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Purpose: A prospective, open-label study in 20 professional swimmers evaluated the efficacy and safety of an ophthalmic solution containing crosslinked hyaluronic acid, coenzyme Q10, and vitamin E TPGS in releasing eye irritation and restoring ocular surface damages after prolonged exposure to chlorinated water. Methods: Individually, one eye was instilled with the ophthalmic solution and the other used as a comparator. Eye drops were self-administered three times a day for 2 months. Tear film breakup time (primary endpoint), Schirmer I test, beating of eyelashes/min, tear osmolarity, corneal and conjunctival staining with fluorescein, Ocular Surface Disease Index questionnaire, subject satisfaction, visual acuity (secondary endpoints), and Efron Grading Scale were evaluated at screening/baseline (V1), week 1 (V2), week 2 (V3), week 4 (V4), and week 8 (V5). Results: After 2 months, breakup time test significantly improved in the treated eyes (+1.67 s) compared to control (−3.00 s) ( p = 0.0002). Corneal and conjunctival surfaces of treated eyes recovered significantly compared to control eyes when assessed by fluorescein staining ( p Conclusion: The adequate combination of crosslinked hyaluronic acid, coenzyme Q10, and vitamin E TPGS, contained in the ophthalmic solution VisuXL®, has been shown to protect ocular surface from potential damages originating from prolonged exposure to chlorinated water. VisuXL may represent a compelling treatment in other situations beyond dry eye syndrome.

Even after a successful keratoplasty with a clear graft, a high postoperative refractive error could occur too hard to correct with spectacles or contact lenses. Therefore, refractive surgery could be considered a good tool to correct these high postoperative defects. The authors showed the reasons involved in the refractive errors after successful penetrating (PKP) or lamellar transplantation (DALK), pre-, intra-, and post-operatively. Moreover, they presented different techniques to correct the refractive errors after transplantation for different corneal pathologies, in the plastic phase (managing of transplant sutures) as well as in the static phase (different refractive techniques: incisional (AK, FemtoAK), ablative (PRK, FemtoLASIK), or IOL implantation (Phakic IOL, PHACO + IOL)). Thus, it is necessary to study accurately every single clinical case to choose the best surgery for each patient. Due to the high risk of graft damage or graft rejection, the patient must be adequately informed about the risks and benefits of the surgery proposed and must specifically accept the possibility of a new corneal transplant in the event of surgery failure or graft damage. Certainly, the refractive surgeon must be able in managing all the different refractive surgery techniques to reach the best result in every single case.

Dry eye disease (DED) is a highly prevalent, chronic and progressive condition that affects 5–33% of the world’s adult population [...]

High-order aberrations (HOAs) have been demonstrated to profoundly affect both visual acuity and stereoacuity in patients with keratoconus. Corneal collagen cross-linking (CXL) has been proven to significantly lower HOAs in keratoconus. Yet, to the present date, no evaluation of the effect of the procedure on stereopsis has been performed. The purpose of the study was to assess differences in binocular visual performance in patients with keratoconus before and after CXL.Patients with keratoconus undergoing standard Dresden protocol epi-off CXL in the ophthalmology department of Policlinico Universitario Agostino Gemelli Hospital received slitlamp examination, uncorrected distance visual acuity and corrected distance visual acuity assessment, corneal tomography, Lang stereotest, TNO stereoacuity assessment, distance and near cover test, and Irvine test before surgery and 6 months after CXL. Stereopsis tests were performed with spectacle correction.The analysis included 30 patients (mean age 24.63 ± 3.49 years). The Lang test improved after treatment (P 0.027), with 6 of 30 patients (20%) showing a positive Lang test before CXL compared with 16 of 30 patients (53.3%) after treatment. Moreover, TNO stereoacuity increased after treatment (P 0.043), and 14 of 30 patients (46.7%) manifested an improvement of at least 250″ at the TNO test after CXL. In this subgroup of patients, total root mean square values decreased after treatment (P0.001), whereas patients who did not manifest a clinically significant improvement in stereoacuity did not show a reduction in total root mean square values after CXL (P = 0.11). The results of cover test and Irvine test did not vary after CXL.Patients with keratoconus showing a reduction of HOAs after CXL also manifest a significant improvement in stereoacuity after the treatment.

Objective To evaluate the efficacy of Perceptual Learning in improving the peripheral reading performance of patients with Stargardt disease (STGD). Design Prospective observational randomized study. Participants Fourteen consecutive patients (7 females, 7 males; median age of 50.4 ± 12.8 years) with STGD were analyzed and divided into two groups: Group A received “Win-flash” as Perceptual Learning training and Group B was used as control. Methods Subjects underwent an ophthalmic evaluation at baseline, after perceptual learning training and at 6 months of follow-up. Outcomes measured included reading speed, contrast sensitivity and fixation stability. Results Reading speed improved of 51,7% after training in group A. Visual acuity, contrast sensitivity and fixation stability enhanced in group A after training from 0.89 (±0.09) LogMAR to 0.75 (±0.2) LogMAR (t(6)= 3.6, p= 0.001), from 0.8 (±0.3) LogC (0.6 − 0.9) to 1.3 (±0.3) LogC (t(13)=3.17, p= 0.003) and from 59.3 % (± 24.3) to 71.5 % (± 20.4) (t(13)=1.8 p= 0.04), respectively. No changes were found in group B. At 6-monts of follow-up, visual acuity and contrast sensitivity decreased in group A. Conclusions STGD patients receiving “Win-flash training”, as PL technique, showed an improvement of reading performance on a real-world task. Early follow-up for perceptual learning re-intervention should be considered.

Hereditary transthyretin amyloidosis (hATTR) is a rare disease caused by a point mutation in the transthyretin (TTR) gene and inherited in an autosomal dominant fashion. TTR is a plasma protein that functions as a carrier for thyroxine (T4) and retinol (vitamin A). Ophthalmological manifestations are due to both the hepatic and ocular production of mutated TTR. In this case series, we report the ocular manifestations of hATTR in eighteen eyes of nine consecutive patients. Corneal nerve abnormalities as well as morphological and functional changes in the retina were investigated. The study was a single-center, retrospective, observational, clinical case series. In all patients, corneal confocal microscopy (CCM), multimodal imaging of the retina, including fundus photography and Optical Coherence Tomography (OCT), as well as rod and cone electroretinography (ERG) were performed. Eight patients had active disease and one was an unaffected carrier. In all study eyes, corneal nerve plexa examined with CCM were poorly represented or absent. Mixed rod-cone and cone ERG b-wave amplitudes were reduced, and photopic b-wave responses were significantly delayed. Photopic Negative Response (PhNR) amplitude was significantly reduced, while PhNR latency was significantly augmented. In 13/18 eyes, vitreous opacities and abnormalities of vitreo-retinal interface were found. The current results highlight the presence of corneal nerve damage. Functional retinal abnormalities, detected by ERG, can be found even in the presence of minimal or absent structural retinal damage. These findings support the use of CCM and ERGs to detect early biomarkers for primary hATTR.

Background In “high-risk” corneal graft recipients, like those with neovascularization of the cornea, the failure rate can exceed 35% at three years, the main cause being graft rejection. The main purpose of the study is to demonstrate the efficacy of pre-transplant Bevacizumab corneal injection in long term lowering of the prevalence of graft failure and rejection in high risk corneal transplantations. Methods This retrospective single-centre case-control study analyzed 37 eyes with significant corneal neovascularization and eligible for corneal transplantation at baseline. One group (BT group) included patients who were treated with a 3 months preoperative cycle of subconjunctival and/or intrastromal 5 mg/0.2 ml Bevacizumab injected at the limbus with a 27 G needle. The control group (NT group) didn’t receive the preoperative treatment. The main outcome was the prevalence of graft failures and rejections during the follow up period. Secondary outcomes included the prevalence of adverse events and the prevalence of patients who avoided corneal transplantation due to the treatment. Results BT group included 24 eyes with a follow up duration of 61.2 ± 24 months. Eight patients (33.3%) avoided transplant surgery after the injection. In the BT group 5 cases of graft failure (20.8%), 1 of which due to graft rejection (4%), occurred during the follow up. The NT group registered 6 cases (46.1%) of immune rejection of the graft and no additional graft failures from other causes. Conclusions Pre-transplant bevacizumab corneal injections are a safe and effective method to prevent graft rejection in neovascularized corneas.

Background Mutations in the cytokine receptor-like factor 1 (CRLF1) gene are responsible for Crisponi/Cold-induced Sweat Syndrome, an extremely rare autosomal-recessive multisystem disorder. The protein encoded is a soluble cytokine receptor, involved in the ciliary neurotrophic factor receptor (CNTFR) pathway. The ciliary neurotrophic factor (CNTF) promotes corneal wound healing and patients with Crisponi/CISS1 syndrome suffer from recurrent keratitis. The aim of the study was to report and discuss the corneal alterations in Crisponi/CISS1 rare disease. Materials and methods We evaluated the cornea of both eyes in four Crisponi/CISS1 patients to provide a detailed description of slit-lamp biomicroscopy findings. Corneal sensitivity, tears functionality and blinking video recording at rest were also assessed in all patients. Two patients were also evaluated with in vivo confocal microscopy, completed with a needle electromyography of their orbicularis muscles. Results None of the patients presented a tears dysfunction and video recording documented a prolonged lid excursion in all patients. Slit lamp examination revealed a chronic epithelial impairment in all cases. Needle electromyography of the orbicularis oculi showed a dystonic pattern. The confocal microscopy confirmed the biomicroscopic observed lesions and documented unusual findings of the corneal nerve plexus. Conclusions This is the first report of microscopic cornea alterations explored with confocal imaging in Crisponi/CISS1 patients. The observed corneal findings suggest a possible direct correlation to the CNTFR pathway defect and the blinking imbalance could exacerbate the compromised epithelial wound healing. Topical administrations of lubricating eye drops are strongly recommended in these patients.

The purpose of this study is to investigate whether subconjunctival and/or intrastromal Bevacizumab injections could help to prevent graft failure in high-risk keratoplasties. Twenty seven eyes of 27 patients, affected by high immune rejection risk and corneal neovascularization, were involved in this prospective interventional case-control series (case group: 14 eyes and control group: 13 eyes). Case group was submitted to a cycle of three subconjunctival and/or intrastromal injections of 5 mg/0.2 ml Bevacizumab. After a mean period of 6.36 months ± 3.38 SD from the last injection, all patients underwent keratoplasty. An adjunctive injection was performed intraoperatively at the end of the surgical procedure. Control group did not receive any Bevacizumab injection, but directly underwent keratoplasty. Each patient was submitted to a complete eye examination and corneal confocal microscopy. The absence of immune rejection signs in the graft, at clinical and confocal microscopy examination, was considered as main outcome measure. All cases showed less ocular inflammation and activity of vessels. No side effects were detected after the injection procedure. No corneal graft rejection was seen during the follow-up (mean 26.1 months ± 5.7 SD) in the case group. Six eyes of the control group showed graft rejection 3.8 months ± 1.4 SD after keratoplasty. As a conclusion, Bevacizumab injection may represent a preconditioning treatment to improve prognosis in high-risk corneal transplantation. The procedure seems to be safe and it may help to reduce the inflammatory stimulus that plays a key role in corneal graft rejection.

Background People with visual impairment have reduced reading performance, which is thought to be related to unstable or eccentric fixation. New microperimeters such as the MP-1 offer straightforward analysis of fixation stability. The aim of this study was to investigate the relationship between fixation stability and reading speed in a large cohort of people with diverse causes of visual impairment and to verify the correlation between reading speed and different methods for the quantification of fixation. Methods The better eye of one hundred and twenty subjects was assessed. Fixation values were obtained from the MP-1 microperimeter. Reading speed was evaluated using newspaper text with magnifiers if required. Results The poorest fixation stability and reading performance was found in people with age-related macular degeneration while the best fixation was in retinitis pigmentosa subjects. A linear relationship was found between reading speed and the proportion of fixations within 2° (r² = 0.51, p

This chapter brings together all the current evidence in children for a now well-established procedure for keratoconus (KC) in children. With the aid of research from Caporossi and his group, most recent results of which will be presented in this chapter, the authors will present the similarities and differences found in KC in children.

The opacification of Akreos Adapt (Bausch & Lomb, Rochester; NY) intraocular lens (IOL) has been previously reported in Literature. A metabolic change in aqueous humour was considered as the main trigger factor to IOL opacification. We report our case and discuss the association with Ex-PRESS, highlighting the particular pattern of IOL opacification and its possible relation with the intraocular convective motions of the aqueous. We analyzed our case using both digital slit lamp acquisition and OCT Visante (Zeiss, Germany) images. A literature review was conducted to evaluate our results with that previously reported. The role of a relative stationary flow was reported as suggested concurrent mechanism in IOL opacification phenomenon.

Purpose To report 3 cases of stromal rejection after deep anterior lamellar keratoplasty (DALK) assisted by a femtosecond laser. Methods Three keratoconus eyes of 2 men (22 and 30 years old) and 1 woman (24 years old) who had DALK with a 60-kHz femtosecond laser developed intrastromal graft rejection with superficial and deep neovascularization after 6, 15, and 12 months, respectively. All patients underwent confocal microscopy and were treated with topical steroid therapy. Results In vivo confocal microscopy revealed cellular inflammatory infiltrates in the subepithelial and middle stroma of the donor lamella without involvement of the endothelium. Graft rejection was rapidly reversed with topical steroid therapy, and a clear cornea was restored in all cases. Conclusions Graft rejection remains a significant complication of lamellar surgery but is associated with good tissue restoration and complete visual recovery.

Purpose To evaluate the outcomes and safety of lamellar keratoplasty (LK) assisted by a femtosecond laser. Methods Twenty-one eyes of 21 patients affected by different corneal pathologies (5 posttraumatic corneal scar, 3 postkeratitis corneal leucoma, and 13 keratoconus) underwent LK procedures by using a femtosecond laser. The mean thinnest corneal thickness, evaluated with ultrasound corneal pachymetry and with confocal microscopy, was 434.19 +/- 62.60 (SD) microm (range, 333-548 microm). Mean preoperative uncorrected visual acuity was 0.09 +/- 0.28 SD and mean preoperative best spectacle-corrected visual acuity was 0.28 +/- 0.15 SD. A femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The donor corneal lamella diameters were 0.20-mm larger and thicker than the recipient to restore a physiologic corneal thickness and shape: mean donor diameter was 8.34 +/- 0.28 mm (range, 8.2-8.7 mm) and mean thickness was 352 +/- 40.27 microm (range, 220-400 microm). Mean follow-up was 20.86 +/- 5.76 months (range, 12-30 months). Results Early postoperative evaluation showed a clear graft in all cases. A normal corneal pattern topography and a physiologic thickness (mean corneal pachymetry, 542.48 +/- 33.20 microm) and transparency were restored. Twelve months after surgery, the mean postoperative uncorrected visual acuity was 0.45 +/- 0.34 SD, and the mean best spectacle-corrected visual acuity was 0.63 +/- 0.16 SD. Conclusions Although the numbers in our study are small, our early results indicate that femtosecond laser-assisted lamellar keratoplasty shows promise as a safe and effective surgical choice in the treatment of various corneal pathologies.

Purpose To report the unknown coexistence of bilateral optic disc pit and keratoconus. Methods A 23-year-old man with bilateral keratoconus underwent complete ophthalmology screening, with an unexpected detection of undiagnosed optic disc pit in both eyes. Computerized corneal topography (CT), Orbscan, corneal pachometry, endothelial microscopy, and optical coherence tomography (OCT) examination were performed. Results The corneal CT showed a keratoconus pattern in both eyes, evolved in the right eye with a minimum corneal pachometry of 336 μm in the right eye and 405 μm in the left eye. Mean endothelial cell density was 1937 cells/mm2 in the right eye and 1912 cells/mm2 in the left eye. The OCT scans showed the presence of the disc pit in both eyes with a normal macular thickness and profile in the right eye, and in the left eye an augmented retinal thickness in the nasal macular zone due to retinal oedema and schisis, with an initial detachment of the neuroepithelium in the parapapillary area starting from the optic pit. Conclusions This is the first clinical report of bilateral optic disc pit and keratoconus. Further investigations will be necessary to assess if there is a possible pathogenetic correlation between these two ocular pathologies or if this is an unusual coexistence of separate entities.

Purpose. To report the risk of methicillin-resistantStaphylococcus aureus(MRSA) ocular infection after UVA-riboflavin corneal collagen cross-linking in a patient with atopic dermatitis.Methods. A 22-year-old man, with bilateral evolutive keratoconus and atopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and cyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum antimicrobic therapy.Results. The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic therapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures was unavoidable.Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in halting keratoconus’ progression. However, this procedure is not devoid of infectious complications, due to known risk factors and/or poor patients’ hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with keratoconus andStaphylococcus aureuscolonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity with atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days after surgery and the imposition of strict personal hygiene rules are strongly recommended.

Background We report the first successful treatment of limbal lesions and corneal erosion experienced by a breast cancer patient undergoing trastuzumab treatment. Case presentation A 49-year-old Caucasian woman with early stage breast cancer was treated with adjuvant trastuzumab and subsequently showed persistent bilateral corneal marginal infiltrates resistant to topical steroid and antibiotic treatment. Autologous serum was applied in the conjunctival sac as an experimental treatment to antagonize the inhibitory effect of the HER2 receptor antibody on the corneal epithelial cells. Topical application of autologous serum led to rapid improvement of the ulcerative keratitis, with complete healing of the corneal defect after 7 days. Continued administration of the serum allowed the resumption of trastuzumab therapy without any further side effects. Conclusions Persistent bilateral corneal marginal infiltrates may occasionally arise as a side effect of trastuzumab treatment. Topical medication with autologous serum may be an effective therapeutic option for the ocular side effects of trastuzumab therapy.

PURPOSE: To evaluate keratectasia after laser in situ keratomileusis (LASIK) for high myopia. METHODS: A 49-year-old male patient with myopia of -23.50 D in both eyes underwent LASIK with a Summit Technology Apex Plus excimer laser. A Moria manually-guided MDSC microkeratome was used. Preoperative corneal topography in both eyes did not reveal underlying or fruste form of keratoconus. Four months after LASDX, a progressive keratectasia occurred in right eye and after 12 months, in left eye. Corneal transplantation was performed in both eyes. RESULTS: Histological and ultrastructural examinations were performed on one corneal button. The analysis showed regular stromal morphology and cellularity, with no sign of inflammation. The morphometric analysis showed an overall thickness of 334 /cm, with a flap of 262 /on and a stromal residual bed of 72 ?a\, in the center of the button. CONCLUSION: A LASIK corneal flap made with a planned 120-/tm plate turned out histologically to be approximately 260 ??\ thick, in an eye with a refractive correction of -23.50 D. The excessive flap thickness and excessive ablation produced progressive keratectasia requiring a penetrating keratoplasty. [J Refract Surg 2002;18:475-480]

Purpose To report on the efficacy of surgical management of total bilateral ankyloblepharon in a child. Methods An 8-year-old African girl from Burundi presented with complete lid-corneo-conjunctival adhesion in both eyes, dating back 6 years. Preoperative ultrasound evaluation of anterior and posterior segment was detected. Electrophysiologic examinations showed low responses. Surgery was performed with scarring tissue removal through manual cleavage in order to separate tarsal conjunctiva and corneal stroma, followed by multiple human amniotic membrane grafts on the cornea, the entire bulbar surface, and fornices. Results Ankyloblepharon removal, excellent width of fornices, and lid motility recovery were obtained. Nevertheless, corneal stroma remained cloudy. The patient's visual acuity reached hand movements perception at 6 months follow-up. Conclusions Even in the presence of deep deprivation amblyopia, total ankyloblepharon surgical removal and anatomic restoration of ocular surface is mandatory in children. Subsequent surgery including corneal keratoplasty or keratoprosthesis implant should be taken into consideration after an accurate evaluation of the cost/benefit ratio. Furthermore, these young patients could be enrolled in specific visual rehabilitation programs to enhance residual visual abilities.

Aim: Limbal cultures restore the corneal epithelium in patients with ocular burns. We investigated the biological parameters instrumental for their clinical success. Methods: We report a long-term multicenter prospective study on 152 patients carrying corneal destruction due to severe ocular burns, treated with autologous limbal cells cultured on fibrin and clinical-grade 3T3-J2 feeder cells. Clinical results were statistically evaluated both by parametric and nonparametric methods. Results: Clinical outcomes were scored as full success, partial success and failure in 66.05, 19.14 and 14.81% of eyes, respectively. The total number of clonogenic cells, colony size, growth rate and presence of conjunctival cells could not predict clinical results. Instead, the clinical data provided conclusive evidence that graft quality and likelihood of a successful outcome rely on an accurate evaluation of the number of stem cells detected before transplantation as holoclones expressing high levels of the p63 transcription factor. No adverse effects related to the feeder layer have been observed and the regenerated epithelium was completely devoid of any 3T3-J2 contamination. Conclusion: Cultures of limbal stem cells can be safely used to successfully treat massive destruction of the human cornea. We emphasize the importance of a discipline for defining the suitability and the quality of cultured epithelial grafts, which are relevant to the future clinical use of any cultured cell type.

The concept of lamellar keratoplasty (LK) is that of targeted lamellar replacement of corneal tissue while retaining normal cornea. It involves replacing anterior stroma at different deepness with an anterior lamellar keratoplasty (ALK). Despite the significant advantages of LK surgery, penetrating keratoplasty (PK) remains the most common procedure, largely because lamellar surgery is more technically demanding and time consuming 1. Moreover, interface irregularity arising from manual lamellar dissection often results in suboptimal visual outcomes 2. Long-term graft survival rates and endothelial cell counts after PK continue to drop for many years after surgery, clearly showing the disadvantage of unnecessary replacement of a healthy endothelium in anterior-stromal disorders 3. For these reasons, PK is now being replaced by various types of lamellar techniques that aim to replace damaged tissue only, while maintaining healthy tissue intact. Recent improvements of surgical techniques and advances in instrumentation, such as microkeratome-assisted LK (ALTK) 4, and excimer laser assisted LK (ELLK), 5,6 have contributed to improve visual quality in corneal lamellar surgery, promoting a paradigm shift in the surgical treatment of anterior corneal disease. The new femtosecond laser technology has been introduced for ophthalmic surgery in the last years with the aim to resolve the microkeratomes related problems in LASIK surgery 7. This new technology has been shown to be the “top” to perform LASIK flaps, creating flaps of precise and homogeneous thickness, reducing the flap related problems (free cap, button hole, flap irregularity) and leaving more stroma for the excimer ablation allowing to correct higher refractive defects (especially with the ultrathin flaps of 90 microns). Moreover, the femtolaser technology, allowing to perform precise corneal cuts with a planned and customized shape, offers clear advantages also applied in anterior lamellar keratoplasty (ALK) surgery8-10. Penetrating Keratoplasty (PK) is still the most common and effective technique for corneal transplantation, but is an “open sky” surgical technique and could be complicated by choroidal effusion or haemorrage, spontaneous lens expression and vitreous loss 1. Moreover, this technique is characterized by an everlasting endothelial cell loss, leading to corneal decompensation necessitating a re-PK to restore a clear graft. To avoid these risks, more conservative surgical techniques have been proposed for the treatment of anterior corneal pathologies with healthy endothelium, enclosed in the great chapter of the lamellar keratoplasty (LK) 2, 3. So that, during the last 10 years, to increase the results of traditional

Ocular mucous membrane pemphigoid (OMMP) is an autoimmune disease involving the eye and characterized by subepithelial detachment resulting from an immunologic reaction against conjunctival basal membrane zone (BMZ) antigens. Lyell syndrome (LS) is a drug-induced, T cell-mediated, cytotoxic reaction involving the mucocutaneous areas. Two patients with LS are presented in whom OMMP developed.Report of 2 cases.Two male patients, 80 and 60 years old, with persistent corneal ulcerations, corneal melting, and inflammation some months after an LS episode.Conjunctival biopsy samples were obtained to perform direct immunofluorescence (DIF) and histologic analyses. Indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) also were performed.Immunodeposit findings on the conjunctival BMZ obtained by DIF and IIF, inflammatory infiltration of the corneoconjunctival samples studied by histologic analysis, and autoantibodies of patient sera directed against BMZ antigens tested by ELISA.Direct immunofluorescence analyses showed immunoglobulin G and complement 3 component deposits along the BMZ in a linear pattern. Histologic analysis revealed the presence of eosinophils, neutrophils, and mast cells with fibrin deposition in the substantia propria of both patients; the data confirmed the clinical suspicion of OMMP. The IIF and ELISA results were negative.Chronic eye surface injury associated with LS may promote autoimmunization against ocular epithelial BMZ antigens, playing a strategic role in the subsequent onset of OMMP. The occurrence of OMMP after LS could be an occasional finding, or conversely, LS could be an underestimated predisposing factor in the development of OMMP.

To evaluate preoperative and postoperative retinal function in patients who underwent macular surgery for idiopathic macular hole.Prospective, comparative, interventional case series.Thirty eyes of 30 patients with idiopathic macular hole were included in the study. Patients underwent pars plana vitrectomy and peeling of the internal limiting membrane (ILM). ILM visualization was improved in 15 patients by using triamcinolone acetonide and in the remaining 15 patients by using infracyanine green dye. Spectral-domain optical coherence tomography examination was performed to document macular hole closure. Retinal function was assessed preoperatively and postoperatively over a period of 12 months by best-corrected visual acuity (BCVA) measurement (ETDRS chart), MP-1 microperimetry, and focal electroretinogram recording (fERG). Focal electroretinograms were recorded in response to a sinusoidally modulated (41 Hz), uniform field presented to the macular (18 degrees) and foveal (2.25 degrees) region.Macular hole closure was achieved in all patients in both groups. At 12 months, visual acuity improved in both groups (P.001), and there were no statistically significant differences between groups. Mean macular sensitivity within the central 2 and 8 degrees increased in both groups, and there were no statistically significant differences between groups at any follow-up. In the triamcinolone acetonide group, 12 months after surgery the amplitude of the fERG's first harmonic (1F) increased both in the macular region (P.001) and in the foveal region (P.05). In the infracyanine green group, at 12 months the amplitude of the first harmonic (1F) decreased in both areas. The decrease was significant in the macular region (P.05) and not significant in the foveal region (P = .095).Vitrectomy and ILM peeling assisted with either triamcinolone acetonide or infracyanine green staining improves visual acuity and mean macular sensitivity at 12 months in patients affected by idiopathic macular hole. However, triamcinolone acetonide staining is associated with an increase of fERG's first harmonic amplitude in the foveal and macular region, whereas in the case of infracyanine green staining it seems to decrease after surgery. The reduction of the amplitude of fERG's first harmonic suggests that infracyanine green may have a late toxic effect on photoreceptor cells.

PURPOSE: Epithelial hyperplasia is one of the factors that plays a role in myopic regression after photorefractive keratectomy (PRK). We evaluated the role of the epithelium following excimer laser in situ keratomileusis (LASIK) performed on highly myopic eyes. METHODS: Fifty eyes of 32 patients (18 females and 14 males; mean age, 31.7 ± 6.5 years) were treated with LASIK for myopia with an attempted correction ranging between -8.50 and -12.25 D (mean, -10.48 ± 1.43 D). No sutures were placed. The thickness of the central epithelium was evaluated either with a 50-MHz ultrasonic pachymeter or an ultrasound biomicroscope. Postoperatively, topical corticosteroid drops were administered for at least 1 month. RESULTS: Follow-up was at least 12 months. Epithelium measurements were thicker compared to preoperative measurements from the first week postoperatively (mean, +1.9 µm, +2.77%; P CONCLUSION: The epithelium seemed to have a role in the regression of refractive effect after LASDX to correct high myopia. [J Refract Surg 2000;16:133-139]