[Show abstract][Hide abstract] ABSTRACT: In this report, we describe an unusual case of post-operative Acremonium falciforme endophthalmitis with orbital and extra-orbital involvement following combined cataract and glaucoma surgery.
A 68-year-old Caucasian man with glaucoma presented with endophthalmitis characterized by pain, redness and impaired vision in the left eye fifteen days after combined cataract and filtering surgery. He subsequently underwent a pars plana vitrectomy, with vitreous sampling, silicone oil placement and intra-vitreal injection of antibiotics, but only after a second vitrectomy we identified Acremonium falciforme as the causative agent for the endophthalmitis. An antifungal systemic and topical therapy was started, but meanwhile the infection extended to orbital and peri-orbital tissues. Following these procedures, even if the eye went slowly in phthisis, we were able to limit the further extension and circumscribe the orbital and extra-orbital involvement.
To our knowledge, this report is the first describe Acremonium falciforme endophthalmitis with orbital and extra-orbital involvement, following anterior segment combined surgery. Ophthalmologists and physicians should be aware of the extension risk of a fungal panophthalmitis, but also to potentially serious side effects related to systemic therapy.
Journal of Medical Case Reports 11/2014; 8(1):373.
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: To evaluate the influence of posterior capsule opacification (PCO) on optical coherence tomography (OCT) acquisition of macular retinal thickness (RT) and volume using time domain OCT (TD-OCT) and spectral domain OCT (SD-OCT). Materials and methods: We studied 37 eyes of 31 patients with PCO. Each patient underwent an evaluation with TD-OCT and with SD-OCT before and after Nd:YAG capsulotomy. We recorded RT and retinal volume in the macular area using only good quality images. Results: Best corrected visual acuity improved in all eyes after Nd:YAG capsulotomy, with the degree of improvement ranging from 0.3 ± 0.7 to 0.1 ±0.7 (p = 0.01). Before the treatment, only 27% of the examinations were valuable with TD-OCT, while using SD-OCT, it was possible to obtain an examination of suitable quality both before and after the Yag laser capsulotomy in 100% of the eyes. We did not observe significant differences between mean preoperative and postoperative RT and total macular volume measurements, neither with TD-OCT nor with SD-OCT. RT and total macular volume values obtained using TD-OCT were always lower than those obtained from the SD-OCT, both before and after capsulotomy. Conclusions: Our study confirmed that with old generation TD-OCT, PCO has a strong negative influence on the quality of OCT acquisition, and examination is reliable only when it is possible to acquire good quality images. With new generation SD-OCT, tomographic acquisitions are always reliable and are not influenced by the presence of PCO.
Current Eye Research 08/2014; · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the efficacy of timolol 0.1% gel in preventing increased intraocular pressure (IOP) after uncomplicated cataract surgery.
In this prospective, double-blinded, randomized study were enrolled 70 patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation. After cataract surgery, 25 patients received a single instillation of timolol 0.1% gel (group A); 20 a single instillation of timolol 0.5% eyedrops (group B); and 25 no treatment (group C). The IOP was measured before surgery (T0) and 5 minutes (T1), 2 hours ± 30 minutes (T2), 4 hours ± 30 minutes (T3), and 24 hours ± 180 minutes after surgery (T4).
The patients in groups A and B had lower mean IOP values than those in group C at T2, T3, and T4; IOP was higher at T2 and T3 than at T1 in the control group. The IOP spikes in group C were higher than those observed in groups A and B: at T2, they were observed in 40% of the patients in group A, 30% in group B, and 76% in group C; and at T3, in respectively 20%, 10%, and 68%; and at T4, in respectively 4%, 0%, and 28%.
Timolol 0.1% gel is as effective as timolol 0.5% eyedrops in reducing IOP and in limiting the occurrence of IOP spikes for up to 24 hours after phacoemulsification.
European journal of ophthalmology 04/2014; · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To verify the efficacy to obtain mydriasis and cardiovascular safety of Mydriasert (ophthalmic insert containing tropicamide and phenylephrine) in diabetic and nondiabetic patients undergoing retinal angiography by comparing it with usually administered eyedrops (tropicamide 1% and phenylephrine 10%).
Methods: This was a prospective randomized study. A total of 154 eyes of 77 patients were randomly divided into 2 groups: group 1 consisted of 78 eyes, group 2 consisted of 76 eyes, and the patients were monitored for pupillary dilation, blood pressure, heart rate, and possible adverse effects at 0, 20, 40, 60, and 90 minutes.
Results: No severe adverse effects were observed in either group. In the entire sample studied, the mean pupillary diameter was greater in the eyedrops group after 20 and 40 minutes, while mydriasis was similar in the 2 groups after 60 minutes. The diabetic patients treated with Mydriasert had less mydriasis than those treated with eyedrops after 20 and 40 minutes, and diabetic patients showed less mydriasis than the nondiabetic patients after 60 and 90 minutes. There was no significant between-group difference in mean heart rate or systolic and diastolic blood pressure at any of the time points.
Conclusions: Mydriasert assures an adequate degree of mydriasis for retinal angiography in both diabetic and nondiabetic patients. There are no differences in efficacy or safety between the insert and the usually administered eyedrops, but the low total drug dose administered with the insert reduces the risk of cardiovascular side effects.
European journal of ophthalmology 02/2014; · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To assess the efficacy of intravitreal anti-vascular endothelial growth factor (VEGF) treatment of vascularized pigment epithelial detachment (PED) due to age-related macular degeneration (AMD).
Methods: A total of 26 patients with vascularized PED secondary to AMD were retrospectively analyzed and treated with anti-VEGF intravitreal injections according to a PRN regimen after 3 initial injections. Best-corrected visual acuity (BCVA), optical coherence tomography, and fluorescein angiography were performed at baseline and quarterly.
Results: Mean follow-up ranged from 9 to 26 months (mean 13.5). There was a deterioration in mean BCVA from 0.46 at baseline to 0.79 logMAR at 12 months (p<0.001). The mean PED greatest linear diameter (GLD) increased from 4499 at baseline to 5206 μm at 1-year follow-up (p<0.001). The mean PED maximum height decreased from 669 μm at baseline to 305 μm at 1-year follow-up (p = 0.001). The mean central retinal thickness (CRT) was unchanged (from 277 to 209 μm at 1 year follow-up) (p = 0.099). No effect was seen on the change of VA according to groups of baseline predictors as defined by the medial value: baseline VA, PED height, and CRT (p>0.10).There was a borderline trend (p = 0.064) that GLD affected response to treatment. The mean number of injections was 5.5 (3 to 9). Seven out of 26 (27%) patients developed a retinal pigment epithelium (RPE) tear.
Conclusions: Intravitreal anti-VEGF therapy, with a PRN regimen, did not prevent visual acuity loss or RPE tear.
European journal of ophthalmology 11/2013; · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT Background: To determine the repeatability and reproducibility of optical coherence tomography (OCT) Spectralis retinal thickness measurements in diabetic patients with clinically significant macular edema (CSME). Methods: Twelve eyes of 12 volunteers (without macular pathology - control group) and 21 eyes of 21 diabetic patients with CSME were included in the study. Reproducibility, repeatability, intraclass correlation coefficients (ICCs) and intrasession correlation coefficients were tested with 20 × 15 degree raster scans consisting of 19 high-resolution line scans that were repeated three times by two experienced examiners. Results: In the control group, examining all regions, coefficient of repeatability was less than 1.1%, while coefficient of reproducibility was less than 2.2%. In diabetic patients, examining all regions, coefficient of repeatability was less than 2.6%, while coefficient of reproducibility was less than 2.4%. ICCs were, respectively, greater than or equal to 0.98 in the control group and 0.99 in diabetic patients. Intrasession coefficients of variation were less than 0.4% in the control group and less than 0.5% in diabetic patients. Conclusion: Retinal thickness measurements are repeatable and reproducible with OCT Spectralis in both the control group and diabetic patients. The results indicate that a change in central subfield thickness exceeding 12 µm and 3% in the diabetic patients is likely to be real.
Current eye research 03/2013; · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: To compare penetration in the aqueous humour of topically applied antibiotics. DESIGN: Randomized prospective study, Department of Ophthalmology, University of Perugia, Italy. PARTICIPANTS: Patients undergoing phacoemulsification and intra-ocular lens implantation. METHODS: 122 patients were included: 14 received one drop of chloramphenicol (CAF) suspension; 12 one application of CAF gel; 11 one drop of netilmicin suspension; 13 one drop of tobramycin suspension; 37 repeated instillations of CAF suspension every 10 minutes for a total of four drops; and 35 repeated instillations of CAF gel every 10 minutes for a total of four drops. Samples were taken immediately before surgery from anterior chamber in order to determine antibiotic by means of HPLC. Samples were taken 45-190 minutes after the eye drops were instilled. MAIN OUTCOME MEASURES: intraocular penetration of CAF, netilmicin and tobramicyn. RESULTS: After a single administration, netilmicin and tobramycin were undectectable, whereas the CAF suspension reached a mean concentration of 0.23+0.21 μg/mL, and the CAF gel a mean concentration of 0.13+0.14 μg/mL. After repeated administrations, the mean concentrations of the CAF suspension and gel were respectively 0.60+0.26 μg/mL and 0.58+0.18 μg/mL. CONCLUSIONS: Tobramycin and netilmicin do not reach detectable concentrations, and so their use in the prophylaxis and treatment of post-operative infections does not seem to be rational. CAF after multiple administrations, reaches concentrations that are effective against Haemophilus influenzae and parainfluenzae, Legionella pneumophila, Moraxella catarrhalis, Neisseria meningitidis, Pasteurella multocida and Streptococcus pneumoniae. This means that CAF can be rationally used in the prophylaxis and the treatment of infections supported by sensitive germs.
Clinical and Experimental Ophthalmology 02/2013; · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To report 3 cases of simultaneous Descemet stripping automated endothelial keratoplasty (DSAEK) and aphakic iris-fixated intraocular lens (IOL) implantation in patients with aphakia and bullous keratopathy.
We retrospectively documented the clinical characteristics of patients before and after simultaneous DSAEK and aphakic iris-fixated IOL implantation undergoing operation between November 2008 and September 2009.
None of the cases showed any intraoperative complications. During the postoperative period, the corneal lenticule was clear and well-attached, and the iris-fixated IOL was well-positioned.
Simultaneous DSAEK and aphakic iris-fixated IOL implantation can be used successfully and simultaneously in patients with aphakia and bullous keratopathy.
[Show abstract][Hide abstract] ABSTRACT: A variety of factors have been implicated in the pathogenesis of age-related macular degeneration (ARMD), and oxidative stress plays an important role in the onset and progression of the disease. Breath ethane is now considered a specific and non-invasive test for determining and monitoring the trend of lipid peroxidation and free radical-induced damage in vivo. This test provides an index of the patients' overall oxidative stress level. We evaluated the breath ethane concentration in exhaled air in patients with advanced ARMD.
In this study, we enrolled 13 patients with advanced ARMD and a control group, and a breath analysis was carried out by gas chromatography.
The mean ethane level in the ARMD patients was 0.82 ± 0.93 nmol/l (range: 0.01-2.7 nmol/l) and the mean ethane value in the control group was 0.12 ± 0.02 nmol/l (range: 0.08-0.16 nmol/l). The difference between the values of the 2 groups was statistically significant (p < 0.005). Receiver operating characteristic analysis showed an elevated area under the curve (0.831; 95% CI: 0.634-0.948), with a significance level of p < 0.0014 (area = 0.5).
These preliminary results seem to indicate that breath ethane levels are higher in most patients with ARMD. The breath ethane test could thus be a useful method for evaluating the level of oxidative stress in patients with ARMD. To our knowledge, there are no data on this type of analysis applied to ARMD.
Ophthalmic Research 02/2011; 46(3):141-4. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the preclinical safety of intravitreal genistein in rabbit eyes over a short-term period.
Twelve New Zealand albino rabbits were selected for this study. Four concentrations of genistein (LC Laboratories, Woburn, MA) were prepared: 24 mg/0.1 mL, 135 mg/0.1 mL, 270 mg/0.1 mL, and 540 mg/0.1 mL. Each concentration was injected intravitreally in one eye of three rabbits. As a control, the vehicle solution was injected into the other eye of each animal. Retinal safety of intravitreal genistein was studied with electroretinography and histologic examination in rabbits. Electroretinography recordings were made before the injection and 3 weeks after the injection. Eventually, the rabbits were killed and the retinas were examined by light microscopy. Immunohistochemical staining with caspase-3 and caspase-9 was also performed to evaluate apoptotic expression in all study and control eyes.
Electroretinography studies showed no significant difference between control and genistein-injected eyes at any of the doses in the rabbit model. Histologic examination showed no retinal abnormality in the rabbits injected with different concentrations of genistein. Immunohistochemical staining with caspase-3 and caspase-9 showed no different apoptotic protein expression in any study or control eyes.
Our results indicate that genistein is a safe intravitreal drug in the rabbit model up to 540 mg. If proven safe and efficacious in human studies, intravitreal injection of genistein could be considered a treatment alternative for ocular neovascularisation in selected cases.
[Show abstract][Hide abstract] ABSTRACT: To report a clinical case of a patient with severe scleritis associated with rheumatoid arthritis (RA) refractive to conventional treatment that was treated effectively with rituximab.
A 55-year-old man with RA, on etanercept and oral methotrexate, was referred with diagnosis of acute stromal keratitis, anterior uveitis, and anterior nodular scleritis in his right eye. Cyclophosphamide induced complete regression of acute stromal keratitis and anterior uveitis, but scleritis was still active and persistent. After two 1000-mg infusions of rituximab, scleritis regressed completely and is still in remission 9 months after the second rituximab infusion, without any concomitant use of oral steroids.
Rituximab may be a treatment alternative in severe scleritis that is refractive to conventional therapy. Considering its safety profile, further studies are needed to refine its mechanism of action, optimal indications, and dosing in ocular inflammation.
Ocular immunology and inflammation 06/2010; 18(3):223-5. · 0.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine macular changes before and after uncomplicated cataract surgery in a healthy population.
In a prospective study, we evaluated 62 eyes of healthy patients having elective cataract phacoemulsification. We performed optical coherence tomography (OCT) measurements preoperatively and at 3, 6, 12, 20, and 28 weeks after surgery. The retinal map was divided into minimal foveal thickness, a central 1-mm disk area, and two peripheral ring areas with diameters of 3 mm and 6 mm, respectively, and centered on the fovea. We compared the postoperative OCT values against the respective preoperative values.
Two eyes (3.2%) developed cystoid macular edema (CME) after cataract surgery and were excluded from the study. With respect to preoperative values, visual acuity improved significantly postoperatively, and at 12 weeks, we observed an asymptomatic increase in retinal thickness at 3 mm and 6 mm. Macular volume showed a statistically significant increase at the 12th week after surgery. There was no correlation between macular changes and best corrected visual acuity (BCVA) or ultrasound time.
Our data indicate that the onset of clinically significant CME is rare after uncomplicated phacoemulsification cataract surgery, but with respect to preoperative values we observed an asymptomatic increase in macular thickness and volume at 12 weeks. The possible onset of macular alterations after uncomplicated cataract surgery must be taken into account as a potential later complication, because it can lead to a permanent loss of visual acuity.
Current eye research 12/2009; 34(12):1036-41. · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the clinical outcomes and the effect of treatment in patients with acute posterior multifocal placoid pigment epitheliopathy.
Cases of acute posterior multifocal placoid pigment epitheliopathy treated at the Massachusetts Eye and Ear Infirmary from 1990 to 2002 and cases from the literature were identified. Data on visual acuity, ocular symptoms, bilateral involvement, foveal involvement at presentation, and treatment regimens were recorded.
Visual acuity was 20/25 or worse in 226 (76.6%) eyes and 20/40 or worse in 172 (58.3%) eyes at presentation. At the last follow-up visit, visual acuity was 20/25 or less in 125 (42.3%) eyes and 20/40 or less in 70 (23.7%) eyes. Topical or systemic therapy was given in nearly half of the cases (54.4%). Overall, 87 (71.9%) eyes were symptomatic at last follow-up visit. Finally, measured visual acuity was more than 20/25 in 20 (87.5%) eyes without foveal involvement at presentation and in 28 (39.2%) eyes with foveal involvement.
Although acute posterior multifocal placoid pigment epitheliopathy shows a relatively benign prognosis, especially when compared with some of the other white dot syndromes, there are patients who experience incomplete visual recovery.
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the incidence and types of adverse drug reactions (ADRs) associated with medications used to treat active toxoplasmic chorioretinitis.
This was a retrospective review of the clinical records of a consecutive series of patients with active toxoplasmic chorioretinitis, examined between March 1991 and August 1998. For inclusion in the review, patients had to have been diagnosed with active toxoplasmic chorioretinitis, been treated with a single drug or drug combination indicated for this condition, and been followed for at least 8 weeks. Patients who were lost to follow-up or who had incomplete chart data were excluded. Demographic data, pertinent aspects of the medical history, drug treatments, and ADRs associated with antitoxoplasmic treatment were recorded.
Fifty-five patients met the criteria for inclusion in the review. In descending order of frequency, they received antitoxoplasmic treatment with clindamycin (n = 50), sulfadiazine (n = 40), pyrimethamine (n = 33), trimethoprim-sulfamethoxazole (n = 16), and atovaquone (n = 10), alone or in combination. Twenty-two patients (40.0%) had a total of 27 ADRs. The most frequently occurring ADRs were rash (19 [34.5%]), mostly associated with sulfadiazine (9/40 [22.5%]) and clindamycin (6/50 [12.0%]), and gastrointestinal ADRs such as diarrhea (6 [10.9%]), stomach upset (6 [10.9%]), and bleeding (1 [1.8%]), mostly associated with clindamycin (5/50 [10.0%], 3/50 [6.0%], and 1/50 [2.0%], respectively). The incidence of ADRs associated with individual antitoxoplasmic drugs was 30.0% (3/10) for atovaquone, 26.0% (13/50) for clindamycin, 22.5% (9/40) for sulfadiazine, 12.5% (2/16) for trimethoprim-sulfamethoxazole, and 12.1% (4/33) for pyrimethamine. There were 2 serious ADRs: gastrointestinal bleeding in a patient treated with clindamycin and leukopenia in a patient treated with pyrimethamine. Twenty-five ADRs were reversed on drug discontinuation; the remaining 2 were mild and did not require drug discontinuation.
The overall incidence of treatment-associated ADRs was high (40.0%) in these patients with ocular toxoplasmosis. The most frequently occurring ADRs were rash and gastrointestinal complaints.
[Show abstract][Hide abstract] ABSTRACT: To determine whether infliximab may be used safely as an intraocular drug, the ocular safety of intravitreal infliximab in rabbits was studied by clinical examination, electroretinography (ERG), and histology in rabbits.
Twelve New Zealand albino rabbits were selected for this study. Different infliximab doses, namely 1.0 mg, 1.7 mg, and 3.3 mg in 0.1 mL, were injected intravitreally into one eye each of three rabbits. As a control, the vehicle solution was injected into the fellow eye of each animal. Eye clinical examination and ERG recordings were made before and 2, 6, and 12 weeks after injection. Eventually, the rabbits were humanely killed, and the retinas were examined by light microscopy. In addition, the elimination half-life of the drug in the vitreous was assessed.
Slit lamp biomicroscopy, indirect funduscopy, and ERG evidenced no significant differences between control and infliximab-injected eyes in this rabbit model, at any of the tested doses. Histologic examination revealed no retinal abnormality in the rabbits injected with 1 mg and 1.7 mg intravitreal infliximab. In two of three eyes injected with 3.3 mg infliximab, significant edema of the nerve fibers was detected compared with the control group. The half-life of the drug was estimated to be 8.5 days.
These results indicate that infliximab may be a safe intravitreal drug in the rabbit model at a dose of up to 1.7 mg. If proven safe and efficacious in further studies, intravitreal injection of infliximab could be considered an alternative to systemic administration in selected patients.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to report a case of retinal astrocytic hamartoma with an associated macular edema and the spontaneous resolution of the latter due to an increase in hamartoma calcification over a seven-year follow-up period. Clinical examination, red-free and colour fundus photographs, fluorescein angiography, and optical coherence tomography were performed during a seven-year follow-up. We conclude that retinal astrocytic hamartomas may be associated with cystoid macular edema. In some cases, the CME may resolve due to an increase in tumor calcification. Whether the progressive calcification of the retinal mass represents an overall positive prognostic factor is still unknown and further histologic studies are certainly required.
Seminars in Ophthalmology 01/2007; 22(3):171-3. · 1.20 Impact Factor