hyper-FAF on NIR-FAF had a higher BCVA than eyes with a reduced FAF signal (0.44 +/- 0.23 LogMAR vs 1.08 +/- 0.19, p

To evaluate the correlation between fundus autofluorescence (FAF) and spectral-domain OCT (SD-OCT) morphological analysis in eyes with acute central serous chorioretinopathy (CSCR). Thirty-one patients with a first episode of CSCR and symptom duration of less than 6 weeks were prospectively enrolled. FAF and SD-OCT examination were performed at baseline and at 2-month intervals. Main outcome measure was the correlation between FAF and SD-OCT retinal morphology. At baseline, 30/31 and 29/31 eyes showed a macular hypo-AF, corresponding to the neurosensory retinal detachment (SRD), on shortwave-FAF (SW-FAF) and near-infrared-FAF (NIR-FAF), respectively. While the SRD resolved, both FAF techniques showed a granular hyper-AF in 31 eyes. At first examination, SD-OCT confirmed the SRD with a photoreceptor outer-segment (OS) elongation in all cases. During SRD resolution, the photoreceptor layer appeared thicker and fragmented. Multiple hyper-reflective precipitates were detected in the outer plexiform and nuclear layer and between the photoreceptors and appeared colocalized with the hyper-AF dots composing the granular hyper-AF. After SRD resolution, the hypo-AF area reverted to a normal pattern on SW-FAF in all eyes and in 25/31 on NIR-FAF. Examination at 12 months showed that the granular hyper-AF was still detectable in 54 % eyes, whereas 6/31 eyes showed hypo-AF dots on NIR-FAF. On SD-OCT, the junction IS/OS was identifiable in 11/31 eyes soon after the SRD resolution and appeared completely restored in all patients at the final visit. The simultaneous acquisition of FAF and SD-OCT provides detailed findings of retinal abnormalities of CSCR and may help to understand the evolving process linked to CSCR.

PURPOSE: To evaluate the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks. DESIGN: Nonrandomized, interventional, prospective case series. METHODS: Fifteen patients (15 eyes) affected by juxtafoveal or extrafoveal CNV secondary to angioid streaks were enrolled in the study. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on Early Treatment Diabetic Retinopathy Study (ETDRS) chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections over a 12-month follow-up period on the basis of the detection of new hemorrhage on biomicroscopic examination, any type of fluid on OCT, or presence of leakage on FA. Primary outcome measures: Mean changes in BCVA and proportion of eyes gaining at least 10. letters (2 ETDRS lines) at the end of the follow-up. Secondary outcomes: Mean changes of central macular thickness (CMT) and extension to the fovea. RESULTS: Mean BCVA did not change throughout the follow-up period, being 0.2 +/- 0.2 logMAR at baseline and 0.2 +/- 0.3 logMAR at the 12-month examination. A functional improvement of at least 2 ETDRS lines was achieved by 5 eyes (33%), with 3 eyes (20%) gaining 3 lines. Mean CMT at baseline was 215 +/- 13 mu m and 225 +/- 85 mu m at the 12-month examination. Two eyes (13.3%) showed CNV extension to the fovea. CONCLUSIONS: Intravitreal bevacizumab injection can be a beneficial approach for the management of nonsubfoveal CNV secondary to angioid streaks over a 1-year follow-up. (C) 2014 by Elsevier Inc. All rights reserved.

Purpose To assess the effects of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularisation (CNV) secondary to serpiginous choroiditis (SC). Design Non-randomised, interventional case series. Participants Seven patients (seven eyes) affected by juxtafoveal CNV (six eyes) and subfoveal CNV (one eye) associated with SC were recruited. Methods Each patient underwent an ophthalmological examination, including measurement of best-corrected visual acuity (BCVA), fluorescein angiography (FA) and optical coherence tomography (OCT). After a first IVB injection (1.25 mg), patients were evaluated monthly over a 12-month follow-up. Further re-treatments were performed on the basis of detection of any type of fluid on OCT and/or presence of leakage on FA. The primary outcome considered was the median change in BCVA, as well as the proportion of eyes gaining at least 5 and 10 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at the end of the 12-month follow-up. Secondary outcomes included median changes in central macular thickness (CMT) and number of injections over the planned follow-up. Results Median BCVA changed from 0.3 to 0.4 LogMAR. A functional improvement of at least 5 and 10 ETDRS letters was obtained in two eyes (28%) and one eye (14%), respectively, at the 12-month examination. Four eyes (57%) had stable BCVA, whereas one eye (14%) experienced a two-line decrease. Median CMT at baseline was 261 μm, decreasing to 196 μm at the 12-month examination. The median number of IVB injections was 1 in 12 months. Conclusions IVB can achieve anatomical stabilisation of CNV secondary to SC, avoiding a decline in visual acuity, in almost 90% of cases over a 12-month follow-up.

Aim: To evaluate the agreement between fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) in detecting myopic choroidal neovascularization (CNV) activity during bevacizumab treatment. Methods: Thirty-four patients with subfoveal myopic CNV were prospectively enrolled. FA and SD-OCT were performed at baseline and at all planned monthly visits. After the first injection, additional treatments were administered following detection of fluid on SD-OCT and/or leakage on FA. κ-Analysis was performed to examine the agreement between FA and SD-OCT. Results: At baseline, FA and SD-OCT agreed in 26/34 cases (κ = 0.23); sensitivity and specificity were 77.4 and 66.7%, respectively. Seven eyes presented leakage on FA with no fluid on SD-OCT, 1 case showed intraretinal fluid on SD-OCT and no leakage on FA. At the 1-month examination, specificity and κ-value improved, and 30/34 cases showed complete concordance. At the 3- and 4-month examinations, a discordance was noted in 6 cases. From the 5-month examination on, a correspondence was achieved in at least 30/34 cases and reached a perfect match in 11 sessions. Conclusions: Our study confirms the key role of FA in diagnosing myopic CNV. It seems possible there may be a role for SD-OCT in assisting FA to monitor the myopic CNV activity during anti-vascular endothelial growth factor antibody treatment.

La tendenza alla personalizzazione ha cambiato profondamente forme e dinamiche della politica in Italia. Ma la forza crescente del personalismo non riguarda solo la leadership monocratica. Si fa strada, secondo modalità e forme ancora non ben messe a fuoco, un personalismo che interessa il ceto politico di livello medio e basso, il cui ruolo nelle competizioni elettorali e nella vita politico-istituzionale sembra assumere via via più rilievo. Il fenomeno è particolarmente chiaro a Napoli, dove il processo di destrutturazione dei partiti politici a vantaggio di aggregazioni estemporanee e personalistiche è stato accelerato dal clamoroso fallimento delle primarie del centrosinistra tenutesi nel gennaio 2011 e dalla conflittualità endemica all’interno della coalizione di centrodestra. Nel vuoto lasciato dai partiti tradizionali, i collettori di voti che agiscono nei rioni e nei quartieri e che siedono in consiglio comunale e nelle municipalità sub-comunali trovano ampi spazi di affermazione per le proprie strategie e carriere politiche. Le recenti elezioni per il sindaco hanno plasticamente mostrato la contemporanea presenza delle due forme di personalismo: la leadership mediatica incarnata da De Magistris e la estrema concentrazione territoriale del voto di preferenza dei candidati nelle liste. Nuove forme di aggregazione del consenso (i centri di assistenza fiscale soprattutto) e di mediazione politica, reti particolaristiche di scambio/fiducia caratterizzano a un livello fortemente territorializzato l’incontro tra domanda e offerta politica. Il saggio propone una lettura di questi fenomeni sulla base di materiale empirico di carattere quantitativo e qualitativo.

Purpose:To investigate the vasomotor responses and diameter of retinal vessels in patients with macular edema secondary to retinal vein occlusion (RVO).Methods:A total of 18 eyes of 18 RVO patients were consecutively included and compared with age- and sex-matched controls. Participants underwent an examination with optical coherence tomography and dynamic and static retinal vessel analyses using the Dynamic Vessel Analyzer.Results:Dynamic vessel analysis in RVO showed mean maximum venous and arterial dilation of 2.22 1.23% and 1.87 +/- 1.41%, respectively, as compared with 5.05 +/- 2.75% (P = 0.001) and 3.95 +/- 1.44% (P = 0.0004), respectively, in controls. Static retinal vessel analysis in RVO revealed a mean arteriovenous ratio (AVR) of 0.74 +/- 0.09 versus 0.90 +/- 0.04 (P < 0.0001) in controls. Mean AVRs of occluded and nonoccluded quadrants in RVO were 0.71 +/- 0.13 and 0.85 +/- 0.19, respectively; in the corresponding quadrants of controls, mean AVRs were 0.90 +/- 0.19 (P < 0.0001) and 0.86 +/- 0.17 (P = 0.89), respectively. In branch RVO patients, mean AVRs of occluded versus nonoccluded quadrants were 0.70 +/- 0.06 and 0.90 +/- 0.22 (P = 0.002), respectively.Conclusion:In patients with macular edema secondary to RVO, dynamic vessel analysis showed an impairment of both venous and arterial motility and/or reactivity and static vessel analysis showed a reduced AVR indicating a general enlargement of the retinal venous network. Moreover, in branch RVO patients, static analysis demonstrated that retinal vessels could actually be uninvolved by the occlusive process in areas spared by disease. OI Corvi, Federico/0000-0002-2661-5500 Purpose:To investigate the vasomotor responses and diameter of retinal vessels in patients with macular edema secondary to retinal vein occlusion (RVO).Methods:A total of 18 eyes of 18 RVO patients were consecutively included and compared with age- and sex-matched controls. Participants underwent an examination with optical coherence tomography and dynamic and static retinal vessel analyses using the Dynamic Vessel Analyzer.Results:Dynamic vessel analysis in RVO showed mean maximum venous and arterial dilation of 2.22 1.23% and 1.87 +/- 1.41%, respectively, as compared with 5.05 +/- 2.75% (P = 0.001) and 3.95 +/- 1.44% (P = 0.0004), respectively, in controls. Static retinal vessel analysis in RVO revealed a mean arteriovenous ratio (AVR) of 0.74 +/- 0.09 versus 0.90 +/- 0.04 (P < 0.0001) in controls. Mean AVRs of occluded and nonoccluded quadrants in RVO were 0.71 +/- 0.13 and 0.85 +/- 0.19, respectively; in the corresponding quadrants of controls, mean AVRs were 0.90 +/- 0.19 (P < 0.0001) and 0.86 +/- 0.17 (P = 0.89), respectively. In branch RVO patients, mean AVRs of occluded versus nonoccluded quadrants were 0.70 +/- 0.06 and 0.90 +/- 0.22 (P = 0.002), respectively.Conclusion:In patients with macular edema secondary to RVO, dynamic vessel analysis showed an impairment of both venous and arterial motility and/or reactivity and static vessel analysis showed a reduced AVR indicating a general enlargement of the retinal venous network. Moreover, in branch RVO patients, static analysis demonstrated that retinal vessels could actually be uninvolved by the occlusive process in areas spared by disease.

Purpose To investigate the outcomes of intravitreal antivascular endothelial growth factor (VEGF) therapy in eyes with both neovascular age-related macular degeneration (AMD) and diabetic retinopathy (DR). Methods Patients from four high-volume referral centres who presented with neovascular AMD and DR, and received intravitreal anti-VEGF therapy, were included. Data retrieved from medical records and multimodal imaging were analysed. Results Forty-one eyes of 38 patients (21 male, 17 female; mean age 78±8 years) were enrolled. Median follow-up was 28±19 (12–72) months with a mean of 9.2±7.4 intravitreal anti-VEGF injections per eye were administrated. Best-corrected visual acuity (BCVA) was 0.5±0.3 logMAR; it improved significantly at 1 year (0.3±0.3 logMAR; p=0.02) and returned to baseline values at last follow-up visit (0.6±0.4 logMAR; p=0.26). Mean central macular thickness (CMT) significantly decreased from 408±150 μm to 328±104 μm at 1 year (p=0.021) and to 335±127 μm at last follow-up visit (p=0.032). The baseline severity of DR was graded as mild non-proliferative DR (NPDR) in 21 (51%) eyes, moderate NPDR in 14 (34%), severe NPDR in 4 (10%) and inactive proliferative DR in 2 (5%). At last follow-up visit, one eye graded as moderate NPDR improved to mild, one eye graded as severe NPDR improved to mild and one eye graded as severe NPDR was inactivated due to panretinal photocoagulation. Conclusions Outcomes analysis of intravitreal anti-VEGF therapy for eyes with both neovascular AMD and DR showed stabilisation of BCVA and reduction of CMT, along with stable or improved DR stage throughout follow-up.

The journal retracts the article titled "Systematic Review of Fatal Sodium Nitrite Ingestion Cases: Toxicological and Forensic Implications" [...].