Photodynamic therapy in chronic central serous chorioretinopathy.
Explore the source record for details and available documents.
Choroid Diseases↗
Biomedical subjects
G Ravalico
Publications and source records attributed to G Ravalico.
Angiographic features after photodynamic therapy for choroidal neovascularisation in age related macular degeneration and pathological myopia.
AIM: To describe the angiographic features after photodynamic therapy (PDT) with verteporfin in choroidal neovascularisation (CNV) associated both with age related macular degeneration (AMD) and pathological myopia (PM). METHODS: 36 patients affected by subfoveal CNV in AMD and 25 patients with subfoveal CNV in PM underwent an ophthalmological examination including fluorescein angiography (FA) and indocyanine green angiography (ICGA) using the IMAGEnet System. Post-PDT examinations were performed 7, 30, and 90 days later. RESULTS: The typical angiographic aspect after PDT for AMD related CNV was a round hypofluorescence visible both on FA and on ICGA, which included both CNV and the surrounding tissues and corresponded to the area exposed to laser light. In PM the CNV appeared hypofluorescent during the early phases and gradually became hyperfluorescent during the late phases on FA, whereas on ICGA it was detectable in its whole extension as a hyperfluorescent lesion since the early phases. Differently from AMD, there was no round hypofluorescence surrounding the CNV on FA or on ICGA. Moreover, five patients in the AMD group showed hot spots on ICGA, which spontaneously disappeared during the follow up. Classic and occult components of the AMD related CNV revealed a different angiographic response to PDT, showing with the latter only a partial closure 1 week after PDT followed by a complete reopening at the first month in 100% of cases. CONCLUSION: The post-PDT hypofluorescence typical of AMD related CNV, especially visible on FA, might be secondary to a combination of choriocapillary occlusion and masking effect due to swelling of retinal pigment epithelium cells. Hot spots in the AMD affected patients could be interpreted as the expression of a non-thermal choroidal vasculitis secondary to PDT.
Choroid↗
Genetic heterogeneity in Malattia Leventinese.
Malattia Leventinese (ML) is a dominant macular dystrophy characterized by drusen at the posterior pole. ML has been associated with a single mutation (R345W) in the EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP-1) gene, but also the EFEMP-2 gene, known to share genetic homology with EFEMP-1, is considered a candidate gene for this genetic disorder. We have characterized clinically and genetically seven members of a three-generation family affected by ML. Results showed that five family members were clinically affected but the DNA sequencing failed to reveal the typical R345W mutation. Furthermore, the linkage analysis to EFEMP-1 (using polymorphic markers D2S337 and D2S2368) and to EFEMP-2 (using D11S987 and D11S1314 markers) gave negative results. Therefore, our results suggest EFEMP-1 or EFEMP-2 genes cannot be excluded as being responsible for ML but other genes have to be considered in the pathogenesis of the disease.
Adult↗
Early angiographic changes after laser treatment of choroidal neovascularisation in age-related macular degeneration.
PURPOSE: To describe angiographic features detectable on fluorescein angiography (FA) and indocyanine green angiography (ICGA) early after laser photocoagulation of choroidal neovascularisation (CNV) in age-related macular degeneration (AMD). METHODS: Thirty-five eyes of patients with AMD and juxtafoveal or extrafoveal CNV referred to the angiographic centre of the Eye Clinic of Trieste were considered. Ophthalmological assessment included FA and ICGA performed 2 days before and 30 min after laser treatment, and then 1, 2, 7, 14, 21 and 28 days after photocoagulation. Further clinical angiographic examinations were carried out 2, 3, 4 and 6 months after treatment. Photocoagulation was performed for classic CNV on FA and occult CNV on FA, appearing as well-defined focal spot on ICGA. RESULTS: Our results show that interpretation of early post-treatment angiographic examinations may be awkward because diffuse leakage on FA and hot spots on ICGA are normally detectable soon after laser treatment and thereafter during the first 2 weeks. Later, at the 3-week control, leakage on FA and hot spots on ICGA are visible in 62.8% and in 37% of cases respectively; they disappear completely by the 4-week control. CONCLUSION: Difficulty in analysing FA and ICGA in the early post-photocoagulation period underlines the importance of the decision regarding when to perform the first reliable post-laser control and how to improve its interpretation. We suggest that the first angiographic control be performed 3 weeks after treatment, strictly monitoring those eyes showing leakage or marginal hot spots over the following weeks. Overlapping the post-laser hypofluorescent area on the pre-laser lesion can ensure the complete coverage of CNV, and analysis of the retinal and choroidal vascular pattern inside and near the photocoagulated area during the different angiographic phases, albeit difficult, is essential for the interpretation of the angiographic lesions.
Aged↗
Inflammatory cell adhesion and surface defects on heparin-surface-modified poly(methyl methacrylate) intraocular lenses in diabetic patients.
PURPOSE: To evaluate the incidence of surface scratches on heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) and the possible influence of these alterations on the biocompatibility of HSM PMMA. SETTING: University Eye Clinic of Trieste, Trieste, Italy. METHODS: Twenty-six diabetic patients had phacoemulsification and implantation of an HSM PMMA IOL (809C, Pharmacia & Upjohn). Patients with proliferative diabetic retinopathy or iridopathy were excluded from the study. On postoperative days 7, 30, 90, and 180, specular microscopy was performed to study and photograph the anterior IOL surface. The presence of scratches on the anterior IOL surface was assessed and the inflammatory cell reaction noted and graded using a semiquantitative scale. Finally, the location of the inflammatory cells in relation to the surface scratches was established. RESULTS: Scratches and other surface defects were found in 88.4% of cases. All patients had small cells on the IOL surface 7 days after surgery. At 30 days, small cells were observed in 88.4% of cases. The inflammatory cells were mainly located inside the scratches rather than throughout the IOL surface. CONCLUSIONS: This in vivo cytology study provides further evidence of the effectiveness of heparin surface modification in improving the biocompatibility of PMMA. In diabetic patients, inflammatory cells adhered to the exposed PMMA surface more than to the HSM surface, suggesting that the use of HSM PMMA in patients with conditions predisposing them to increased postoperative blood-aqueous barrier breakdown is beneficial.
Cell Adhesion↗
Iris alteration using mechanical iris retractors.
A 74-year-old woman had a 3-port pars plana vitrectomy for a dropped nucleus after complicated phacoemulsification. Flexible nylon iris retractors were positioned to dilate the small pupil. The patient died of a pulmonary embolus 1 day after surgery. The eyeball was removed at autopsy, and pathology of the iris was investigated. Localized damage to the iris where the retractor hooks were positioned was noted, but no other alterations to the iris were observed. These findings may explain the recovery of pupil function that is common after surgery with mechanical iris retractors.
Aged↗
Comparative evaluation of corneal epithelial permeability after the use of diclofenac 0.1% and flurbiprofen 0.03% after phacoemulsification.
PURPOSE: To assess the corneal epithelial function after prolonged topical administration of diclofenac 0.1% and flurbiprofen 0.03% single-dose eyedrops. SETTING: University Eye Clinic of Trieste, Trieste, Italy. METHODS: This randomized prospective study comprised 24 patients scheduled for phacoemulsification. The patients were randomly assigned to receive diclofenac or flurbiprofen eyedrops for 2 months after surgery. Corneal epithelial permeability was determined by fluorophotometry 7, 37, and 67 days after surgery. RESULTS: An increase in corneal epithelial permeability was observed in the diclofenac group 37 and 67 days after surgery. No epithelial function alterations occurred in the flurbiprofen group. CONCLUSIONS: Subclinical impairment of the epithelial function was observed during topical treatment with diclofenac 0.1% single-dose eyedrops after phacoemulsification. The mechanism responsible for this effect remains unknown.
Aged↗
Neodymium: YAG laser membranotomy after extracapsular cataract surgery in diabetic patient.
Explore the source record for details and available documents.
Aged↗
A pilot study of ICG-guided laser photocoagulation for occult choroidal neovascularization presenting as a focal spot in age-related macular degeneration.
PURPOSE: To evaluate the effect of indocyanine green angiography (ICG)-guided laser photocoagulation in eyes with age-related macular degeneration (AMD) and occult choroidal neovascularization (O-CNV), appearing as a well-defined focal spot on ICG. METHODS: Eyes with extrafoveal or juxtafoveal focal spot on ICG, either without PED (Group A) or with PED (Group B) at baseline, were selected. The hyperfluorescent area was photocoagulated by krypton red laser within 24 hours from diagnosis on ICG guide. At 1, 3, 6, 9 and 12 months from treatment, all eyes underwent clinical examination, FA and ICG. Parameters as best corrected visual acuity (BCVA), CNV closure and recurrence onset were analyzed. RESULTS: 53 eyes were enrolled in Group A and 33 in Group B. After 1 year from treatment, a stabilized (+/-1 Snellen line) or improved (2 or more Snellen lines) visual acuity was measured in 37 eyes (43%), 32 in Group A and 5 in Group B. After 1 year, a complete resolution of exudative signs was achieved with one or more laser sessions in 41 eyes (48%), 34 in Group A and 7 in Group B. After 1 year, 50 eyes (58%) had one or more episodes of recurrent CNV, appearing in 51% of eyes of Group A and in 70% of eyes of Group B. Most of the recurrences (86%) occurred during the first trimester after photocoagulation. CONCLUSIONS: ICG-guided laser photocoagulation for O-CNV appearing as a focal spot produced encouraging anatomical and functional outcome in eyes without PED at presentation. When focal CNV is associated with a PED, our treatment technique produced disappointing results.
Aged↗
Acute posterior multifocal placoid pigment epitheliopathy and ulcerative colitis: a possible association.
PURPOSE: To report a case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) in the course of Ulcerative Colitis (UC). METHODS: A complete ophthalmologic evaluation, including fluorescein and indocyanine green angiography, was performed. RESULTS: A patient with exacerbation of UC was referred to our department for sudden visual loss in RE. Ophthalmoscopy disclosed multifocal yellow-white placoid lesions typical of APMPPE in RE. There were no lesions in the fellow eye. On fluorescein angiography (FA), the active lesions showed early hypofluorescence, followed by late staining. Indocyanine green angiography (ICGA) revealed early and late hypofluorescence corresponding to the lesions observed clinically, and late anular staining surrounding a hypofluorescent lesion at the posterior pole. On LE ICGA revealed lesions not detected with ophthalmoscopy and FA. After corticosteroid therapy the lesions healed. CONCLUSION: Ulcerative Colitis may be responsible for the onset of AMPPPE by an immunological mechanism of delayed type hypersensitivity reaction.
Acute Disease↗
Photodynamic therapy for choroidal neovascularization associated with choroidal osteoma.
Explore the source record for details and available documents.
Adult↗
Pit defects on the anterior surface of hydrophilic foldable intraocular lenses.
A series of pits varying in depth and size appeared on the anterior surface of hydrogel intraocular lenses (IOLs) soon after they were implanted. In all cases, the pits increased in size but not in number during a 1 year follow-up. The origin of the pit defects is unknown and does not seem related to inflammatory or lens epithelial cell activity. Hydration of the IOL could be a cause even if a manufacturing defect were present. This IOL surface alteration did not seem to impair visual function or cause visual disturbances.
Acrylic Resins↗
Iris indocyanine green angiography in pseudoexfoliation syndrome and capsular glaucoma.
PURPOSE: The iris vasculature shows typical changes in pseudoexfoliation syndrome (PXS) revealed by iris fluorescein angiography (IFA), such as hypoperfusion, microneovascularisation, and anastomotic vessels. Iris indocyanine green angiography (IICGA) can visualize more precisely details of the iris vascular pattern, especially as regards hypoperfusion and capillary dilatations. The aim of the present study is to describe the angiographic features of PXS on IFA and IICGA, comparing eyes affected with those not affected by capsular glaucoma. METHODS: In a prospective study 42 consecutive patients affected by PXS underwent a complete ophthalmologic examination including IFA and IICGA. Thirty-two eyes were affected by capsular glaucoma. IICGA was performed using IMAGEnet System H1024. RESULTS: IFA can easily detect the microneovascularisation, whereas IICGA allows a better recognition of iris hypoperfusion and anastomotic vessels, and it can reveal iris pigment epithelium defects. While the degree of hypoperfusion was similar in the two subgroups, eyes affected by capsular glaucoma more frequently showed signs of both microneovascularisation (marked stromal tufts and marked plexi), and of anastomotic vessels (peripheral loop, lesser circle and oblique vessels), with statistically significant difference. A clear correlation between hypoperfusion, microneovascularisation, and anastomotic vessels as regards site and extent was not noticed. CONCLUSIONS: A different angiographic pattern can be detected in PXS eyes with capsular glaucoma in comparison with eyes without it. Further studies are needed to correlate angiographic features revealed by IFA and IICGA, with clinical features.
Aged↗
Hyperfluorescence associated with serous retinal pigment epithelial detachment on indocyanine green angiography.
PURPOSE: Indocyanine green angiography has been reported to improve detection and delineation of occult choroidal neovascularisation in serous pigment epithelium detachment in age-related macular degeneration. The study aims to evaluate the visual acuity results of eyes affected by serous pigment epithelium detachment in age-related macular degeneration, having had indocyanine green-directed laser photocoagulation, and to correlate them to the pattern of serous pigment epithelium detachment on indocyanine green angiography. METHODS: Thirty-four eyes of 31 patients affected by serous pigment epithelium detachment in age-related macular degeneration were prospectively considered. Each patient underwent an ophthalmological examination including fluorescein and indocyanine green angiography one day before, and 6 weeks, 3 months, 6 months, 9 months, 12 months and 24 months after krypton-laser treatment. The serous pigment epithelium detachment was classified in the late-phases angiograms as either hypofluorescent, isofluorescent or hyperfluorescent comparing the fluorescence of the serous pigment epithelium detachment with the choroidal background fluorescence. RESULTS: The indocyanine green-guided laser treatment was associated with a temporary stabilization and a long-term progressive reduction of visual acuity: after 24 months visual acuity improved in 2.9%, stabilized in 26.5% and worsened in 70.5% of cases. Serous pigment epithelium detachment presenting a pretreatment hyperfluorescence had a final visual acuity of 0.06, with subfoveal choroidal neovascularisation development in 100% of cases, whereas serous pigment epithelium detachment presenting a pretreatment hypofluorescence and isofluorescence showed a final visual acuity of 0.12, with subfoveal choroidal neovascularisation development in 43.5% of eyes, with statistically significant difference. CONCLUSION: Overall visual acuity decreases with time after indocyanine green-guided laser treatment of choroidal neovascularisation in serous pigment epithelium detachment, and serous pigment epithelium detachment becoming hyperfluorescent in the late-phases of indocyanine green angiography has the worst functional outcome.
Aged↗
Grid laser treatment in macular branch retinal vein occlusion.
BACKGROUND: Macular branch retinal vein occlusion (MBRVO) is a subgroup of branch retinal vein occlusion in which the occlusion is limited to a small venous vessel draining a sector of the macular region. The present study aimed to evaluate prospectively whether grid laser treatment is useful in improving the visual acuity of eyes affected by MBRVO with significant macular edema. METHODS: Ninety-nine patients affected by MBRVO of recent onset were prospectively studied during a 24-month period; eyes were randomly assigned to the control group, the early grid laser treatment group or the delayed grid laser treatment group. Clinical and angiographic features were recorded during the whole follow-up; parameters such as visual acuity and macular edema were carefully evaluated, the latter even by means of stereophotography. RESULTS: With respect to the baseline mean visual acuity values, a statistically significant improvement was noted at the 3-month follow-up and at the 1-year follow-up. No additional improvement was noted at the 2-year follow-up. No statistically significant difference was found between the treated groups and the control group. CONCLUSIONS: We hypothesize that the abrupt ischemic damage subsequent to MBRVO is the main factor causing the central function impairment. Grid laser treatment is not able to reduce the macular edema more than the natural evolution, and does not improve visual acuity.
Aged↗
Visual representation of space in congenital and acquired strabismus.
The aim of the present work was to readdress the problem of altered spatial localization in strabismic subjects and to assess whether and how spatial representation is affected by the degree of plasticity of the brain. We therefore compared targeting performance in adult subjects affected by acquired strabismus versus children affected by congenital strabismus. Our data confirm the correlation between deviation of the eye and targeting errors, but they also show that this correlation is not present when strabismus occurs early in life. We suggest that the neuronal machinery involved in the building of an internal representation of space reaches its full maturity several years after birth and that this might explain the limited differences observed in targeting errors between normal and strabismic children.
Adult↗
Effect of astigmatism on multifocal intraocular lenses.
PURPOSE: To study the effect of astigmatism on multifocal intraocular lens (MIOL) function. SETTING: Laser Laboratory, Department of Electronics, Electrotechnics and Informatics, University of Trieste, Italy. METHODS: Using an experimental optical system, this study compared the division of a laser beam in the focal spots of 1 monofocal IOL (Pharmacia 722A), 1 bifocal IOL (Pharmacia 811E), and 2 MIOLs (AMO Array MPC25NB and Domilens Progress 1). The model consists of a helium-neon laser and an optical system: a triangular optical bench with a precision collimator, a micropositionable immersion stage to support the IOL, and a digital image-processing system. Astigmatism was induced by interposing a +1.0 diopter (D) cylinder lens between the IOL and the television camera. Astigmatism was corrected by adding a -1.0 D cylinder lens in front of the IOL on the same axis. RESULTS: Astigmatism creates pairs of focal lines, 1 for each focal spot in the IOL. In the multifocal IOL, the posterior focal line of the nearest focus interfered with the anterior line of the next focus. Correcting the astigmatism led to a significant reduction (mean 20%) in light intensity. CONCLUSIONS: Astigmatically neutral surgery or surgical correction of pre-existing astigmatism is essential in MIOL implantation to minimize the decrease in contrast sensitivity.
Astigmatism↗
Spontaneous dislocation into the vitreous of a poly(methyl methacrylate) disc lens 9 years after surgery.
A 76-year-old woman had sudden visual loss 9 years after an extracapsular cataract extraction with implantation of a poly(methyl methacrylate) disc intraocular lens (IOL) in the capsular bag. Slitlamp examination showed the disc IOL had luxated into the vitreous through a linear inferior opening in the capsular bag; the IOL lay on the retinal surface. A pars plana vitrectomy was performed. The vitreous cavity was filled with perfluorocarbon liquid, floating the IOL to behind the iris. The IOL was removed through a limbal incision, then another type of IOL was implanted in the ciliary sulcus using transscleral fixation. Thirty days after surgery, best corrected visual acuity (BCVA) was 20/20. At 2 months, total retinal detachment appeared with a large superior retinal dialysis. Another pars plana vitrectomy was performed and the scleral-fixated IOL removed through a limbal incision. Internal gas tamponade was used. The eye was left aphakic. Final BCVA was 20/25.
Aged↗