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To compare macular pigment optical density (MPOD) in healthy eyes versus eyes affected by primary epiretinal membrane (ERM) in different stages and to assess the relation between MPOD and optical coherence tomography findings.Prospective cross-sectional study of 62 eyes of 62 patients affected by unilateral primary ERM. Contralateral healthy eyes from the same patients were used as a control group. Main outcome measures were MPOD, ERM stage, central foveal thickness (CFT), outer nuclear layer thickness (ONLT), integrity of outer retinal bands, and presence of central bouquet abnormalities.In the study group, mean CFT was 444 ± 75 μm and mean ONLT was 245 ± 40 μm, whereas in the control group, mean CFT was 230 ± 21 μm and mean ONLT was 102 ± 14 μm (P0.001). Mean MPOD was 0.86 ± 0.07 in eyes with ERM and 0.48 ± 0.09 in contralateral healthy eyes (P0.001). Macular pigment optical density was associated with CFT (P = 0.006) and ONLT (P0.001), whereas no significant associations were observed between MPOD and outer retinal bands integrity (P = 0.14) and central bouquet abnormalities (P = 0.08).Macular pigment optical density increased in eyes affected by primary ERM proportionally to CFT and, especially, ONLT. Probably, centripetal forces exerted by ERM contraction on the retinal surface lead to a progressive foveal packing of foveal Müller cells.

Proliferative vitreoretinopathy (PVR) is an abnormal intraocular scarring process that can complicate cases of rhegmatogenous retinal detachment (RRD). Although previous studies have examined the relevance of microRNAs (miRNAs) in ophthalmic diseases, only a few studies have evaluated the expression profiles of microRNAs in subretinal fluid. We hypothesized that the expression profiles of specific miRNAs may change in response to RRD, in the subretinal fluid that is directly in contact with photoreceptors and the retinal pigment epithelium (RPE). We looked for a potential correlation between the expression of specific miRNAs in eyes with RRD and known clinical risk factors of PVR. A total of 24 patients (59 ± 11 years) who underwent scleral buckling procedure were enrolled in this prospective study. Twenty-four undiluted subretinal fluid samples were collected, RNA was isolated and qRT-PCR was performed to analyze the expression of 12 miRNAs. We found the existence of a positive association between the expression of miR-21 (p = 0.017, r = 0.515) and miR-34 (p = 0.030, r = 0.624) and the duration of symptoms related to retinal detachment. Moreover, the expression of miR-146a tended to decrease in patients who developed PVR. Subretinal fluid constitutes an intriguing biological matrix to evaluate the role of miRNAs leading to the development of PVR.

Objectives. The inverted internal limiting membrane (ILM) flap technique has been shown to increase the success rate in large full-thickness macular holes (FTMHs) and in FTMHs associated with high myopia. The aim of our study was to confirm the efficacy and safety of inverted ILM flap technique in idiopathic FTMHs independent of their dimensions and to assess functional outcomes and their correlation to morphologic findings. Methods. Sixteen consecutive patients affected by idiopathic FTMH were enrolled in this prospective study. The preoperative mean (±SD) diameter of the FTMH was 422 (±106) µm. All patients underwent vitrectomy and ILM peeling with inverted ILM flap. At 1-, 3-, and 6-month postoperative visits, visual acuity measurement, indirect ophthalmoscopy, and microperimetry were performed, and the foveal contour and the integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM) were investigated using spectral domain optical coherence tomography (SD-OCT). Results. At six months postoperatively, 15 out of 16 (93.75%) patients obtained FTMH closure. The mean best corrected visual acuity (BCVA) improved from 1.1 LogMAR to 0.3 LogMAR, and the mean retinal sensitivity (MS) improved from 7.2 to 23.4 dB. ELM defects were evident in 1 out of 16 (6.25%) eyes, and EZ defects were detected in 2 out of 16 (12,50%) eyes. A statistically significant relationship was observed between BCVA, MS, and EZ reconstitution at each follow-up visit. Conclusions. Results confirm that the inverted ILM flap technique is a safe and effective option for FTMH treatment and show a strong correlation between higher BCVAs and MSs and EZ reconstitution after surgery.

(1) Background: The aim of this observational comparative study was to investigate early retinal vascular and functional changes in patients undergoing vitreoretinal surgery for idiopathic epiretinal membrane (iERM) or macular hole (MH) using a widefield swept-source optical coherence tomography angiography (WSS-OCTA). (2) Methods: Forty one diseased eyes were enrolled in the study. Twenty three eyes with iERM diagnosis (ERM group) underwent 25-gauge vitrectomy with inner limiting membrane (ILM) and MER peeling, while eighteen eyes with MH (MH group) underwent 25-gauge vitrectomy with inverted flap technique. Functional and anatomical/perfusion parameters were evaluated pre- and postoperatively in all eyes by means of WSS-OCTA system, microperimetry (MP3), best corrected visual acuity assessment, central macular thickness (CMT) and MH diameter calculation. For each eye, 12 × 12 mm OCTA volume scans were acquired by a retinal specialist and a semi-automated algorithm was used for a quantitative vessel analysis of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC). In detail, perfusion density (PD) of the SCP, DCP and CC was evaluated in four circles (one central in the macular area of 5 mm diameter, three midperiphery circles (temporal, superior and inferior) of 3 mm). In addition, the vessel length density (VLD) of the SCP and DCP for the same circles was quantified. (3) Results: In the MH group, PD of the SCP significantly increased in the macular area (p = 0.018) and in the superior ring (p = 0.016), PD of the DCP significantly increased in the macular area (p = 0.015) and in the superior and inferior ring (p = 0.016) 3 months after surgery. In the ERM group, PD of the SCP and DCP significantly increased in the macular area and superior ring, respectively (p = 0.001, p = 0.032), 3 months after surgery. During follow-up there was a significant improvement in terms of functional (Best corrected visual acuity, p = 0.007 and p = 0.029, microperimetry ((MP3) 10°, p = 0.003 and p = 0.004, MP3 2°, p = 0.028 and p = 0.003 in MH group and ERM group respectively) and anatomical parameters (CMT, p = 0.049 in ERM group, hole complete closure in MH group). (4) Conclusions: After vitreoretinal surgery, early retinal vascular and functional changes can be promptly observed and quantified to monitor and potentially predict surgery outcomes. Widefield OCTA devices allow for a detailed microvasculature analysis of retina and choriocapillaris in the macular area and in the periphery, showing a different behaviour of retinal sectors in two distinct vitreoretinal disorders.

Purpose. To describe the reliability and the limits of bursa premacularis (BPM) evaluation using a swept source optical coherence tomography (SS-OCT) device with enface and 16 mm-high definition (HD) longitudinal scans. Methods. 60 eyes of 60 subjects were enrolled and imaged with SS-OCT system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). BPM area was measured using enface scans imported to ImageJ. HD horizontal and vertical longitudinal scans centered at the fovea were used to detect width (W) and central thickness (CT) of BPM at baseline (T0) and after 30 minutes (T30) performed by two different observers. An enhanced vitreous visualization software provided by the manufacturer of the device was used to highlight vitreous structures. Results. BPM was identifiable in 100% of eyes using both horizontal and vertical longitudinal scans. On horizontal scan, BPM was not entirely measurable in 21.7% and in 18.3% of cases at T0 and T30, respectively. On vertical scan, BPM was not entirely measurable in 75.0% and in 81.7% at T0 and T30, respectively. No statistically significant differences were found between the two different time measurements with an intraclass correlation coefficient above 70%. Median BPM area was 26.9 (Q1-Q3: 19.5-40.5) mm2. In en face imaging, the most frequent BPM shape was the boat one. Conclusion. SS-OCT is a reliable tool for a detailed quantification and mapping of BPM, and it is able to add useful details about the morphological BPM features in youth population. However, the enhanced visualization of the vitreous structures is still a challenge, also with the most forefront devices.

To describe the helpfulness of using intraoperative optical coherence tomography (OCT) during surgery for full-thickness macular hole (FTMH). This observational case series identifies three patients with FTMH who were treated with vitrectomy, internal limiting membrane (ILM) peel with inverted ILM flap, which was tucked into the MH, and air with 18% Sulfur Hexafluoride (SF6) gas tamponade. Intraoperative OCT was used to confirm positioning of the ILM flap, even after complete air-fluid exchange. The patients were followed for three months after surgery and all reached a good morphological and functional outcome. If confirmed by a prospective longitudinal study, the intraoperative OCT might become an important tool in assisting FTMH surgery.

To evaluate superficial capillary plexus (SCP) changes occurring after internal limiting membrane (ILM) peeling for the treatment of idiopathic epiretinal membrane (ERM). A total of 15 eyes of 15 patients affected by idiopathic ERM (eight males and seven females; mean age 59.8 ± 9.6 years) were enrolled in the study. Patients were treated with pars plana vitrectomy followed by ERM and ILM peeling. Subjects were evaluated at baseline and at the week-1 and month-1 follow-up visits. At each visit, patients were evaluated with a complete ophthalmologic evaluation, which included imaging with optical coherence tomography angiography. Overall, the SCP vessel density was 43.0 ± 3.0% at baseline and was stable throughout the follow-up (40.0 ± 4.0% at week-1 and 41.0 ± 4.0% at month-1 follow-up visits; p = 0.087 and p = 0.426, respectively). Nevertheless, the SCP vessel density was reduced at week-1 visit in both the superior and inferior sectors. In these sectors, the superficial vessel density was still reduced at the month-1 follow-up visit. We observed a reduction in the SCP vessel density occurring after pars plana vitrectomy with ILM peeling. The reduction is referred to those areas where other changes (e.g., swelling of the arcuate nerve fiber layer) have been already described. In theory, superficial vessel density modifications may be due to the direct surgical trauma to the inner retina, where the superficial plexus is contained, during the ILM grasping.

Purpose To evaluate the efficacy, effect profile, and safety of dexamethasone implant on diabetic macular edema (DME) in a real-life setting, further comparing results by DME duration, previous treatment status, and diabetic control. Design A multicenter, retrospective cohort of 340 DME eyes of 287 patients from 25 clinical sites from 8 countries. Methods Data were analyzed in 2 perspectives: per injection, in which all measurements were grouped and baseline was defined as the day of injection, and thus the pharmacodynamics of single injections could be assessed; and injection series, defined as 2 or more injections with 3 to 6 months between injections analyzing the outcome 3 to 6 months after the last injection. Main Outcome Measures Primary outcome was improvement of 15 or more letters in best-corrected visual acuity (BCVA) from baseline. Secondary outcomes included improvement of 10 letters or more in BCVA, change in central macular thickness (CMT), and time to maximum improvement and safety. Results Overall, 762 injections were administered to 340 eyes of 287 patients. Injection series analysis included 171 series in 171 eyes of 150 patients, for a total of 444 injections, with a mean follow-up of 1.7±0.8 years. Of the 762 injections analyzed per injection, 22.7% achieved a 15-letter or more improvement, and 37.8% achieved a 10-letter or more improvement. Mean time to peak improvement was 81.9±39.7 days. Mean maximum change in CMT was –174±171 μm. Overall, 7.6% lost 15 or more letters. More eyes with early DME gained 10 or more letters and fewer eyes lost 10 or more letters compared with eyes with late DME (47.4% vs. 33.9% [P = 0.001] and 8.2% vs. 13.5% [P = 0.029], respectively). Patients with controlled diabetes showed greater CMT reduction (P = 0.0002). A higher percentage of treatment-naive patients gained 10 or 15 letter or more in BCVA (P = 0.001 and P = 0.006, respectively). Intraocular pressure elevation of more than 25 mmHg was found following 7.9% of injections; no endophthalmitis was reported. Conclusions Dexamethasone implant is an effective and safe treatment for DME. Peak improvement was achieved 3 months after injection and dissipated thereafter. Clinicians and providers may consider shortening treatment intervals.

(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA), (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling were evaluated pre- and postoperatively using SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 6x6-mm OCTA volume scans were acquired by two observers independently. The en face images of superficial capillary plexus (SCP) were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. Perfusion density (PD), vessel length density (VLD), vessel diameter index (VDI) and vessel tortuosity (VT) of SCP were evaluated in both the parafoveal (2.5 mm diameter) and perifoveal areas (5.5 mm diameter), (3) Results: At OCTA analysis statistically significant differences were found between controls and diseased eyes for all parameters in parafoveal and perifoveal regions (p&lt, 0.001, p&lt, 0.05) except for perifoveal VLD. During 6-month follow up, both anatomical/perfusion and functional parameters showed a statistically significant improvement if compared to preoperative values. In detail, at one month post vitrectomy, VLD and VT significantly changed in parafoveal region (p=0.043, p=0.045), while PD and VDI showed a trend of increase in both parafoveal and perifoveal region. At 6 months after surgery, PD, VLD and VT of parafoveal region significantly improved (p=0.021, p=0.018, p=0.047 respectively). (4) Conclusions: SS-OCTA provides a quantitative and qualitative analysis of the superficial capillary plexus allowing for early vascular changes assessment after vitrectomy with iERM and ILM peeling.

The aim of this work was to characterize the choriocapillaris (CC) in patients with Stargardt disease (STGD) using the swept source widefield optical coherence tomography angiography (SS WF OCTA) and to compare CC perfusion density to retinal sensitivity, analyzed using microperimetry (MP). This cross-sectional study included 9 patients (18 eyes) with STGD and central CC atrophy (stage 3 STGD). The CC was analyzed using SS WF OCTA and areas of different CC impairment were quantified and correlated with retinal sensitivity analyzed using MP. The main outcome measures were the percent perfused choriocapillaris area (PPCA), retinal sensitivity, and correlation between PPCA and retinal sensitivity. Seventeen eyes of 9 patients suffering from stage 3 STGD were analyzed. SS WF OCTA revealed a vascular rarefaction in central atrophic zones and a near atrophy halo of choriocapillaris impairment. In all eyes were noticed a central atrophy (CA) area with absolute absence of CC that corresponded to 0 dB points at MP, a near atrophy (NA) zone of PPCA impairment that included points with decreased sensitivity at MP and a distant from atrophy (DA) zone with higher PPCA and retinal sensitivity values. The mean difference of PPCA and retinal sensitivity between NA and CA and DA and CA was statistical significantly different (p &lt, 0.01), the latter showing higher values. A direct relationship between PPCA and retinal sensitivity was found (p &lt, 0.001). Choriocapillaris damage evaluated using SS WF OCTA correlates with MP, these data suggest that CC impairment may be a predictor of retinal function in patients with STGD.

PURPOSE To describe the occurrence of epiretinal membrane (ERM) in eyes with vitreomacular traction and to correlate the presence of ERM with retinal structural alterations detected using spectral domain optical coherence tomography. METHODS In this retrospective observational cross-sectional study, we collected data from 502 eyes (307 patients) with diagnosis of vitreomacular traction. The presence of ERM and retinal lesions (cystoid cavities, neuroepithelial detachment, external limiting membrane, and ellipsoid zone discontinuity) was determined by standardized grading of macular spectral domain optical coherence tomography scans. RESULTS The occurrence of ERM in eyes with vitreomacular traction was 37.5%. The mean ± SD central foveal thickness was 411 ± 60 µm in eyes with ERM and 380 ± 148 µm in eyes without ERM (P < 0.05). The occurrence of cystoid cavities (38.3% vs. 23.2%, P < 0.05), neuroepithelial detachment (24.5% vs. 9.9%, P < 0.0001), external limiting membrane discontinuity (16.5% vs. 5.1%, P < 0.0001), and ellipsoid zone discontinuity (13.3% vs. 6.7%, P < 0.05) was higher in eyes with ERM. The mean ± SD best-corrected visual acuity was 0.45 ± 0.16 logarithm of the minimum angle of resolution (Snellen equivalent of approximately 20/50) in eyes with ERM and 0.37 ± 0.09 in eyes without ERM (Snellen equivalent of approximately 20/40, P < 0.0001). Symptoms of metamorphopsia were present in 55 of 188 eyes with ERM (29.3%) and 40 of 314 eyes without ERM (12.7%, P < 0.0001). CONCLUSION This study reported the occurrence of ERM in eyes with vitreomacular traction and demonstrated that ERM is significantly associated with an increased occurrence of other structural changes of the neuroretina and a negative effect on quantity and quality of vision.

To investigate associations between changes in retinal vessels and alterations detected by spectral domain optical coherence tomography (SD-OCT) scans in intermediate stage age-related macular degeneration (AMD).Thirty eyes of 30 patients with intermediate dry AMD were enrolled in the study. Of the cohort study, 15 eyes (changes-AMD group) showed OCT changes preceding the development of drusen-associated atrophy. A control group of healthy subjects was selected for statistical comparisons. All patients underwent an ophthalmologic evaluation, including OCT angiography (OCTA) and SD-OCT scans. Main outcome measures were superficial vessel density, deep vessel density, macular thickness.Foveal macular thickness was 215.2±32.9 μm in changes-AMD patients and was significantly thinner than no changes-AMD patients (248.3±23.3 μm, p=0.002) and healthy subjects (268.1±19.2 μm, p0.0001). Furthermore, in the parafoveal area, the thicknesses of both the inner retina and the outer retina were reduced in the changes-AMD group, after comparison with the two other groups. Parafoveal superficial vascular plexus flow density was 43.3±2.7% in changes-AMD patients and was decreased compared with the no changes-AMD group (48.7±3.3%, p=0.003) and healthy controls (50.4±6.1%, p=0.001). A direct correlation of the superficial plexus flow density with the inner retina parafoveal macular thickness (RWe demonstrated an association between SD-OCT signs and retinal blood supply in patients with intermediate AMD and we showed that patients with signs predicting development of geographic atrophy have a reduced flow in superficial vascular plexus and damage of the inner and the outer retina.

PURPOSE To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). METHODS Twenty RRD eyes were consecutively enrolled. AS-OCT was performed at RRD diagnosis (RRD-D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD-D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra-scleral hypo-reflective spaces area (MIHSA) at AS-OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra-ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. RESULTS Rhegmatogenous retinal detachment- diagnosis (RRD-D) overall-mean intra-scleral hypo-reflective spaces (MISHA), -MMD and -MMA were significantly higher in affected eye (AE) compared with UE (p

Purpose To investigate alterations of superficial and deep retinal vascular densities, as well as of choroidal thickness, in patients affected by adult-onset foveomacular vitelliform dystrophy (AOFVD). Methods A total of 22 eyes (15 patients) affected by AOFVD were recruited in the study. Furthermore, 20 eyes of 20 healthy subjects and 20 eyes of 18 patients affected by intermediate dry age-related macular degeneration (AMD) were enrolled. All patients underwent a complete ophthalmologic examination, including optical coherence tomography angiography. Outcome measures were superficial vessel density, deep vessel density, and choroidal thickness. Results Parafoveal superficial vessel density was increased in patients with AOFVD compared with the AMD group (50.6 ± 4.3% and 46.3 ± 4.3%, respectively, P = 0.016). Parafoveal deep vessel density was 57.9 ± 6.4% in patients with AOFVD, 52.2 ± 3.8% in patients with AMD, and 52.7 ± 6.0% in healthy controls (P = 0.006 and P = 0.035, respectively, after comparison with the AOFVD group). Conclusion We demonstrated that both superficial and deep vessel densities were significantly increased in patients with AOFVD, after the comparison with intermediate patients with AMD. These findings suggest that the pathogenic mechanisms in AOFVD are different from those in AMD and that optical coherence tomography angiography could be useful in differentiate early stages of these two diseases.

The aim of this study was to evaluate retinal and choriocapillaris vessel density using optical coherence tomography angiography (OCTA) in eyes with central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) complicated by macular edema (ME). Sixty eyes of 60 patients with CRVO or BRVO and ME and 40 healthy subjects underwent measurements of superficial and deep foveal and parafoveal vessel density (FVD, PFVD) and choricapillary density using OCTA at baseline and 60 days after intravitreal dexamethasone implant (IVDEX). FVD and PFVD of the superficial plexus were not significantly lower in CRVO group compared to the controls while in the BRVO group overall PFVD were significantly lower compared to control group (p

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

The aim of this study was to evaluate retinal and choriocapillaris vessel density using optical coherence tomography angiography (OCTA) in eyes with central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) complicated by macular edema (ME). Sixty eyes of 60 patients with CRVO or BRVO and ME and 40 healthy subjects underwent measurements of superficial and deep foveal and parafoveal vessel density (FVD, PFVD) and choricapillary density using OCTA at baseline and 60 days after intravitreal dexamethasone implant (IVDEX). FVD and PFVD of the superficial plexus were not significantly lower in CRVO group compared to the controls while in the BRVO group overall PFVD were significantly lower compared to control group (p

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

Purpose To investigate vessel changes occurring after aflibercept injections in treatment-naive exudative age-related macular degeneration patients. Methods Fifteen eyes of 15 patients affected by wet age-related macular degeneration were enrolled in the study. All the patients had a diagnosis of Type 1 choroidal neovascularization and were treated with 3 monthly aflibercept intravitreal injections (IVI). Subjects were evaluated by means of optical coherence tomography angiography at baseline, the day after the first injection and one month after both the first and the second IVI. At last, all the patients were followed up to 2 months after the third IVI. Results Foveal superficial vascular plexus flow density was 29.01% (21.13-37.32%) at baseline and was significantly reduced as soon as 1 month after the first IVI (median: 20.78%; interquartile range: 14.75-23.13%; P = 0.017). Parafoveal superficial vascular plexus flow density was 47.09% (44.91-51.72%) at baseline and significantly decreased as soon as 1 month after the second IVI (median: 44.40%; interquartile range: 41.59-49.29%; P = 0.034). Choroidal neovascularization lesion area remained stable throughout the follow-up. Nevertheless, interestingly, choroidal neovascularization flow area was significantly reduced as soon as the next day the first IVI (median: 0.37 mm and interquartile range: 0.27-0.72 mm at baseline; median: 0.30 mm and interquartile range: 0.24-0.64 mm at 1 day after the first IVI; P = 0.047). Conclusion Intravitreal aflibercept injections are associated with a significant change in native retinal and choroidal vasculature. Moreover, the treatment did not cause a reduction in lesion area, but rather reduced the flow in the choroidal neovascularization.

Purpose To evaluate signal transduction and early apoptosis protein levels in subretinal fluid collected during scleral buckling surgery for macula-off rhegmatogenous retinal detachment (RRD). Our aim was to assess both their relation with RRD features and their influence on the posttreatment outcome. Methods Thirty-three eyes of 33 RRD patients scheduled for scleral buckle surgery were enrolled in the study. Undiluted subretinal fluid samples were collected during surgery and analyzed via magnetic bead-based immunoassay. All patients underwent a complete ophthalmologic evaluation at baseline and at each follow-up visit (months 1, 3, and 6). Moreover, both at baseline and at the postsurgery month 6 visit, the patients were tested by means of spectral-domain optical coherence tomography (SD-OCT) in order to evaluate the average ganglion cell-inner plexiform complex thickness, as well as the photoreceptor inner segment/outer segment junction status. Results Patients' clinical features (retinal detachment size, detachment duration, and occurrence of proliferative vitreoretinopathy) were associated with several early apoptotic factors (caspase-8, caspase-9, and B-cell lymphoma 2 [Bcl-2]-associated death promoter [BAD]). Furthermore, both early apoptosis factors (caspase-8, Bcl-2, and p53) and signal-transduction proteins (ERK 1/2) were found to influence the postsurgery month 3 OCT characteristics. Conclusions Signal-transduction proteins and early apoptosis proteins are associated with different clinical features and postsurgery outcomes.

Purpose To investigate correlations among macular ganglion cell complex (GCC) layer thickness, macular capillary density, and macular function in patients affected by retinitis pigmentosa (RP). Methods Fourteen patients (28 eyes) with previous diagnosis of RP were enrolled. The diagnosis of these conditions was made based on both clinical features and electrophysiological examination. All patients underwent a complete ophthalmologic examination, including optical coherence tomography angiography (OCTA) and multifocal electroretinogram (mfERG). Main outcome measures were macular GCC layer thickness; superficial capillary plexus (SCP) vessel density; deep capillary plexus (DCP) vessel density; choriocapillaris plexus (CCP) vessel density; and amplitudes of mfERG N1 and P1 waves. Results Average GCC thickness was significantly thinner in RP patients (76.0 ± 25.1 and 109.2 ± 17.5 μm, P = 0.028). Superficial capillary plexus density was 42.2 ± 3.4% in the RP group and 51.4 ± 2.3% in the control group (P < 0.001). Deep capillary plexus density was reduced in RP patients (42.7 ± 6.2%) after the comparison with healthy subjects (56.6 ± 2.2%, P < 0.001). Choriocapillaris plexus density was significantly less in RP patients than in the control group (65.3 ± 2.7% and 67.2 ± 1.4%, P = 0.024). Superficial capillary plexus and DCP density were significantly correlated with both mfERG values and GCC thickness. Conclusions We showed that both choroid and retinal vessels were modified in RP patients after comparison with healthy subjects. Moreover, we demonstrated that the SCP and DCP vessel densities are correlated with the macular function, as well as with the GCC thickness.

PURPOSE. To report morphologic features of idiopathic macular telangiectasia (MacTel) type 2 by means of optical coherence tomography angiography (OCTA) and to compare these findings to fundus fluorescein angiography (FFA), fundus autofluorescence (FAF), confocal blue reflectance (CBR), and spectral-domain OCT (SD-OCT). In addition, foveal vessel density and parafoveal vascular density (PFVD), and foveal retinal thickness and parafoveal retinal thickness (PFRT) were compared between MacTel 2 patients and normal aged-matched controls. METHODS. Eight patients (15 eyes) with MacTel 2 and 17 normal controls (17 eyes) underwent retinal multimodal imaging assessment and grading. Results from different imaging techniques were used to compare interimaging modalities. Objective quantification of retinal vessel density and macular thickness was evaluated in MacTel 2 patients (15 eyes). RESULTS. In MacTel 2 eyes a comparison of OCTA to the other imaging techniques showed that the strongest correlations were present with SD-OCT, early FFA, and late FFA. Moderate correlations were found between OCTA and CBR and FAF. Foveal vessel density was significantly lower in MacTel 2 eyes than control eyes both in the superficial plexus (23.74% vs. 33.14%; P = 0.003) and in the deep plexus (24.63% vs. 34.21%; P = 0.005). Superficial PFVD was significantly different in the two groups (47.06% vs. 51.40%; P = 0.005) but not the deep PFVD. Foveal retinal thickness was 214.13 mu m in MacTel 2 eyes and 258.18 mu m in normal controls, and PFRT was 279.60 and 323.29 mu m, respectively (P CONCLUSIONS. Optical coherence tomography angiography is useful for retinal vasculature characterization in MacTel type 2 patients and showed a high correlation with well-established imaging techniques.

Purpose: To assess the reproducibility and repeatability of peripapillary retinal nerve fibre layer (RNFL) thickness measurements using a spectral-domain optical coherence tomography (SD-OCT) device in healthy subjects. Methods: In this observational study, 68 young Caucasian healthy volunteers (68 eyes) were subjected to Cirrus™ high-definition (HD) OCT (Zeiss) peripapillary RNFL thickness measurements by two experienced examiners in two different sessions. Average, 4-quadrant and 12-clock-hour sector RNFL thicknesses were analysed. For each option, intra-observer, intrasession repeatability and interobserver, intersession reproducibility were tested. To assess the repeatability of measurements, the Bland and Altman plots were used and the coefficient of repeatability was calculated. Interobserver and intersession reproducibilities were analysed by means of concordance correlation coefficients (CCCs). Results: The sample age ranged from 21 to 39 years (mean 29.09, standard deviation ±5.21). The average RNFL thickness ranged from 90.97 to 91.46 and from 91.34 to 91.78 µm, for the first and the second operator, respectively. The highest repeatability and reproducibility were obtained for average RNFL thickness with coefficients of repeatability of 5.30 and 6.05 µm for the first and the second operator, interoperator CCCs of 0.95 and 0.96 for the first and the second session, and intersession CCCs of 0.96 and 0.97 for the first and the second operator, respectively. Conclusions: Cirrus OCT peripapillary average RNFL thickness measurement in young healthy subjects showed high interoperator and intersession reproducibility. Intrasession repeatability as tested by coefficient of repeatability was next to the device resolution, with very similar results between the two operators. When analysing quadrant and clock hour sector RNFL thickness measurements, both repeatability and reproducibility tend to decrease.

To determine the feasibility and initial outcomes of using a femtosecond laser to perform arcuate keratotomies to correct high post-keratoplasty astigmatism.Prospective noncomparative interventional case series.Twelve eyes of 12 consecutive patients (mean age 44.9+/-9.5 years) who presented with a high degree of astigmatism, noncorrectable with spectacles or contact lenses (10 post-penetrating keratoplasty, 2 post-deep lamellar keratoplasty), and were candidates for relaxing incisional corneal surgery.The Femtec (20/10 Perfect Vision, GmbH, Heidelberg, Germany) femtosecond laser performed paired 90-degree angled arcuate incisions on the graft button. The incision sites and depths were programmed at 1.00 mm inside the graft edge and at 90% of the corresponding local graft thickness, whereas the angular lengths of the cuts were determined by analyzing the locations and extents of the steepest meridians in the topographic map.Changes in uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), mean subjective and topographically determined astigmatism; imaging of incisions by anterior segment optical coherence tomography (AS-OCT); and wound healing by in vivo confocal microscopy (IVCM).Postoperative follow-up extended to 6 months. Mean uncorrected logarithm of the minimum angle of resolution (logMAR) BSCVA and UCVA improved from preoperative values of 0.25+/-0.16 and 1.05+/-0.18 to 6-month values of 0.11+/-0.12 (standard deviation) and 0.55+/-0.34, respectively (P0.05). Mean subjective astigmatism was 7.16+/-3.07 diopters (D) preoperatively and 2.23+/-1.55 D at 1 month after surgery (P = 0.002) and remained stable to the end of follow-up. Anterior segment optical coherence tomography image analysis showed that the depth and location of the incisions were consistent with the preoperative surgical plan. In vivo confocal microscopy showed mild edema and keratocyte activation along the incision edges, together with initial epithelial ingrowth inside the wound, followed by subsequent moderate fibrotic scarring.Arcuate keratotomies performed with the femtosecond laser were effective in reducing post-keratoplasty astigmatism. Laser-generated incisions within the graft button presented precise geometry and reliable depth of incision, with a wound healing pattern characterized by epithelial ingrowth and mild fibrosis.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

A 72-year-old woman with cataract had phacoemulsification and intraocular lens implantation in the capsular bag with continuous curvilinear capsulorrhexis in the right eye. One day postoperatively, cortical remnants were noted between the posterior capsule and the intra-ocular lens optic located inferiorly. Uncorrected visual acuity was 1.0 and the patient was emmetropic. At a control visit 6 years postoperatively, the patient showed a hyperopic shift compared with the refraction of the first postoperative period with a best-corrected visual acuity of 0.4. A transparent liquefied substance that accumulated between the lens optic and the fibrotic capsule and surrounding the residual cortical masses was clearly visible using slit-lamp biomicroscopy and anterior segment optical coherence tomography. A surgical revision with aspiration of the cortical masses and the fluid was performed, resolving the capsular block syndrome. A neodymium:YAG laser posterior capsulotomy followed to clear the visual axis.

PurposeTo study neuroretinal alterations in patients affected by type 2 diabetes with no diabetic retinopathy (DR) or mild nonproliferative diabetic retinopathy (NPDR) and without any sign of diabetic macular edema.Patients and methodsIn total, 150 type 2 diabetic patients with no (131 eyes) or mild NPDR (19 eyes) and 50 healthy controls were enrolled in our study. All underwent a complete ophthalmologic examination, including Spectral-Domain optical coherence tomography (SD-OCT). Ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) thickness values were calculated after automated segmentation of SD-OCT scans.ResultsMean best-corrected visual acuity was 0.0±0.0 LogMAR in all the groups. Mean GC-IPL thickness was 80.6±8.1 μm in diabetic patients and 85.3±9.9 μm in healthy controls, respectively (P=0.001). Moreover, evaluating the two different diabetic groups, GC-IPL thickness was 80.7±8.1 μm and 79.7±8.8 μm in no-DR and mild-NPDR group (P=0.001 and P=0.022 compared with healthy controls, respectively). Average RNFL thickness was 86.1±10.1 μm in diabetes patients and 91.2±7.3 μm in controls, respectively (P=0.003). RNFL thickness was 86.4±10.2 μm in no-DR group and 84.1±9.4 μm in mild-NPDR group (P=0.007 and P=0.017 compared with healthy controls, respectively).ConclusionWe demonstrated a significantly reduced GC-IPL and RNFL thickness values in both no-DR and mild-NPDR groups compared with healthy controls. These data confirmed neuroretinal alterations are early in diabetes, preceding microvascular damages.

To investigate alteration in superficial and deep retinal vascular densities and choroidal thickness, in patients affected by early and intermediate age-related macular degeneration (AMD).All patients had undergone optical coherence tomography angiography (OCTA). All eyes were grouped into two stages: "early AMD" and "intermediate AMD." Outcome measures were superficial vessel density, deep vessel density, and choroidal thickness. A control group of healthy subjects was selected for the statistical comparisons.A total of 37 eyes of 37 dry AMD patients were enrolled for the study. Fourteen of 37 eyes were classified as having early AMD, the remaining 23 of 37 eyes were classified as being affected by intermediate AMD. Superficial and deep vessel densities were 39.21% ± 10.67% and 43.84% ± 11.57%, respectively, in the control group and 28.30% ± 10.73% and 36.41% ± 12.30%, respectively, in AMD patients (P = 0.001 and P = 0.017, respectively). Choroidal thickness was significantly reduced in AMD patients.In the last years, several studies have reported vascular factors playing an important role in AMD pathogenesis. We demonstrated that both superficial and deep retinal plexuses are altered among patients affected by AMD. Interestingly, this alteration starts immediately at the intermediate AMD stage and also the choroidal thickness reduction.

We report a case of corneal infection caused by Streptococcus pneumoniae after hyperopic photorefractive keratectomy (PRK) that produced severe corneal melting, ulceration, and multiple perforations. Treatment included antibiogram-based antibiotic topical therapy and multilayer amniotic membrane transplantation (AMT) performed to seal the perforations and restore the globe integrity. Clinical and anterior segment optical coherence tomography (Visante OCT, Carl Zeiss Meditec) examinations documented progressive integration of the amniotic membrane tissues within the cornea, stromal and epithelial healing, and recovery of a stable and regular anterior chamber. The cornea healed with an avascular leucoma; the best corrected visual acuity was reduced to 20/200. Severe pneumococcal ulcerative perforation is a potential complication of PRK. Penetrating keratoplasty, at high risk for failure in the acute settings of an infected and inflamed eye, can be delayed until the cornea is healed. Amniotic membrane transplantation may be an alternative surgical option to achieve this goal.

Purpose: To evaluate the longterm efficacy of 1 CU® accommodative intraocular lenses (IOLs) to restore near visual performance. Methods: This prospective study comprised 14 eyes previously included in a 6-month, case-control clinical trial, undergoing phacoemulsification and implantation of a 1 CU® accommodative IOL. The main outcome measures were subjective refraction, uncorrected distance visual acuity (UCDVA), best corrected distance VA (BCDVA), distance-corrected near VA (DCNVA), best corrected near VA (BCNVA), and subjective amplitude of accommodation (AA). In addition, anterior and posterior capsule opacification were assessed. Patients were examined over a 2-year follow-up period. Results: Distance and near visual performance worsened after 6 months. Uncorrected DVA and BCDVA were 0.8 ± 2.1 and 1.0 ± 0.8 at 6 months and 0.4 ± 0.1 and 0.6 ± 0.1 at 1 year, respectively (p = 0.001). Distance-corrected NVA and BCNVA were 3.7 ± 2.1 Jaeger (J) and 1.0 ± 0.7 J at 6 months and 8.1 ± 0.7 J and 1.5 ± 0.5 J at 1 year, respectively (p = 0.001). Anterior and posterior capsule opacification were present, respectively, in 28% and 21% of patients at 6 months and in 100% of patients at 1 and 2 years (p

Background/aims To assess the reproducibility and repeatability of foveal avascular zone (FAZ) area measurements using optical coherence tomography angiography (OCT-A) in healthy subjects. Methods Sixty healthy volunteers (60 eyes) were subjected to FAZ area measurements by means of high speed and high resolution spectral-domain OCT (SD-OCT) XR Avanti with the split-spectrum amplitude decorrelation angiography algorithm by two experienced examiners in two different sessions. Results The mean±SD age of the subjects was 28.9±7.6 years. Overall FAZ areas measured by the first and second observer were 0.251±0.096 mm2 and 0.252±0.096 mm2, respectively. Within subjects, the coefficients of variations were 1.83% (95% CI 1.51% to 2.20%) and 1.86% (95% CI 1.33% to 2.43%) for the first and second observers, respectively. The coefficient of repeatability average measurements of FAZ area were 0.015 mm2 and 0.013 mm2 for the first and second observers, respectively. The intraclass correlation coefficient values were 0.997 (95% CI 0.995 to 0.998) and 0.998 (95% CI 0.996 to 0.999) for the first and second observers, respectively. Inter- and intraobserver concordance correlation coefficients ranged from 0.994 (95% CI 0.990 to 0.977) to 0.999 (95% CI 0.997 to 0.999) and from 0.997 (95% CI 0.995 to 0.998) to 0.996 (95% CI 0.994 to 0.998), respectively. Conclusions FAZ area measurements by means of OCT-A showed excellent reproducibility and repeatability in healthy eyes. OCT-A is a non-invasive diagnostic method, and its reliability makes it an interesting potential diagnostic tool for disease detection and follow-up in retinal pathologies involving foveal microcirculation.

PURPOSE. To evaluate the refractive and aberrometric outcome of wavefront-guided photorefractive keratectomy (PRK) compared to standard PRK in myopic patients. METHODS. Fifty-six eyes of 56 patients were included in the study and were randomly divided into two groups. The study group consisted of 28 eyes with a mean spherical equivalent (SE) of -2.25±0.76 diopters (D) (range: -1.5 to -3.5 D) treated with wavefront-guided PRK using the Zywave ablation profile and the Bausch & Lomb Technolas 217z excimer laser (Zyoptix system) and the control group included 28 eyes with a SE of -2.35±1.01 D (range: -1.5 to -3.5 D) treated with standard PRK (PlanoScan ablation) using the same laser. A Zywave aberrometer was used to analyze and calculate the root-mean-squar e (RMS) of total high order aberrations (HOA) and Zernike coefficients of third and fourth order before and after (over a 6-month follow-up period) surgery in both groups. Preoperative and postoperative SE, uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were evaluated in all cases. RE S U LT S. There was a high correlation between achieved and intended correction. The differences between the two treatment groups were not statistically significant for UCVA, BCVA, or SE cycloplegic re f r a c t i o n . Postoperatively the RMS value of high order aberrations was raised in both groups. At 6-month control, on average it increased by a factor of 1.17 in the Zyoptix PRK group and 1.54 in the PlanoScan PRK group (p=0.22). In the Zyoptix group there was a decrease of coma aberration, while in the PlanoScan group this third order aberration increased. The difference between postoperative and preoperative values between the two groups was statistically significant for coma aberration (p=0.013). No statistically significant difference was observed for spherical-like aberration between the two groups. In the study group eyes with a low amount of preoperative aberrations (HOA RMS lower than the median value

To analyze ocular wavefront error and corneal asphericity (Q) in patients treated with aspheric profile photorefractive keratectomy (PRK) compared with patients having conventional PRK to correct myopia and myopic astigmatism and to evaluate the effect of postoperative corneal shape on visual performance.Eye Clinic, University G. d'Annunzio, Chieti-Pescara, Italy.Fifty eyes were treated with aspheric profile PRK using the MEL 80 flying-spot excimer laser, and 24 eyes were treated with standard PRK using the MEL 70 flying-spot excimer laser.Postoperative wavefront error increased in both groups. Six months after surgery, there was a smaller increase in root mean square (RMS) of total higher-order aberrations and spherical aberration (59% and 106%, respectively) in the aspheric profile PRK group than in the conventional PRK group (94% and 136%, respectively) (P.01). The aspheric profile PRK group showed more prolate corneal asphericities (mean Q of 0.15 +/- 0.26) than the conventional group (mean Q of 0.45 +/- 0.26) (P.001), with increasing oblateness for higher attempted corrections. A higher percentage of patients with better low-contrast uncorrected visual acuity and best corrected visual acuity was observed in the aspheric PRK group than in the conventional PRK group (P.05).Aspheric profile and conventional PRK were safe and efficient for the correction of myopia and myopic astigmatism. Moreover, aspheric profile PRK induced a smaller increment of total wavefront error, was related to a smaller increase in spherical aberration, and better maintained the physiology of the corneal surface than conventional treatment.

PU R P O S E. To evaluate variability of retinal nerve fiber layer (RNFL) thickness measure m e n t s in normal eyes and their correlation with optic disc diameter by using two different scan options of the ultimate commercial optical coherence tomography (OCT) unit (STRAT U S OCT™, Carl Zeiss Meditec, Inc., Dublin, CA). ME T H O D S. In this observational case series and instrument validation study 30 eyes of 30 normal subjects were enrolled. Each eye underwent optic disc vertical diameter m e a s u rement by means of both stereoscopic photography and planimetry and OCT; RNFL thickness measurements were performed using OCT. Three repetitions of two series of scans were performed. Each eye was scanned at two different options (RNFL thickness 3.4 and Nerve Head Circle). For each option descriptive statistics, analysis of variance, intraclass correlation coefficients (ICCs), and coefficients of variation (COVs) were calculated. To verify the correlation between the two methods of optic disc diameter assessment and to study the influence of optic disc diameter on RNFL m e a s u rement using the two different OCT options, Pearson’s correlation coefficients w e re calculated. RE S U LT S. Optic disc diameter length ranged from 1.47 to 2.04 mm (mean 1.709 mm, SD ± 0.147) with stereoscopic photographs, and from 1.47 to 2.02 mm (mean 1.703 mm, SD ± 0.143) with OCT (Pearson correlation coefficient 0.999, p

Background To investigate changes in macular morphology and function after an intravitreal dexamethasone implant for diabetic macular edema (DME). Methods Twenty-seven eyes in 27 treatment-naive patients affected by DME were treated with intravitreal Ozurdex® injections (IVOI) and followed up 12 months to evaluate morphological and functional changes by means of best-corrected visual acuity (BCVA), microperimetry (MP1), multifocal electroretinography (mfERG), pattern electroretinography (PERG) and spectral domain optical coherence tomography (SD-OCT). Results Both BCVA and retinal sensitivity improved significantly at one month after the IVOI (p = 0.031 and p

A 29-year-old man with Schnyder’s central crystalline dystrophy was treated with phototherapeutic keratectomy (PTK) in his right eye. Ocular examination revealed abnormal deposits of cholesterol and lipid within the corneal stroma (appearing as crystalline spindle-shaped deposits), high myopia, phakic anterior chamber intraocular lens implantation, and myopic macular degeneration in both eyes. Phototherapeutic keratectomy ablation to a central zone of 7.0 mm and a depth of 96 μm was performed with an Aesculap Meditec MEL-70 excimer laser. Confocal microscopy performed before PTK showed multiple deposits of large, brightly reflective crystalline material extending from the anterior to the mid stroma. The Z-scan curves revealed that the highest density of crystalline deposits was located within the first 140 μm of corneal depth. Six months after PTK, confocal microscopy showed a markedly decreased density of corneal crystalline deposits in the anterior stroma.

Purpose: To evaluate the reproducibility of nerve fiber layer (NFL) thickness measurements by optical coherence tomography (OCT) in individuals with silicone oil-filled eyes. Methods: Eighteen patients who had undergone pars plana vitrectomy and silicone oil tamponade for retinal detachment were enrolled in a prospective, case-controlled clinical study. Each patient underwent OCT measurement of NFL thickness. Five repetitions of a series of scans on five separate occasions within a 0.5-month period were performed. Each eye was scanned at two different nerve head programs [radius (R) = 1.5 and R = 1.73]. The contralateral healthy eye was used as control. For each option (R = 1.5 and R = 1.73) and region (superior, inferior, temporal, nasal and overall mean), variance components and intraclass correlation coefficients (ICCs) were determined using repeated-measures regression. In these models, NFL thickness, as measured by OCT, was considered to have three variance components: intersubject, intervisit (within subject, between dates), and intravisit (within subject, within date). The ICC (intersubject variance/total variance) was used as a measure of reliability. Results: The contralateral healthy eye provided a higher degree of reproducibility than the silicone oil-filled eye (p = 0.0001). Reproducibility was higher in a given eye on a given visit than from visit to visit. Reproducibility as measured by ICCs was as follows: R = 1.5, 0.54/0.30 (control eyes/silicone oil-filled eyes); R = 1.73, 0.51/0.30. Conclusions: Reproducibility results for OCT measurement of NFL thickness are different in healthy eyes and silicone oil-filled eyes. NFL thickness measurement is not reliable in silicone oil-filled eyes.

A case-control masked study was performed in 37 patients with chronic fatigue syndrome (GFS) to evaluate ocular signs, symptoms, and functional parameters. A significant association was found between CFS and blurred vision at near, foggy vision, shadowed vision, headaches, and photophobia. Blurred vision, foggy vision, and headaches were associated with abnormal oculomotor function, and shadowed vision and photophobia were associated with tear deficiency. These data suggest that CFS affects the ocular system.

To compare the efficacy and side effects and the effect on aqueous humor dynamics of 0.005% latanoprost applied topically once daily with 0.5% timolol given twice daily for 12 months to patients with pigmentary glaucoma.Prospective, randomized, double-masked, clinical study.Thirty-six patients affected with bilateral pigmentary glaucoma controlled with no more than a single hypotensive medication were enrolled in the study.The sample population was randomly divided into 2 age- and gender-matched groups each of 18 patients. Group 1 received 0.005% latanoprost eyedrops once daily and the vehicle (placebo) once daily; group 2 was assigned to timolol 0.5% eyedrops twice daily.Diurnal curves of intraocular pressure (IOP) were performed on the baseline day and after 0.5, 3, 6, and 12 months of treatment. The IOP measurements were performed at 8:00 AM, 12:00 noon, 4:00 PM, and 8:00 PM. Outflow facility ("C") was measured on the baseline day and on the last day of the study with a Schiotz electronic tonometer. A two-tailed Student's t test for paired or unpaired data was used for statistical evaluation of differences between treatment and baseline values or between the latanoprost and timolol group. Diurnal IOP measurements were compared hour by hour. Mean values of the two eyes IOP and "C" were used for analysis.Compared with baseline measurements, both latanoprost and timolol caused a significant (P0.001) reduction of IOP at each hour of diurnal curve throughout the duration of therapy. Reduction of IOP was 6.0 +/- 4.5 and 5.9 +/- 4.6 with latanoprost and 4.8 +/- 3.0 and 4.6 +/- 3.1 with timolol after 6 and 12 months, respectively. Comparison of mean diurnal measurements with latanoprost and timolol showed a statistical significant (P0.001) difference at 3, 6, and 12 months. Mean "C" was found to be significantly enhanced (+30%) only in the latanoprost-treated group compared with the baseline (P = 0.017). Mean conjunctival hyperemia was graded at 0.3 in latanoprost-treated eyes and 0.2 in timolol-treated eyes. A remarkable change in iris color was observed in both eyes of 1 of the 18 patients treated with latanoprost and none of the 18 patients who received timolol. Darkening of the peripheral iris stroma was suspected in two patients treated with latanoprost. In the timolol group, heart rate was significantly reduced from 72 +/- 9 at baseline to 67 +/- 10 beats per minute at 12 months.Although further studies may need to confirm these data on a larger sample and to evaluate the side effect of increased iris pigmentation on long-term follow-up, in patients with pigmentary glaucoma, 0.005% latanoprost taken once daily was well tolerated and more effective in reducing IOP than 0.5% timolol taken twice daily.

Purpose Vitreomacular traction syndrome is a clinical entity characterized by partial posterior vitreous detachment in combination with persistent macular adherence. Recently, optical coherence tomography (OCT) allowed visualization of incomplete posterior vitreoschisis leading to vitreomacular traction. Methods The authors report on a 57-year-old woman with blurred vision in her left eye. Results OCT scan showed incomplete posterior vitreoschisis with vitreomacular traction syndrome and impending macular hole in her left eye. Conclusions The intraoperative findings together with the evidence that the internal limiting membrane (ILM) thickness is thinner than the axial resolution of the Stratus OCT (8 μm) and a spontaneous ILM detachment has never been demonstrated are likely to support the hypothesis that posterior vitreoschisis exists and can be associated with vitreomacular traction syndrome.

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

Purpose: To assess the reproducibility and repeatability of macular ganglion cell-inner plexiform layer (GC-IPL) thickness measurements in healthy subjects. Procedures: In this observational study, 60 healthy eyes were subjected to macular GC-IPL thickness measurements by means of Cirrus™ high-definition optical coherence tomography (Cirrus version 6.0; Carl Zeiss Meditec, Dublin, Calif., USA) by two examiners in two sessions. Average, minimum and 6 sectoral GC-IPL thicknesses were measured. Inter- and intraobserver reproducibility was tested and analyzed by means of the concordance correlation coefficient (CCC). The repeatability of measurements was assessed by the coefficient of repeatability (CR). Results: Mean age (±SD) was 29.63 (±5.1) years. The CRs for average GC-IPL thickness were 2.1 and 2.2 µm for the first and the second operator, respectively. Inter- and intraobserver CCCs ranged from 0.91 (95% CI: 0.89-0.93) to 0.98 (95% CI: 0.96-0.99) and from 0.92 (95% CI: 0.88-0.94) to 0.98 (95% CI: 0.97-0.99), respectively. Conclusions: GC-IPL thickness measurements in young healthy subjects showed excellent reproducibility and repeatability, especially for average and sectoral GC-IPL thickness measurements.

Purpose. The authors investigated the use of dapiprazole, an alpha-adrenergic blocking agent, in preventing pigment release and IOP increase after exercise in patients affected with PDS. Methods. Three young myopic males (31, 34 and 35 years old) affected with pigmentary dispersion syndrome performed 30 minutes of jogging on a computerized treadmill. Telemetric heartbeat measurement was performed to obtain constant pulse rate training. Computerized tonography and IOP measurement were performed 10 minutes after the exercise. After one month the patients repeated the same exercise after pre-treatment with dapiprazole 0.5% eyedrops (one drop 30, 20 and 10 minutes before the exercise). Ten minutes after the exercise IOP measurements and computerized tonography were repeated. Results. After 30 minutes of exercise IOP measurements showed values ranging from 19 to 45 mmHg (mean 30.33; SD 8.73). Computerized tonography C values after exercise ranged from 0.04 to 0.16 (mean 0.09; SD 0.04). After pre-treatment with dapiprazole 0.5% eyedrops, IOP values ranged from 18 to 28 mmHg (mean 23.33; SD 3.44) and tonography C values ranged from 0.10 to 0.20 (mean 0.14; SD 0.03). Conclusions. The study supports the concept that exercise-induced pigment release temporarily obstructs the acqueous outflow channels, causing IOP increase in some patients with PDS. Pre-treatment with dapiprazole was useful in reducing IOP spikes and in increasing tonographic total outflow facility after exercise. The absence of induced myopia and the lack of dangerous vitreoretinal tractions on retinal periphery make dapiprazole a safe method to reduce exercise-induced pigment dispersion.

Background The aim was to describe the morphology and localisation of crystals in a case of Bietti's crystalline corneo-retinal dystrophy (BCD) by means of spectral domain optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM). Methods Clinical examination, SD-OCT and IVCM evaluation of a 35-year-old woman with BCD. Results Optical coherence tomography examination of the macular region revealed multiple crystals in the retinal pigment epithelium (RPE)-choriocapillaris, some crystals within the full thickness of the neurosensory retina and less numerous crystals in the choroid. Crystals were present peripherally in areas of retinal atrophy, predominantly in the choroid and to a lesser extent in the RPE-choriocapillaris and the neuroepithelium. In vivo confocal microscopy showed multiple crystals of varying morphology in the peripheral and paralimbal cornea, mainly located in the anterior stroma over 360°. Conclusions SD-OCT provided greater precision in the localisation of crystals, found mainly in the choroid and RPE-choriocapillaris rather than the neuroepithelium. In vivo confocal microscopy revealed a higher number of crystals compared to those visible using conventional slitlamp biomicroscopy and showed a different crystal morphology.

Background The aim was to evaluate visual performance and wavefront error after implantation of three models of Acrysof ReSTOR multifocal intraocular lenses (MIOLs). Methods This prospective comparative six-month study comprised 60 eyes having phacoemulsification and implantation of three diffractive AcrySof ReSTOR MIOLs: SN60D3 +4.00 D spherical MIOL (group 1), SN6AD3 +4.00 D aspheric MIOL (group 2) and SN6AD1 +3.00 D aspheric MIOL (group 3). Results The distance visual acuity was at least 0.1 logMAR in 88.8 per cent of group 1, 88.8 per cent of group 2 and 87.5 per cent of group 3. The distance-corrected near vision was 0.02 ± 0.04 logMAR in group 1, 0.02 ± 0.05 logMAR in group 2 and 0.01 ± 0.03 logMAR in group 3 (p = 0.822). The distance-corrected intermediate vision was 0.26 ± 0.07, 0.22 ± 0.09 and 0.04 ± 0.05, respectively (p < 0.001). The root-mean-square (RMS) of ocular spherical aberration was significantly lower in groups 2 and 3 compared to group 1 (p = 0.048). Conclusion All diffractive MIOLs provided good vision for far and near. ReSTOR MIOL +3.00 also restored intermediate vision. Aspheric MIOLs +4.00 and +3.00 induced significantly lower spherical aberration compared to spherical MIOL +4.00.