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Marco Ciancaglini

Publications and source records attributed to Marco Ciancaglini.

11 recordsLinked to original sources
PubMed2007

Fundus microperimetry patterns of fixation in type 2 diabetic patients with diffuse macular edema.

BACKGROUND: Recently developed fundus microperimetry (MP-1; Nidek Technologies, Srl. Vigonza PD, Italy) was used to evaluate fixation patterns and retinal sensitivity in patients who had clinically significant macular edema with a diffuse pattern and type 2 diabetes mellitus. METHODS: In a prospective, observational case series study, 84 consecutive patients with type 2 diabetes (84 eyes) who had clinically significant macular edema with a diffuse pattern were studied by means of MP-1. Main outcome measures were fixation stability and position and mean retinal sensitivities within the central 2 degrees and 8 degrees areas. Logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was evaluated by means of an Early Treatment of Diabetic Retinopathy Study chart. Foveal thickness was measured by Stratus optical coherence tomography (OCT; Carl Zeiss Meditec, Inc., Dublin, CA). Age, duration of diabetes, hemoglobin A1c (HbA1c) levels, duration of symptoms, history of panretinal photocoagulation, vitreomacular adhesion, and cystoid macular changes were documented. Patients were grouped according to both position of fixation (central or eccentric) and stability of fixation (stable or unstable). Statistical analyses included independent samples t-test, binomial test, Bonferroni correction for multiple comparisons, and generalized linear model univariate analysis. RESULTS: Of 84 eyes, 44 (52.4%) had central fixation, and 40 (47.6%) had eccentric fixation. Of 84 eyes, 34 (40.5%) had stable fixation, and 50 (59.5%) had unstable fixation. In the whole sample, mean central 2 degrees retinal sensitivity +/- SD was 6.26 +/- 3.19 dB (range, 0-14.80 dB), and mean central 8 degrees retinal sensitivity +/- SD was 7.62 +/- 2.55 (range, 3.85-14.90 dB); logMAR BCVA ranged from 0.1 to 1.3 (mean +/- SD, 0.6 +/- 0.29). Mean OCT foveal thickness +/- SD was 300.77 +/- 66.93 m (range, 220-525 m). Both comparisons between groups (stable vs. unstable and central vs. eccentric) showed statistically significant differences in mean logMAR BCVA, mean central 2 degrees and 8 degrees retinal sensitivities, and mean OCT foveal thickness. Duration of symptoms was significantly longer and HbA1c levels were higher in the groups with deterioration of stability or centrality of fixation. The prevalence of cystoid macular changes was significantly higher in the groups with eccentric or unstable fixation (P < 0.001). Generalized linear model statistical analysis showed that logMAR BCVA was significantly associated with stability of fixation (P = 0.020), mean central 8 degrees retinal sensitivity (P < 0.001), and mean OCT foveal thickness (P < 0.001). The interaction between stability of fixation and mean OCT foveal thickness showed a statistically significant association with logMAR BCVA (P = 0.003). Some eyes with eccentric fixation presented with stable fixation, especially in the presence of long-lasting symptoms, and had better visual acuity than eyes with central, but unstable fixation. CONCLUSION: Visual acuity, central retinal sensitivity, foveal thickness, duration of symptoms, HbA1c levels, and presence of cystoid macular changes were strongly associated with fixation impairment in type 2 diabetic patients who had clinically significant macular edema with a diffuse pattern. Stability of fixation and foveal thickness play a major role in conditioning BCVA.

Aged↗
PubMed2006

Corneal and conjunctival manifestations in Fabry disease: in vivo confocal microscopy study.

PURPOSE: To describe the microscopic corneal and conjunctival findings in patients with Fabry disease (FD) related keratopathy by using in vivo confocal microscopy. DESIGN: Prospective observational case series. METHODS: Twelve eyes of six patients affected by Fabry disease, belonging to two different families, underwent in vivo confocal microscopic examination. Corneal and conjunctival morphology were assessed by means of a scanning slit corneal confocal white-light microscopy and confocal laser-scanning microscope. RESULTS: Confocal microscopy examination evidenced two different types of corneal epithelial changes. The three hemizygous patients presented bright hyper-reflective intracellular inclusions located within the basal epithelial cells, while the three heterozygous patients showed fine diffusion of reflective substance at the level of superficial, basal epithelial cells and basal membrane, in all eyes. The complex basal-Bowman's membrane appeared irregular, distorted, and nonhomogeneous in all subjects. Stromal increased reflectivity attributable to haze and epithelial ingrowth with bright intracellular inclusions was noticed in one hemizygous patient. In all patients, conjunctival epithelial involvement represented by bright roundish intracellular inclusions was evidenced, appearing more pronounced in tarsal than in bulbar conjunctiva. CONCLUSIONS: Although FD-related cornea verticillata attributable to glycosphingolipids accumulation is considered to be primarily a corneal disease, in vivo confocal microscopy demonstrated structural alterations throughout the entire ocular surface epithelia. It is still unclear whether the different type of corneal epithelial lesions observed for hemizygous and heterozygous patients is related to different physiopathological mechanisms. Confocal microscopy may assist ophthalmologists in the diagnosis of FD-related ocular surface and corneal manifestations.

Adult↗
PubMed2006

Epithelial dendritic cell distribution in normal and inflamed human cornea: in vivo confocal microscopy study.

PURPOSE: To evaluate dendritic cell (DCs) density, distribution, and morphology in central corneal and limbal epithelium in normal subjects and patients with immune-mediated corneal inflammation using in vivo confocal microscopy (IVCM). DESIGN: Comparative case-controlled, observational confocal microscopy study. METHODS: A total of 135 eyes of 135 patients were investigated. Group 1 (normal eyes) included 45 eyes of 45 healthy volunteers, group 2 photorefractive keratectomy (PRK-treated eyes) included 45 myopic eyes of 45 patients treated with PRK, and group 3 (inflamed eyes) comprised 45 eyes of 45 patients affected by immune-mediated corneal inflammation. The central cornea and limbus were examined for epithelial dendritic-shaped cells using laser scanning IVCM. DCs density was calculated using image analysis software. RESULTS: Cells with a branching dendritic morphology were visualized in the basal epithelial layer, basal lamina, and subbasal nerve plexus, in the central cornea, and in the basal layer and basal membrane of the limbal epithelium. The limbal epithelium demonstrated DCs in 93.3%, 89%, and 97.7% of eyes in group 1, 2, and 3, respectively (P = ns). Central epithelial DCs were observed in 20.0% and 13.3% of eyes in group 1 and 2 (P = ns), while in 93.3% of eyes in group 3 (P < .001). DCs were found to be significantly higher at the limbus compared with central cornea in each group (P < .001). Cell densities observed in group 3 were significantly greater than groups 1 and 2, at both locations (P < .05). CONCLUSIONS: Laser scanning IVCM is a useful method for evaluating epithelial DCs distribution at the limbus and central cornea in both healthy and diseased eyes.

Adult↗
PubMed2006

Deep lamellar keratoplasty by intracorneal dissection: a prospective clinical and confocal microscopic study.

OBJECTIVE: To evaluate the clinical findings, visual outcomes, and confocal microscopic corneal features of a surgical technique for manual deep lamellar keratoplasty (DLKP) with intentional sparing of the most posterior stroma. DESIGN: Noncomparative, prospective, 12-month interventional study. PARTICIPANTS: Forty-six eyes of 45 patients who had corneal pathologic features without endothelial abnormalities and requiring corneal graft were treated by DLKP by manual stromal delamination. They were examined clinically after surgery and using in vivo confocal microscopy at 2 weeks and 1, 3, 6, and 12 months. INTERVENTION: The surgical technique consisted of an intracorneal deep manual stromal dissection through a 4-mm limbal incision at 50 mum from Descemet's membrane (DM). After trephination, an endothelial free graft was sutured. MAIN OUTCOME MEASURES: Topographic parameters, interface depth and reflectivity, and anterior and postinterface keratocyte density; visual acuity was correlated with these parameters. RESULTS: Two eyes had rupture of the DM. Two eyes that had delayed epithelial healing because of graft override with stromal inflammation underwent a second surgery (penetrating keratoplasty). Mean uncorrected logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity and logMAR best-corrected visual acuity (BCVA) improved from preoperative values (1.342+/-0.239 and 0.923+/-0.226, respectively) to 0.421+/-0.122 and 0.104+/-0.068, respectively, at 12 months. Mean topographic astigmatism was 3.09+/-1.30 diopters (D) at 3 months after suture adjustment, and 2.87+/-0.92 D at 12 months after suture removal. Average interface depth was 64.2+/-6.7 microm at 15 days and showed no significant changes up to 12 months. Mean interface reflectivity was highest at 15 days (95.5+/-15.7 light reflectance units [LRU]) and showed a progressive decrease over time of 55.3+/-8.7 LRU at 12 months. A significant negative correlation was observed between BCVA and topographic astigmatism up to 1 month and between BCVA and interface reflectivity starting from 6 months after surgery. CONCLUSIONS: Deep lamellar keratoplasty by intracorneal dissection provides visual and clinical results comparable with that of other DLKP techniques. Visual recovery is slow and progressive, taking up to 1 year. Confocal microscopy enables precise evaluation of corneal features, interface morphologic features, and reflectivity, demonstrating a negative correlation between interface reflectivity and BCVA showing that the progressive recovery over months of the interface transparency is correlated with the increase in visual acuity after 6 months.

Adolescent↗
PubMed2006

Humphrey matrix frequency doubling technology perimetry and optical coherence tomography measurement of the retinal nerve fiber layer thickness in both normal and ocular hypertensive subjects.

PURPOSE: The purpose of this study was to determine by means of the Humphrey Matrix frequency doubling technology (FDT) perimetry and the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurement whether functional and/or structural differences exist between normal and ocular hypertensive (OHT) subjects. PATIENTS AND METHODS: One eye of 60 consecutive normal individuals and 60 OHT subjects was enrolled in this prospective observational comparative case series study. All subjects were examined at either the Ophthalmology Clinic, University of Chieti-Pescara, Chieti, Italy or the Department of Ophthalmology, S. Maria della Misericordia Hospital, Udine, Italy. All subjects underwent a full ophthalmic examination, including visual acuity, slit-lamp biomicroscopy, central corneal thickness ultrasound pachymetry measurement, achromatic automated perimetry, Matrix FDT perimetry, stereoscopic optic nerve head photography, and OCT. Matrix FDT perimetry mean deviation (MD), pattern standard deviation, glaucoma hemifield test, and 12 OCT RNFL thickness parameters were examined. Student t test, Bonferroni correction for multiple comparisons and receiver operator characteristics curve areas (AUROCs) were used to find any discrimination function between healthy and OHT eyes. Sensitivities at 83% and 92% specificities were reported. RESULTS: The FDT MD scores ranged from -1.10 to +3.80 decibels (db) in normal individuals and from -4.75 to +3.20 db in OHT subjects. The comparison between the average MD in the 2 groups showed a statistically significant difference (P=0.024). OCT showed a statistically significant difference between the 2 groups when examining the ratio between the inferior and the superior mean RNFL thickness (P=0.004). For OCT, the parameter with the largest AUROC for discriminating between healthy and hypertensive eyes was the ratio between the mean inferior and superior RNFL thickness (AUROC=0.85, sensitivity=75% at specificity=83%, sensitivity=67% at specificity=92%). For Matrix FDT perimetry, the parameter with the largest AUROC was MD (AUROC=0.78, sensitivity=67% at specificity=83%, sensitivity=58% at specificity=92%). CONCLUSIONS: Our results suggest that OHT eyes having a normal achromatic automated perimetry and a normal clinical disc appearance cannot be differentiated from normal eyes using conventional OCT parameters. When analyzing the ratio between inferior and superior average RNFL thickness, however, a significant difference is evident between healthy and hypertensive eyes. Using Matrix FDT perimetry, a significant difference in MD seems to exist between these 2 groups of eyes. The AUROCs confirm that OCT Iavg/Savg and Matrix FDT MD show the greatest sensitivity and specificity among the examined OCT and Matrix FDT parameters.

Adult↗
PubMed2004

Long-term complications of bilateral posterior chamber phakic intraocular lens implantation.

A 34-year-old woman had posterior chamber phakic intraocular lens (PCP IOL) implantation to correct high myopia in both eyes. Five years postoperatively, the patient presented with a decrease in visual acuity from central anterior subcapsular cataract formation in both eyes and IOL dislocation in the left eye. In vivo confocal microscopy of the cornea showed markedly decreased endothelial cell density in both eyes and the presence of bright endothelial microdeposits possibly related to pigmentary dispersion. Gonioscopy showed angle pigmentary deposits with no intraocular pressure increase. The patient was successfully treated by removing the PCP IOLs and performing phacoemulsification with in-the-bag IOL implantation in both eyes. This led to a recovery of visual acuity. This case report presents the rare occurrence and surgical management of cataract formation, IOL dislocation, and severe endothelial cell loss as a late complication of PCP IOL implantation.

Adult↗
PubMed2003

Reliability of nerve fiber layer thickness measurements using optical coherence tomography in normal and glaucomatous eyes.

OBJECTIVE: To evaluate the reliability of nerve fiber layer (NFL) thickness measurements by optical coherence tomography (OCT) in normal and glaucomatous eyes. DESIGN: Prospective, comparative, observational case series and instrument validation study. PARTICIPANTS: Twenty-four glaucomatous patients were compared with 24 gender- and age-matched normal subjects. METHODS: Each individual underwent OCT measurements of NFL thickness. Five repetitions of a series of scans on five separate occasions within a 0.5-month period were performed. Each eye was scanned at three different nerve head programs (1.5 radius [R], R = 1.73 mm, 2.0 R). For each option (1.5 R, R = 1.73 mm, and 2.0R) and region (superior, inferior, temporal, nasal, and overall mean), variance components and intraclass correlation coefficients were determined using repeated measures regression. In these models, NFL thickness, as measured by OCT, was assumed to have three variance components: intersubject, intervisit (within-subject between-dates), and intravisit (within-subject within-date). The intraclass correlation coefficient (intersubject variance/total variance) was used as a measure of reliability. MAIN OUTCOME MEASURES: Measurements of NFL thickness using OCT were performed. RESULTS: Reliability values, as measured by intraclass correlation coefficients, resulted as follows: 1.5 R, 0.54/0.52 (normal/glaucoma); R = 1.73 mm, 0.50/0.50; 2.0 R, 0.49/0.50. CONCLUSIONS: Our results indicate that the recent commercially available OCT provides reliable NFL thickness measurements in both healthy and glaucomatous eyes with each circle radius tested. The greatest amount of variability can be attributed to intersubject differences.

Adult↗
PubMed2002

In vivo confocal microscopy in primary congenital glaucoma with megalocornea.

PURPOSE: To report the microscopic findings of congenital glaucoma-related megalocornea using in vivo confocal microscopy. PATIENTS AND METHODS: Two consecutive adult patients presenting the typical features of glaucomatous megalocornea underwent a complete ophthalmologic examination. The first patient presented with progressive glaucoma with bilateral megalocornea. The second patient's left eye was affected by megalocornea without actual evidence of glaucoma, whereas the right eye was healthy. Both patients were examined using a new-generation scanning slit corneal confocal microscope. RESULTS: In both patients, confocal microscopy revealed a mild reduction of keratocyte density in the mid and rear stroma, a particular abnormal "clew-shaped" morphology of stromal nerves, and the presence of discontinuous hyperreflective structures overhanging the endothelial layer at the level of the Descemet membrane. The endothelium showed severe polymegethism, pleomorphism, and a markedly decreased cell density, and focal cellular lesions were noted. CONCLUSION: Confocal microscopy is a diagnostic tool used to evaluate microscopic aspects of Haab striae and endothelial morphologic changes in glaucomatous megalocornea. Unsuspected alterations, such as nerves abnormalities and focal endothelial tractions by scar tissue, were observed.

Adult↗
PubMedDate not supplied

Ocular perfusion pressure and visual field indice modifications induced by alpha-agonist compound (clonidine 0.125%, apraclonidine 1.0% and brimonidine 0.2%) topical administration. An acute study on primary open-angle glaucoma patients.

OBJECTIVE: The aim of this study was to verify the acute effects of alpha-adrenoreceptor agonist eyedrop administration on visual field parameters and ocular perfusion pressure (OPP) in patients affected by primary open-angle glaucoma. METHODS: A prospective, randomized double-blind study was carried out. Sixty-four glaucomatous subjects were enrolled in the clinical trial and subsequently separated into four study groups, of 16 patients each, to compare the systemic and ocular effects of placebo, clonidine 0.125%, apraclonidine 1.0% and brimonidine 0.2%. RESULTS: No significant variations in the ocular or systemic parameters were observed after placebo administration. All the alpha-adrenoreceptor agonist compounds induced a significant reduction of the intraocular pressure. Clonidine induced significant modifications of mean blood pressure, OPP and visual field indices. The acute administration of apraclonidine did not affect both mean blood pressure and OPP, but a worsening of the visual field was nevertheless recorded. The analyzed parameters did not significantly vary after brimonidine instillation. CONCLUSIONS: The present findings demonstrate that the lack of effects on the blood flow and the absence of vasomotor activity at the level of the posterior pole exhibited by brimonidine is related to its alpha-2 selectivity, as appears by comparing this compound with the other alpha-agonists available for the management of glaucoma.

Administration, Topical↗
PubMedDate not supplied

Prospective randomized comparison of wavefront-guided and conventional photorefractive keratectomy for myopia with the meditec MEL 70 laser.

PURPOSE: To study refractive results and aberrometric changes in myopic patients treated with wavefront-guided photorefractive keratectomy (PRK) in comparison with standard PRK. METHODS: Sixty eyes of 60 patients with myopic astigmatism were randomly divided into two groups. Group 1 included 30 eyes (mean spherical equivalent refraction -4.39 +/- 1.31 D; range -2.50 to -6.50 D) treated with wavefront-guided PRK using the WASCA workstation and the Asclepion Meditec flying spot MEL 70 excimer laser. Group 2 had 30 eyes (mean spherical equivalent refraction -4.33 +/- 1.22 D; range -2.50 to -6.50 D) that underwent conventional PRK using the same laser, and served as the control group. Wavefront analysis of high order aberrations was performed before and 6 months after surgery. RESULTS: Postoperatively, wavefront error increased in both groups (5.0-mm wavefront aperture diameter). Six months after surgery, the eyes that received the WASCA ablation had a smaller increase in root-mean-square (RMS; 70% of increment) compared to the conventional PRK group (139% of increment) (P<.001). In the standard PRK group, all aberrations notably increased; in the wavefront-guided PRK group there was a smaller increase of trefoil and spherical aberrations (P<.001) and a decrease of coma aberrations (P<.001). The smaller increase of wavefront error in the wavefront-guided PRK group compared to the standard PRK group was more evident when preoperative RMS values were higher than 0.4 microm (P<.01). The visual parameters (spherical equivalent refraction, uncorrected and best spectacle-corrected visual acuity) did not show significant differences between the two groups. CONCLUSION: Wavefront-guided PRK induced a smaller increase of postoperative wavefront-error compared to conventional PRK, particularly in patients with higher preoperative higher order aberrations.

Adult↗