-
[show abstract]
[hide abstract]
ABSTRACT: We performed a prospective noncomparative study to report the results of reduced fluence photodynamic therapy (PDT) combined with intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy with active exudation and hemorrhage.
Seventeen polypoidal choroidal vasculopathy eyes were treated, and follow-up for all patients was 12 months. Photodynamic therapy was administered with reduced fluence (exposure time of 70'') and followed (48 hours later) by intravitreal ranibizumab (0.5 mg in 50 μL). Intravitreal ranibizumab, with or without reduced fluence PDT, was repeated as indicated by clinical and angiographic findings.
During the follow-up, the mean best-corrected visual acuity significantly improved from 0.45 ± 0.29 logarithm of the minimum angle of resolution at baseline to 0.29 ± 0.28 logarithm of the minimum angle of resolution at 12 months. The mean total macular volume (documented by optical coherence tomography retinal map examination) decreased from 7.5 ± 1.18 mm to 6.7 ± 0.8 mm. In 95% of the cases, best-corrected visual acuity remained stable or improved.
Reduced fluence PDT limits laser exposure, minimizing the risks of PDT-induced adverse effects. Intravitreal injections of ranibizumab 0.5 mg reduced bleeding and leakage in polypoidal choroidal vasculopathy eyes and interfere with rebound upregulation of vascular endothelial growth factor because of PDT-induced choroidal hypoperfusion. Combined treatment may improve treatment outcomes in polypoidal choroidal vasculopathy while minimizing ocular and systemic complications of treatment.
Retina (Philadelphia, Pa.) 01/2012; 32(7):1280-8. · 2.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the mydriatic effects of 2% ibopamine and collyrium containing 10% phenylephrine + 0.5% tropicamide and to study the associated drug in patients with ocular pseudoexfoliation (PEX) syndrome.
This was a prospective, comparative, interventional clinical study. The study group consisted of 20 patients with ocular PEX syndrome. Intervention procedures included administration of 10% phenylephrine-0.5% tropicamide versus 2% ibopamine versus 2% ibopamine followed by the combination drug. Main outcome measurement was mydriatic efficacy measured in terms of mean pupil diameter. Adverse effects on intraocular pressure (IOP) were measured with a Goldmann applanation tonometer. Mean premedication pupil diameters in all patients were less than 3.5 mm.
Instillation of 10% phenylephrine-0.5% tropicamide caused significantly greater mydriasis than 2% ibopamine (pupil diameters: 6.17 mm, SD=1.14 versus 5.33 mm, SD=1.34; p<0.001). Combined use of both collyria significantly increased mydriasis (7.19 mm; SD=0.69) compared with that induced by either of the products alone (p<0.001). Inadequate mydriasis (pupil diameters < 5.5 mm) was observed in 2 patients after administration of 10% phenylephrine-0.5% tropicamide and in 10 following instillation of 2% ibopamine, but the addition of 10% phenylephrine -0.5% tropicamide to ibopamine-treated eyes resulted in adequate dilation in all cases. IOP increases of 4 mmHg over baseline values were observed in 12 (60%) patients after 2% ibopamine.
In patients with ocular PEX, instillation of 2% ibopamine exerts a significant additive effect on mydriasis induced with 10% phenylephrine-0.5% tropicamide with only minimal increases in IOP.
European journal of ophthalmology 10/2009; 20(1):120-3. · 0.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The first section of this chapter describes the anatomy and the physiology of the choroid and the vascular pattern of the
choroidal vessels. The choroid is of fundamental importance for nourishment of the retina so that all the alterations of the
choroid lead to a disfunction of the retinal pigment epithelium (RPE), Bruch's membrane, and choriocapillary complex. The
various methods used to study the choroid and its pathologies in post-mortem studies and in vivo are described—injection of chromopolimer, Indocyanine Green Angiografy, and Doppler flow studies. Age-related changes of
choroid are analyzed. Alterations have been described in the various layers of the choroid, which are part of the physiologic
aging process. In certain cases, they can cause disease, but sometimes the border between physiologic and pathologic age-related
changes is very hard to identify. The choroid represents the preferential target of certain age-related diseases. In particular,
we describe the physiopathology of age-related pathologies such as hypertension, diabetes, AMD, and atherosclerosis—so common
in the elderly. In particular, diabetes and AMD represent the main causes of blindness in industrialized countries.
Keywordschoroid aging–age-related macular disease–choroidopaty hypertensive choroidopathy
05/2008: pages 217-238;
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of our study was to compare the effects of systemically administered acetazolamide and topical apraclonidine 0.5% in the control of intraocular pressure (IOP) following phacoemulsification of senile cataracts.
The study was conducted on patients affected by cataract and followed at the Department of Ophthalmology.
Seventy-eight eyes in 78 patients were selected. Twenty-six eyes were randomly assigned to postoperative treatment with topical apraclonidine 0.5%, 26 received oral acetazolamide and the remaining 26 received no hypotensive treatment (control group). Statistical analyses were performed mainly by means of analyis of variance.
IOPs measured 24 h after surgery were significantly (p = 0.01) lower in the apraclonidine group compared to the control group.
Our double-blind prospective study conducted on patients randomly assigned to treatment with apraclonidine or acetazolamide shows that the former drug is undoubtedly effective in the prevention of IOP increases following phacoemulsification. IOPs recorded in patients treated with this drug were lower than those observed in the acetazolamide and the control groups. Considering the lower risk of toxicity associated with topical administration, apraclonidine 0.5% seems to be preferable to oral acetazolamide in this postoperative setting.
Ophthalmologica 02/2006; 220(6):356-60. · 1.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Using Goldmann applanation tonometry (GAT) as a gold standard, we evaluated the accuracy of Nidek NT-4000 pneumotonometry (NPT) in adults without corneal disease. Bland and Altman analysis of serial intra-ocular pressures (IOPs) measured with NPT and GAT in 10 healthy subjects revealed that the repeatability coefficients for the two methods were similar. NPT, GAT and ultrasonic pachymetry were then performed in 100 patients. Bland and Altman analysis showed that NPT yielded significantly higher readings than GAT [mean biases for right and left eye measurements were 1.37 mmHg (95% limits of agreement: -3.02-5.76) and 1.17 mmHg (95% limits of agreement: -2.76-5.11) respectively] and was more affected by corneal thickness variations. For detection of IOPs > or =21 mmHg, NPT displayed very high sensitivity (0.90) and good specificity (0.95). NPT may be useful in screening and clinical settings but borderline-high IOP readings should be confirmed with GAT.
Ophthalmic and Physiological Optics 01/2006; 26(1):33-9. · 1.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine whether implantation of a new intraocular lens (IOL) with a modified prolate anterior surface, designed to reduce the positive spherical aberration of the pseudophakic eyes, results in improved contrast sensitivity assessed in terms of low contrast visual acuity (VA).
We carried out an intraindividual study of 12 patients with bilateral cataracts, randomized to receive a prolate anterior surface IOL (Tecnis Z9000, Pharmacia) in one eye and a biconvex spherical surface IOL (CeeOn 911 A, Pharmacia) in the other. High and low contrast VA was assessed under photopic conditions, before and after pupil dilation.
After mydriasis, the Technis Z9000 provided significantly better low contrast VA at contrast levels < or = 25%. No significant difference was found under normal pupil conditions.
Our results confirm the hypothesis that the spherical aberration of the eye after cataract surgery can be reduced by an anterior prolate surface IOL.
Acta Ophthalmologica Scandinavica 01/2005; 82(6):718-22. · 1.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Lens opacities are associated with a higher risk of death, although there are some discrepancies regarding the specific types of cataract representing risk. The purpose of the present study was to further investigate the relationships between different types of lens opacity and patient survival.
In 1987, 860 residents of Priverno, Italy, aged 45-69 years underwent an ophthalmologic examination. Based on patient histories and the findings of the slit-lamp examination, each of the 860 patients was classified according to the type of opacity (pure cortical, pure nuclear, pure posterior subcapsular, mixed, and surgical aphakia). The survivors of the original cohort were re-examined in 1994. Death and survival rates were computed by the Kaplan-Meier method. Associations between mortality and significant factors were included in a stepwise Cox proportional-hazards regression model.
Forty-four members of the original cohort had died during the 7-year follow-up. Age-adjusted survival curves based on Kaplan-Meier estimates showed significantly lower survival in those whose baseline examinations had revealed pure nuclear opacity (log rank test: P=0.020) and aphakia (log rank test: P<0.001). When adjusted for other mortality risk factors (age, sex, diabetes, cardiovascular diseases), the hazard ratio was 4.32 for pure nuclear opacity (95% CI 1.13-16.4) and 18.3 for aphakia (95% CI 3.21-104.0).
The analysis of the Priverno data seems to confirm an association between lower survival and cataracts, particularly those confined to the lens nucleus and those that had already prompted surgery.
Albrecht von Graæes Archiv für Ophthalmologie 05/2004; 242(4):289-94. · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The authors describe their findings on 12 subjects who were treated with 50 mg of sildenafil (Viagra) and underwent ERG measurements prior to and 1 hour after ingestion. The Naka-Rushton equation was used to describe the b-wave luminance-response function of the scotopic ERG. Statistically significant differences were noted in the Vmax and K values. Sildenafil ingestion resulted in an increase in Vmax (higher rod response to light stimuli) and a decrease in K (higher sensitivity).
Documenta Ophthalmologica 10/2003; 107(2):111-4. · 2.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the measurement of intraocular pressure (IOP) using a new induction/impact rebound tonometer (ICare®) compared with Goldmann applanation tonometry (GAT). We also aimed to quantify the systematic and random errors (bias) of the 2 methods, to evaluate the sensitivity and specificity of the ICare® tonometer in identifying patients with 21 mmHg or more measured with the GAT, and to study the influence of corneal thickness on IOP measurement with the 2 tonometers.
We compared the IOP values obtained with the 2 instruments in 97 patients.
Analysis based on the Bland and Altman method revealed that the IOP values recorded with the ICare® tonometer were slightly higher than those obtained with the GAT. The estimated bias for right eye measurements was 0.78 mmHg with 95% limits of agreement ±3.55 mmHg. This overestimation, which is not clinically relevant, was confirmed when we used the IOP values corrected according to central corneal thickness for data analysis. The sensitivity and specificity were 0.90 and 0.95, respectively.
The ICare® tonometer proved to be comparable with other nonconventional tonometers and can be used by nonophthalmologists and paramedical personnel during screening tests of populations. In addition, the ICare® tonometer could be considered a valid alternative to GAT when GAT is not available.
European journal of ophthalmology 21(3):251-7. · 0.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The study aim was to evaluate the short-term safety and efficacy of pegaptanib sodium injections (Macugen, Eyetech Pharmaceuticals, Inc., New York, NY) in the compassionate-use therapy of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Intravitreal pegaptanib was used to treat 41 eyes in 40 patients with CNV. Injections were given every 6 weeks, and a minimum of three injections were planned. The mean change in BCVA for all lesions was a loss of 0.03 Snellen lines. Seven eyes (17.1%) gained more than 3 lines, three (7.31%) lost 6 lines or more, and in 75.6% the BCVA stabilized or improved.
Seminars in ophthalmology 25(1-2):16-20.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the incidence of endophthalmitis in Italy.
The Ministry of Health Hospital Admissions online database was searched to identify cases of endophthalmitis and cases with risk factors for endophthalmitis (corneal ulcer, open wound of the eyeball, and intraocular surgery including retinal, iris, and lens procedures with or without vitrectomy). Annual Incidence rates (overall, and age- and gender-specific) were computed in the general population and in the population with one or more of the risk factors for endophthalmitis.
The overall annual incidence of endophthalmitis / 100,000 inhabitants was 2.0 (95% confidence interval (CI):1.8-2.1) in 2003. The risk for endophthalmitis and for most factors that cause predisposition to endophthalmitis was higher in males. The annual incidence rates of corneal ulcer, open wounds of the eyeball, retinal procedures, iris procedures, lens procedures, and other intraocular procedures were respectively (per 100,000 inhabitants) 4.6, 4.8, 43.0, 9.2, 775.7, and 63.0. The annual incidence of endophthalmitis per 100,000 predisposed subjects was 220 (95% CI: 210-230), and the risk was higher in males (relative risk 1.7, 95% CI: 1.5-1.9). Annual incidence rates remained stable from 1999 to 2003.
Higher rates of open wounds of the eyeball, corneal ulcers, and retinal surgery among males may be responsible for their higher risk for endophthalmitis.
Ophthalmic epidemiology 15(6):366-71. · 1.93 Impact Factor
