Laser treatment of macular diseases.
Explore the source record for details and available documents.
Diabetic Retinopathy↗
Biomedical subjects
P Lanzetta
Publications and source records attributed to P Lanzetta.
Indocyanine green angiographic aspect of choroidal vascular occlusion after photocoagulation of choroidal neovascularization.
Explore the source record for details and available documents.
Aged↗
Recurrent RPE microrips in a case of vascularised pigment epithelial detachment.
Microrips of the RPE are an infrequent finding in vascularised pigment epithelial detachments (PEDs). Fluorescein angiography revealed that they are identical to the leaks seen in central serous chorioretinopathy (CSC); it has been hypothesised that both may be caused by hydrostatic forces generating a mechanical disruption of the RPE. We report a case of vascularised PED that was complicated by repeated subretinal haemorrhages and presented recurrent microrips of the RPE, which is a finding never described before according to our knowledge. In this case, a very high protein concentration in the subretinal space, due to prolonged bleeding from the neovascular membrane, might have damaged the RPE and reduced the choroidal suction, as believed for CSC. It might also have increased the intraluminal pressure in the PED, finally determining the passage of fluid through the microrips, which have been hypothesised to be RPE defects. These observations represent further speculation about the pathogenesis and the unique angiographic pattern of the leaks in CSC and of RPE microrips.
Aged↗
Scleral fixated intraocular lenses: an angiographic study.
PURPOSE: We reviewed the results, complications, and fluorescein angiographic (FA) findings in eyes that had undergone transscleral fixation of posterior chamber intraocular lenses (IOLs). METHODS: Posterior chamber IOL implantation with scleral fixation was performed on 18 patients. Three patients were aphakic, 14 had an intraoperative posterior capsule rupture during cataract surgery, and one was operated on for a retained lens nucleus and dislocated IOL in the vitreous. Follow-up examinations measured visual acuity, intraocular pressure, and IOL decentration and tilting. In 14 patients, iris and retinal FA were performed. RESULTS: No major complications were noted during the procedure. Mean best-corrected visual acuity was 20/70 preoperatively and 20/30 postoperatively after a mean follow-up of 9.8 months. Fourteen patients achieved a visual acuity of 20/40 or better. Macular epiretinal membranes were diagnosed after surgery in five eyes but only one eye showed significant distortion of the fovea (macular pucker). Iris FA revealed no major vascular abnormalities. Fluorescein angiography showed cystoid macular edema in six cases. Light-induced retinal lesions occurred in six eyes. CONCLUSIONS: Transscleral fixation of posterior chamber IOLs provided adequate visual acuity in most patients. Incomplete visual recovery after surgery may be related to the occurrence of macular edema and epiretinal membranes. Light-induced retinal injury was the major irreversible intraoperative complication.
Aged↗
Retinal neovascularization in a case of macular branch retinal vein occlusion.
BACKGROUND: Retinal neovascularization (RNV) has never been described in cases of macular branch retinal vein occlusion (MBRVO), due to the limited amount of ischemia in this form of retinal vein occlusion. Ischemic areas as wide as 5-10 disc diameters were required by previous studies to count as ischemic cases of central or major branch retinal vein occlusion. CASE REPORT: A 56-year-old woman who had been suffering from MBRVO for 3 years presented at the posterior pole a zone of non-perfusion, extending over 7.5 disc areas, and three small tufts of RNV. RNV regressed after two subsequent laser treatments of the ischemia. Retrohyaloid hemorrhage was observed 2 months after the first treatment. CONCLUSION: Since the average diameter of the non-perfused area was about 2.75 disc diameters, this case demonstrates that small RNVs can appear in less extensive areas of ischemia than is generally believed.
Female↗
Sedation with ketamine during cataract surgery.
PURPOSE: To evaluate the cardiovascular and ocular effects of a low-dose sedation-analgesia regimen in cataract surgery. SETTING: Department of Ophthalmology, University of Udine, Udine, Italy. METHODS: Eighty patients were randomly assigned to two groups. The first was treated with droperidol 0.03 mg/kg, diazepam 0.06 mg/kg, ketamine 0.3 mg/kg; the second (control), with the same drugs except for ketamine. Heart rate, arterial pressure, and intraocular pressure (IOP) in the fellow eye were measured before and 3 minutes after injection of the sedative mixture. The anesthetic block was then performed. RESULTS: Heart rate increased in both groups by about 5%. Systolic arterial pressure fell by 15.6 mm Hg +/- 22.3 (SD) in the ketamine group and by 31.7 +/- 17.3 mm Hg (P < .005) in the control group. Intraocular pressure fell in the two groups by 5.24 +/- 2.8 mm Hg and 4.5 +/- 2.5 mm Hg, respectively. None of the ketamine-treated patients reported pain during the administration of anesthesia or postoperatively. Eighty percent of the control group reported pain. In the early postoperative period, no episodes of nausea, emesis, or hallucination were reported. CONCLUSION: In a regimen with other drugs, ketamine did not influence IOP and enabled comfortable completion of anesthesia and surgery.
Adjuvants, Anesthesia↗
Indocyanine green angiography in central serous chorioretinopathy. ICG angiography in CSC.
PURPOSE: To analyse images obtained by indocyanine green angiography in central serous chorioretinopathy (CSC). METHODS: Ninety patients affected with CSC were examined using indocyanine green angiography. RESULTS: CSC was detected in 127 of the 180 eyes examined. Leakage points were detected in 99 eyes with fluorescein angiography; in 85 of these eyes, they corresponded to hyperfluorescence with indocyanine green angiography, while a hyperfluorescence of the neuroepithelial detachment was seen in 21 eyes. Areas of choroidal hyperpermeability were seen in all 127 eyes with CSC and in 9 fellow eyes. With ICG angiography, the appearance of pigment epithelial detachments was similar to that previously described (early hyperfluorescence and later hypofluorescence), and was seen in 47 eyes. In 103 eyes, hypofluorescent lesions of various sizes, were detected which became more marked in the later stages. These lesions corresponded to retinal pigment epithelium lesions in fluorescein angiography, mainly hyperfluorescence caused by window defect. We were also able to observe RPE atrophic tracts in 31 eyes. These tracts appeared hyperfluorescent in 11 eyes where a minimal amount of RPE atrophy was present and hypofluorescent in 20 eyes in which the tract had marked RPE atrophy. CONCLUSION: The results obtained confirm the finding of choroidal hyperpermeability and subretinal diffusion of ICG, which indicate involvement of the choroid in CSC. The observation of progressively hypofluorescent lesions corresponding to retinal pigment epithelium alterations suggests that there may be as yet unknown interactions of pigment epithelium and ICG.
Adult↗
Use of protective filters by fluorescein angiography nursing staff.
Explore the source record for details and available documents.
Adult↗
Indocyanine green angiography in vitelliform macular lesions.
Many vitelliform macular diseases have been described through the years. Some arguments still exist about the appropriate terminology, the classification criteria and the etiopathogenesis. The alterations of the retinal pigment epithelium, the lipofuscin storage and the role of the choriocapillaris are being investigated. The aim of our study was to describe indocyanine angiographic features in Best's disease and pattern distrophies. Twenty-one eyes of 14 patients underwent indocyanine and fluorescein angiography. The indocyanine angiogram showed hypofluorescent and hyperfluorescent areas. The possible etiopathogenesis of the lesions includes a role of the retinal pigment epithelium.
Coloring Agents↗
Continuous wave Nd:YAG laser photocoagulation in proliferative diabetic retinopathy.
AIMS: The therapeutic efficacy of the continuous wave (CW) Nd:YAG laser (working in the free running mode) was investigated in proliferative diabetic retinopathy (PDR) comparing it with a conventional laser source such as the krypton laser. METHODS: Twenty four eyes of 12 patients affected with bilateral PDR were included and divided in two groups. The right eyes were treated with a red krypton laser and the left eyes with a CW Nd:YAG laser. RESULTS: Three months after krypton photocoagulation 10 eyes showed a reduction or a complete regression of PDR and two eyes were unchanged. In the CW Nd:YAG laser group no eyes showed any regression of new vessels, in seven eyes the angiographic features were unchanged, and in five eyes they worsened. All the eyes of the second group underwent retreatment with the krypton laser after 3 or 6 months. After a mean follow up of 13 months all eyes in the krypton group showed a reduction or complete regression of PDR; in the retreated group 10 eyes improved and two were unchanged. CONCLUSIONS: The statistical analysis showed a highly significant difference (p = 0.001) between krypton and CW Nd:YAG laser which indicated the lack of efficacy of the latter in the treatment of PDR. In the krypton laser group no significant difference (p = 0.05) after the retreatment was found confirming the efficacy of this treatment.
Adult↗
Ocular involvement in acute lymphoblastic leukemia: an echographic study.
We report a case of acute lymphoblastic leukemia (ALL) with ocular involvement in which bilateral swelling of the optic disk head was noticed. Massive direct infiltration of the optic nerve head by leukemic cells can give rise to a clinical picture identical to that of a true papilledema. Ocular echography allowed a better and more complete interpretation of the optic disk involvement. No echographic description of a leukemic infiltration of the optic nerve head has been reported previously.
Adult↗
Diode laser photocoagulation of choroidal neovascular membranes.
BACKGROUND: Krypton or argon laser treatment of choroidal neovascularization (CNV) has been shown to be effective in reducing the incidence of severe visual loss. The usefulness of diode laser in the treatment of many chorioretinal disorders is currently under evaluation. METHODS: Our study involved 42 eyes of 41 patients affected with CNV which were treated with a near infrared diode laser. RESULTS: The mean follow-up was 10.12 months. Visual acuity improved in 12 eyes (28.6%), did not change in 17 eyes (40.5%) and worsened in 13 eyes (30.2%). Mean visual acuity before treatment was 0.23 and 0.21 after treatment. Recurrent CNV was seen in 13 eyes. In a subgroup of 24 well-defined juxtafoveal or extrafoveal CNVs which underwent direct photocoagulation visual acuity improved in 8 eyes (33.3%), was unchanged in 11 (45.8%) and worsened in 5 (20.9%). Five eyes showed recurrent CNV. CONCLUSIONS: Our results appear to support the use of diode laser in the treatment of CNVs. The deeper penetration into the choriocapillaris of the diode wavelength could be effective in blocking CNV by inducing a more extensive chorioretinal atrophy.
Adult↗
Diode laser photocoagulation of choroidal hemangioma.
BACKGROUND: The argon laser photocoagulation has recently become the treatment of choice in choroidal hemangioma. We evaluated the efficacy of the near infrared wavelength diode laser in the treatment of such tumours. This wavelength is not highly absorbed by the retinal pigment epithelium and penetrates deep into the choroid. METHODS: Two cases of choroidal haemangioma with a serous detachment of the neural retina were diagnosed with ophthalmoscopy, fluorescein and indocyanine green angiography, A-scan and B-scan ultrasonography and treated with a surface photocoagulation with a diode laser. The efficacy of photocoagulation was evaluated three, six, twelve and fifteen months after laser treatment. RESULTS: The resorption of the subretinal fluid and a reduction in thickness of the tumour followed laser photocoagulation. CONCLUSIONS: Diode lasers might be effective in the treatment of choroidal haemangioma.
Aged↗
Quality of vision: A consensus building initiative for a new ophthalmologic concept.
PURPOSE: Many studies have addressed the quantification of visual acuity, and the conventional method of measuring it has so far demonstrated serious limitations. Vision testing requires new methods that can more precisely express the quality of vision as perceived by the patient. METHODS: This study employed the Delphi method of consensus building. Concepts associated with quality of vision (QoV) were identified by a board of experts and proposed to participating specialists in two subsequent questionnaires. Upon receipt of the completed questionnaires, the replies were classified to determine the building blocks of a consensus. RESULTS: By analyzing the replies to the two questionnaires, the authors determined the key elements of QoV on which a consensus was found among the respondents. CONCLUSIONS: A consensus was reached on the opinion that the quantification of visual acuity by traditional means is inadequate for investigating QoV. Although visual acuity is still a basic element for testing, the experts believe that contrast sensitivity, reading speed, and microperimetry are additional parameters necessary for quantifying QoV. The use of a psychometric questionnaire on visual function could allow a better interpretation of visual impairment.
Consensus↗
Efficacy of collagen shields after extracapsular cataract extraction.
The efficacy of presoaked porcine collagen shields was compared with subconjunctivally injected corticosteroids and antibiotics in reducing ocular inflammation after ECCE with IOL implantation, and signs of reduced oxygen delivery to the cornea were assessed. Fifty eyes of fifty patients were recruited. At the end of surgery 25 eyes (group 1) received a 24-h shield presoaked with 0.1% betamethasone disodium phosphate and 0.5% netilmycin. The other 25 eyes (group 2) received 1 mg betamethasone disodium phosphate and 250 mg piperacillin as a subconjunctival injection. The eyes were then taped closed. Inflammatory parameters (anterior chamber flare, fibrin, folds of Descemet's membrane, corneal edema) and tolerability of the delivery system (pain, itching) were evaluated 24 h after surgery. None of the patients lost the shield and the collagen devices were well tolerated. Groups 1 and 2 showed no significant differences in the parameters considered. There was, however, transient, slight diffuse superficial corneal edema in 24% of group 1 and 4% of group 2, raising the question of inadequate oxygen transmission through collagen shields under closed lids. The results suggest that collagen shields used with the right solution have no significant adverse effect and may be a less invasive alternative to subconjunctival injection.
Betamethasone↗
Retinal pigment epithelium tear following toxemia of pregnancy.
A 28-year-old woman with toxemia during the 34th week of pregnancy complained of visual loss in one eye. Two weeks after abruptio placentae and delivery a retinal pigment epithelium (RPE) tear which presumably followed a RPE detachment (PED) was found in the macular region of the right eye. Visual acuity was 0.8 at the time of diagnosis but was 1.0 in both eyes one year after the delivery. Some authors have described peculiar choroidal lesions associated with central serous chorioretinopathy (CSC) in pregnancy and ischemic exudative choroidal lesions during severe toxemia. However, the findings we describe are highly unusual, indicating that the mechanisms of choroidal and RPE pathology are still poorly understood. We also demonstrate that a pathological tear following toxemia of pregnancy is compatible with good acuity in spite of the anatomical damage.
Abruptio Placentae↗