PURPOSE: The electro-oculogram (EOG) is a powerful test to diagnose primary and metastatic choroidal tumors. While in benign tumors light-peak to dark-trough ratio values are in the range of normal subjects, these values appear highly altered in eyes affected by malignant choroidal tumors. Here we report a clinical case of a patient with intraretinal metastasis from cutaneous melanoma; notwithstanding the malignancy of the tumor, the EOG doesn't present alterations. METHODS AND RESULTS: Standard electro-oculographic recordings were performed before and after local excision of the tumor: recordings from the normal eye were taken as control. The EOG values were always normal in both eyes. Histological sections showed no evident change in the cell population of the retinal pigment epithelium (RPE) and Bruch's membrane. CONCLUSION: Our results suggest that the presence of an intact RPE is a crucial requirement to obtain a normal EOG.

Adult↗

PubMedDate not supplied

Eventual error caused by dehydration with pachometry.

Among the possible variables responsible for systemic errors in the acquisition of pachometric measurements, the corneal hydration condition plays a determinant role. In the present study, the authors have investigated the importance of this condition with two different pachometers (Storz Corneoscan II and Allergan Humphrey), reproducing an experimental dehydrated condition. The main datum arising from the comparison of the measurements obtained is represented by the different time course of the value of the measurement in the two groups. In fact, confronting the medium initial superimposed thickness value in the two tables (521 vs. 520 microm) there is a substantial difference in the final examination. For the first group of 60 corneas, the thickness values appear almost identical in the different intervals of time (medium initial thickness 521 vs. 512 microm final thickness). For the group examined with the solid-point machine, a decreasing thickness equal to 7% was evidenced (520 vs. 482 microm) with a significant decrease in the corneal thickness after only 45 s.

Adult↗

PubMedDate not supplied

Electro-oculographic abnormality in eyes with uveal melanoma.

PURPOSE: To seek out correlations between preoperative electro-oculogram (EOG) recordings with different types of uveal melanomas, after surgery. METHODS: We analysed the EOG recordings of 120 patients with uveal melanomas, histologically verified, 100 in the choroid and 20 in the iris and ciliary body. The EOG data were correlated with the site, size and histological type of the tumor. RESULTS: In 100 eyes with choroidal melanoma the Arden Index (AI) was less than in fellow eyes (mean 126.6, SD +/- 23.8 and 202.9, SD +/- 47.0; p=0.01). The EOG values were not different with respect to the histological type, site and size of tumor. In cases with iris and ciliary body melanomas the AI were not significantly different from the fellow eyes (mean 180.6, SD +/- 23.6 and 203.2, SD +/- 38.7; p=0.07). CONCLUSIONS: Since the EOG is abnormal in eyes with choroidal melanoma, it can be considered a powerful auxiliary for diagnosing these tumors.

Adult↗

PubMedDate not supplied

Escherichia coli endophthalmitis after trans-scleral resection of uveal melanoma.

PURPOSE: To report a case of Escherichia coli endophthalmitis after trans-scleral resection of an uveal melanoma. METHODS: A large ciliary body melanoma was treated by trans-scleral resection and full-thickness sclerectomy because of epibulbar tumor extrusion, followed by adjuvant ruthenium plaque therapy. RESULTS: Two months after treatment the patient developed wound dehiscence and consecutive endophthalmitis. Cultures of the involved sclera yielded Escherichia coil. The infection resolved after systemic intravenous ciprofloxacin and ceftriaxone, with aggressive topical ciprofloxacin and tobramycin. Final visual acuity was light perception. CONCLUSIONS: We assume that the ruthenium plaque placed over the scleral patch was responsible for the delay in scleral healing, with consequent wound dehiscence and E. coli endophthalmitis.

Aged↗

PubMedDate not supplied

Intravitreal triamcinolone in cystoid macular edema due to uveitis and repeated surgery after a penetrating trauma.

PURPOSE: To test the effectiveness of intravitreal triamcinolone acetonide in treating macular edema due to multiple vitreoretinal surgical procedures and uveitis after a penetrating trauma with metallic foreign body retention in a 37-year-old man. METHODS: The patient received two intravitreal injections of triamcinolone acetonide-2 mg/0.05 mL and 4 mg/0.1 ml(-1) month apart. The 6-month follow-up included best-corrected visual acuity (BCVA) measurement and optical coherence tomography evaluation. RESULTS: After the first injection (2 mg) the foveal thickness (685 microm, as compared to a normal value of <165 microm) and the BCVA (20/200) remained unchanged with respect to the preinjection values; 1 week after the second injection (4 mg), the foveal thickness went down to 130 microm and the BCVA improved (20/80). Such results were unchanged at the 6-month control. No complications occurred. CONCLUSIONS: A 2 mg dose of triamcinolone acetonide did not improve the anatomic and functional status of the macula. A 4 mg dose markedly improved BCVA and reduced the macular thickness in this case of macular edema.

Adult↗

PubMedDate not supplied

Efficacy and safety of bimatoprost in patients with uncontrolled glaucoma as alternative to filtration surgery.

PURPOSE: To evaluate the efficacy and safety of bimatoprost 0.03% as an alternative to filtration surgery in patients with uncontrolled glaucoma. DESIGN: Interventional study. METHODS: A total of 83 consecutive patients (83 eyes) awaiting glaucoma surgery were enrolled in eight ophthalmic centers. Reasons for listing were inadequate intraocular pressure (IOP) control despite medical therapy and documented progression of visual field loss. All patients discontinued the previous treatment and were switched to bimatoprost 0.03% QD (one drop at 9 pm). The primary efficacy outcome was a 20% IOP reduction from baseline at each timepoint. IOP was measured at day 7, day 30, day 60, and day 90 of treatment; less than 20% IOP reduction was considered as a failure. RESULTS: An IOP reduction of at least 20% was achieved in 74 patients (89.1%) after 7 days and in 64 patients (86.5%) after 30 days. Sixty-two patients (74.6%) maintained IOP readings 20% lower than baseline after 60 and 90 days. In these patients, visual field indices improved in 8 eyes (13%), and remained unchanged in 54 eyes (87%). Ocular side effects were conjunctival injection (15.6%), burning sensation (9.6%), foreign body sensation (4.8%), and eyelash growth (2.4%). CONCLUSIONS: This preliminary study shows that bimatoprost 0.03% could represent a useful therapeutic tool that might defer filtration surgery.

Aged↗

PubMedDate not supplied

Necrotic uveal melanoma with orbital inflammation.

PURPOSE: Extraocular extension of uveal melanoma can be accompanied by proptosis and signs of orbital inflammation but this clinical presentation is an uncommon feature if the tumor is solely intraocular. METHODS: Case report. RESULTS: The authors describe a patient with a medium-sized necrotic uveal melanoma, without extraocular spread, presenting with the clinical picture of orbital cellulitis. CONCLUSIONS: The ophthalmologist needs to be aware of this uncommon presentation of uveal melanoma, and not assume the presence of proptosis and orbital inflammation as signs of extraocular extension.

Cellulitis↗

PubMedDate not supplied

Optical coherence tomography and focal electroretinogram evaluation of cystoid macular edema secondary to retinitis pigmentosa treated with intravitreal triamcinolone: case report.

PURPOSE: To assess macular structure and function by optical coherence tomography (OCT) and focal electroretinogram (FERG) before and after intravitreal triamcinolone acetonide (IVTA) administration for cystoid macular edema (CME) in a patient with retinitis pigmentosa (RP). METHODS: A 33-year-old man with RP and refractory bilateral macular edema was treated with IVTA in his left eye and evaluated with visual acuity, OCT, and FERG for 6 months. RESULTS. Compared to the fellow eye, after IVTA mean retinal thickness significantly decreased, while FERG amplitude and phase did not show significant changes at the end of follow-up. Visual acuity showed a significant tendency to improve. CONCLUSIONS: In this case report, IVTA improved macular anatomy and visual acuity; this result, however, was not associated with a similar electrophysiologic response.

Adult↗

PubMedDate not supplied

Malignant conjunctival epibulbar fibrous histiocytoma with orbital invasion.

The Authors report on a rare case of malignant conjunctival epibulbar fibrous histiocytoma with orbital invasion. Fibrous histiocytoma is a tumour of mesenchymal origin, which, although among the most common adult age soft tumours, appears very rarely at the conjunctival level. In fact the most frequent site is the orbit. So far only 15 cases concerning conjunctiva have been described in the Literature only 4 of those have been reported as malignant. We observed a male patient, who 6 years ago, at the age of 53, noticed a neoformation on the temporal portion of the bulbar conjunctiva. In June 1988, after three successive operations, with a histological diagnosis of inflammatory granuloma, he came to our Clinic, where, because of the characteristics of the orbit infiltrations, only a partial excision was carried out for a biopsy. The histological examination, associated with immunohistochemical techniques, gave the result of malignant fibrous histiocytoma. Consequently in, July 1988, the patient underwent an exenteratio orbitae. To date, the patient enjoys good health without a trace of recurrence. Besides the clinical presentation of the case, histopathological and immunohistochemical findings concerning this type of lesion are presented and discussed, with a comparison of our findings with those reported in the literature.

Conjunctival Neoplasms↗

PubMedDate not supplied

Imipenem reaches therapeutic concentrations in aqueous humor, as determined by HPLC.

The majority of ocular infections in the industrialized countries arise after surgical interventions. An appropriate antibacterial prophylaxis is therefore highly desirable in eye surgery. We used high performance liquid chromatography (HPLC) to measure the concentrations reached by imipenem, a modern wide-spectrum beta-lactam antibiotic, in plasma and aqueous humor of 26 patients scheduled for cataract surgery. Even a single 500 mg dose of imipenem achieved therapeutic levels of the molecule for the most common ophthalmic pathogens (1 microgram/ml or above) in the aqueous humor within one to two hours after administration. This drug may therefore be suitable for antibacterial prophylaxis in eye surgery.

Adolescent↗

PubMedDate not supplied

PERG and P-VEP after surgical trabeculectomy in primary open-angle glaucoma.

Pattern-reversal electroretinograms (PERG) and visual evoked potentials (P-VEP) were measured for 10 eyes from 10 rigorously selected patients with bilateral advanced primary open angle glaucoma (POAG), before and after surgical trabeculectomy. The aim was to establish whether electrofunctional examinations improved after major IOP reduction. Only one eye at random was operated, and the fellow eye was used as control. The aim of this study, using electrofunctional examinations, was to clarify whether ganglion cell damage was reversible after marked reduction of IOP by surgery. The results indicate that glaucomatous damage seems to be irreversible.

Adult↗

PubMedDate not supplied

Local excision of retinal metastasis from cutaneous melanoma.

The incidence of cutaneous melanoma is constantly rising. Ocular involvement is rare and the choroid is the most accessible structure to metastatic emboli. The case described is noteworthy on account of several particular features: 1) the missed diagnosis of the primary malignancy. This might be because either cutaneous melanoma or cutaneous nevi show several common features; 2) the rarity of the retinal metastatic site. Unlike the choroid, the retina is an unusual metastatic site but, regardless of organ blood flow, the metastatic efficiency may be related to interactions between tumor cells and host tissue; 3) the treatment of the retinal metastasis, excised conservatively. As far as we know, this is the first report of a retinal metastasis being treated by local resection.

Adjuvants, Immunologic↗

PubMedDate not supplied

Iris diaphragm implantation in post-traumatic aniridia and tractional retinal detachment.

The implantation of an artificial iris diaphragm is described in a case of aniridia and traumatic aphakia with a relapsed, tractional retinal detachment. The addition of heparin and dexamethasone to the infusion liquid is useful to reduce the fibrinous exudation which seems to be the main cause of diaphragm obliteration.

Aniridia↗

PubMedDate not supplied

Four techniques for retreatment after excimer laser photorefractive keratectomy.

BACKGROUND: Retreatment should be considered for patients unsatisfied because of undercorrection and/or haze following excimer laser photorefractive keratectomy (PRK) for myopia. It is unclear if any specific type of retreatment is superior to another, especially in terms of post-treatment myopic shift and haze. METHODS: After a mean follow-up of 12.4 +/- 5.5 months, we retreated 10 eyes by four different techniques following failed PRK: only PRK, PRK with phototherapeutic keratectomy (PTK), only PTK, and mechanical scraping. RESULTS: After a mean follow-up of 11.4 +/- 7.8 months (range, 6 to 28 mos), the final mean refraction was 2.40 +/- 2.00 D (range, 0 to -6.00 D). Corneal clarity improved in 70% of eyes. The mean uncorrected visual acuity improved from 20/200 to 20/40. Of the four retreatment techniques, only scraping proved ineffective, due to unstable outcome. CONCLUSIONS: PRK alone, PRK with PTK, and PTK alone appeared safe and effective methods of retreatment, with no worsening of corneal clarity.

Adult↗