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Purpose To describe a short questionnaire for a rapid assessment of risk factors for AMD, and assess its feasibility and relevance in a large-scale Italian study. Methods Risk factors having shown the most consistent associations with AMD in the literature were included in the STARS (Simplified Théa AMD Risk-assessment Scale) questionnaire, which was designed to be simple, quick and easy to fill in. Its feasibility and relevance were assessed in an Italian nationwide study. Between May and September 2010, all patients of both genders, aged 55 years or more, consulting the participating ophthalmologists during one week of consultations, were invited to take part in the study. Items on demography, medical history, and lifestyle were filled in by the patient. The ophthalmologist then performed the eye examinatio,and filled in the second part of the questionnaire (iris colour, cataract extraction, refraction, AMD classification). Patients affected by soft drusen and/or pigmentary abnormalities were classified as early AMD, whereas patients affected by geographic atrophy and/or neovascular AMD were classified as late AMD. Subjects with early and late AMD were compared to those without AMD using polytomous nominal logistic regression. Results One hundred and seventy-seven ophthalmologists prospectively recruited 12,639 subjects. Overall, 6061 (48.0%) were affected by early AMD, 1483 (11.7%) by late AMD, whereas 5095 (40.3%) were not affected by AMD. In the final multivariate model, age, female gender, North-African origin, family history of AMD, smoking, obesity, history of cardiovascular diseases,cataract surgery, myopia, hyperopia, living in a sunny area and usual solar protection were significantly associated with increased risk for both early and late AMD. High fruit consumption was associated with a significantly decreased risk for early and late AMD, while consumption of green vegetables and fish were not significantly associated with early or late AMD.Consumption of alcohol (beer or wine) and clear iris wereassociated with increased risk for early but not late AMD. Conclusions The STARS questionnaire can easily be implemented in the practice of ophthalmologists. It may prove useful as a screening tool, after improvement and further validation.

Purpose Melanin is a protective agent from light and oxidative damages. Melanin distribution can be visualized by means of near-infrared fundus autofluorescence (NIR-FAF). Aim of the study is to describe the NIR-FAF patterns in early stages of age-related macular degeneration (AMD) and to compare them with the patterns visible with blue-light fundudautofluorescence (BL-FAF). Methods Eighty-four patients affected by age-related maculopathy were considered for the study. Each patient underwent a complete ophthalmologic examination including EDTRS best corrected visual acuity (BCVA), NIR-FAF, and BL-FAF. The results were compared with those obtained in 40 health, age-matched subjects. Results Four NIR-FAF patterns were identified. More specifically, normal pattern was detected in 7%, normal pattern associated with hyper/hypoautofluorescent spot not involving the fovea was identified in 65.5%. Moreover, normal pattern associated with hyper/hypoautofluorescent spot involving the fovea, and patchy pattern were visible in 15.5% and 12% of cases, respectively. Minimal change and focal increased were the most frequent patterns detectable on BL-FAF. Lower BCVA value was associated with foveal involvement. Conclusions NIR-FAF shows specific patterns in early stages of AMD. There is no direct correlation between BL-FAF and NIR-FAF patterns. BL-FAF turned out to be altered in all cases, whereas NIR-FAF was normal in 7% of cases. Central involvement on NIR-FAF corresponded to lower BCVA.

Purpose To assess the effects of intravitreal bevacizumab injection (IVBI) in the treatment of choroideal neovascularization (CNV) secondary to pattern dystrophy (PD) of the retinal pigment epithelium. Methods Prospective interventional case series. Patients with PD complicated by CNV were considered. All patients underwent a complete ophthalmologic examination, including ETDRS visual acuity, electroretinogram, electrooculogram, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. The protocol required 3 monthly consecutive IVBI, followed by repeat injections on the basis of OCT parameters and angiographic features over the 24-month follow-up. Results Twelve patients completed the planned visits and were considered for the purpose of the study. Mean best corrected visual acuity (BCVA) and mean central macular thickness (CMT) at the baseline were 0.73±0.34 (logMAR±SD) and 276±95µm SD, respectively. At three-month examination, mean BCVA significantly improved to 0.48±0.27, whereas mean CMT decreased to 220±71µm SD. At 12-month examination, mean BCVA was 0.45±0.24, and mean CMT was 209±53µm. At the 24-month examination, mean BCVA showed a substantial stabilization whereas mean CMT decreased to 199±34µm. No side-effect or complication was registered. Conclusions IVBI is a valuable treatment for subfoveal CNV associated with PD over a 2-year follow-up. Further studies are necessary to validate our results, and to examine other morpho-functional parameters such as fundus autofluorescence and retinal sensitivity changes.

Purpose To describe the effectiveness of subthreshold laser treatment (SLT) with infrared micropulse diode laser for the treatment of retinal arterial macroaneurysms (RAM) associated with macular exudation. Methods Interventional case series including 8 cases of RAM who underwent treatment with SLT. Complete ophthalmic examinations, including Early Treatment of Diabetic Retinopathy Study visual acuity (ETDRS-VA), OCT and fluorescein angiography, were performed at the moment of the study entry and at 3-month intervals, with a planned follow-up of 12 months. Main outcome measures were the decrease in mean foveal thickness (MFT) on OCT, and the changes in ETDRS-VA. Results The change in MFT from the initial values was statistically significant (p

Purpose To assess the effects of intravitreal bevacizumab (Avastin) injections in the treatment of choroideal neovascularization (CNV) with large submacular hemorrhage (LSH) secondary to age-related macular degeneration (AMD). Methods Prospective interventional case series. Patients with occult CNV with LSH greater the 50% of the entire lesion were considered. The protocol required 3 monthly consecutive injections, followed by repeat injections over the 12-month follow-up on the basis of OCT parameters, angiographic features, visual acuity response. Results Eight patients were enrolled in the study and prospectively followed up. Mean visual acuity and mean foveal thickness (FT) at baseline were 0.72±0.35 (logMAR±SD) and 296±86µm SD, respectively. At three-month examination, mean visual acuity improved to 0.46±0.28 SD and mean FT decreased to 240±105µm SD. At 12-month examination, mean visual acuity was 0.48±0.32 SD, and mean FT 238±50µm SD. A progressive resolution of macular bleeding was registered in 7 patients. Neither side-effect or complication was registered. Conclusions Intravitreal bevacizumab seems to be a beneficial treatment for CNV with LSH secondary to AMD. A randomized clinical trial with greater number of patients and control group is needed to confirm our preliminary results.

Purpose Yo describe fundus autofluorescence (FAF) characteristics of Adult-onset Foveomacular Vitelliform Dystrophy (AOFVD) and to find a correlation with the functional responses. Methods Patients affected by AOFVD underwent a complete ophthalmologic examination, including ETDRS visual acuity, blue-light autofluorescence (BL-FAF) and near-infrared autofluorescence (NIR-FAF) performed using the HRA confocal scanning laser ophthalmoscope, and microperimetry (MP-1 Microperimeter, Nidek). Results 15 patients affected by AOFVD were enrolled. Three different patterns were identified on BL-FAF and 2 on NIR-AF. Patchy pattern both on BL-FAF and on NIR-FAF reveal the worst functional response, showing lowest visual acuity and retinal sensitivity values. Conclusions A functional correlate with visual acuity and retinal sensitivity, measured by means of microperimetry, can be found. Longitudinal studies investigating the natural course of FAF patterns of AOFVD may be useful both to identify genetic influence and prognostic factors, and to determine specific clinical and functional correlates.

Purpose: To evaluate the effects of the therapy combining intravitreal triamcinolone injection (IVT) and subthreshold grid laser treatment with infrared micropulse 810 nm diode laser for macular edema secondary to branch retinal vein occlusion (BRVO). Methods: Prospective interventional case series, including 11 patients (11 eyes) with macular edema secondary to BRVO. All the patients received IVT (4 mg) and 3 weeks later underwent infrared subthreshold (no intraoperative visible endpoint) grid laser treatment. Best–corrected visual acuity with ETDRS charts, foveal thickness measured by optical coherence tomography, fluorescein angiography, and intraocular pressure were evaluated at baseline and at each follow–up examination. Main outcome measures were the changes of at least 2 lines of visual acuity and the foveal thickness reduction of at least 25% from the baseline values. The follow–up ranged from 8 to 12 months (mean: 8,9 months). Results: At the end of the follow–up an improvement of at least 2 lines of best–corrected visual acuity was registered in 9 eyes (82%). Foveal thickness improved in 9 eyes (82%), with an overall change from a mean initial value of 479µ to a mean final value of 259µ. Four eyes (36%) developed an intraocular pressure rise over 22 mmHg requiring glaucoma therapy. No patient revealed cataract progression. Conclusions: Combined therapy of IVT and subthreshold grid laser treatment with infrared micropulse 810 nm diode laser is an effective treatment in improving visual function in patients affected by macular edema associated with BRVO.

Purpose: To evaluate the effectiveness of subthreshold grid laser therapy with infrared micropulse 810 nm diode laser in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). Methods: In a prospective, randomized clinical trial, thirty–six patients with macular edema secondary to BRVO were randomized either to infrared subthreshold (no intraoperative visible endpoint) grid laser treatment, or to conventional threshold (visible endpoint) grid laser treatment with 647 nm krypton laser. The primary outcome measure was the number of eyes that gained at least 10 letters (approximately 2 or more lines of visual acuity gain) at the 12– and 24–month examinations in the two groups. Results: By the month–12 visit, an improvement of at least 2 lines of visual acuity was registered in 59% and 58% of patients treated using infrared subthreshold grid and using krypton laser, respectively. A gain of at least 2 lines of visual acuity was registered in 64% and 58% of patients treated using infrared subthreshold grid and using krypton laser, respectively, by the month–24 examination. Interestingly, no clinically or angiographically visible sign of the administered laser spots was detectable after subthreshold grid laser treatment. Conclusions: Subthreshold infrared micropulsed grid laser treatment is as effective as krypton grid laser treatment in improving visual acuity in patients affected by macular edema secondary to BRVO.

Purpose: to evaluate the fluorescein and indocyanine green angiographic characteristics of recurrent choroidal neovascularization (R-CNV)in age-related macular degeneration (AMD). Method: a prospective investigation performed on 107 consecutive patients with exudative AMD and CNV not involving the foveal avascular zone was conducted. Laser treatment was ICGA-guided. In each patient, best corrected visual acuity (BCVA) on ETDRS charts was measured. FA and ICGA were performed in the same session the day before treatment and later repeated 3 weeks and 2, 3, 4, 6, 9, 12 months after photocoagulation. In eyes with questionable angiographic features for R-CNV at 3-week control, examinations were repeated each week till the pattern was defined. Result: at 1 year from photocoagulation, R-CNV occurred in 53 (49.5%) eyes, with classic features in 14 (26.4%) eyes, and occult in 39 (73.6%) on FA. At the 3-week follow-up visit, 49 (45.8%) eyes showed leakage beyond margins of laser scar on FA, whereas on ICGA hot spots appeared in 23 (21.5%) eyes, marginally in 21 cases and centrally in 2. One week later, in 5 of these eyes leakage persisted on FA and marginal hot spots on ICGA with subfoveal location were still detectable. Additional FA and ICGA performed at 5 weeks revealed lesion enlargement in all 5 eyes, leading to persistent CNV diagnosis. ICGA highlighted 3 patterns of R-CNV: Focal R-CNV (39 eyes, 73.6% of all R-CNV), a single dot-like hyperfluorescence along photocoagulated area margin, already detectable in early phases; Anular R-CNV (10 eyes, 18.8%), a hyperfluorescent, irregulary-shaped lesion, partially or completely encircling treated area, detectable in intermediate and late phases; Plaque R-CNV (4 eyes, 7.5%), a hyperfluorescent lesion greater than 1 disc diameter, expanding sectorially from the border of the treated area, and visible during intermediate and late phases. At the time of R-CNV onset, focal pattern had the BCVA among the three patterns whereas the final mean values are similar in the three groups. Conclusion: R-CNV resulted to be ill-defined in 73.6% of eyes, highlighting the role of ICGA in defining R-CNV site and extension. Only after disappearance of temporary hot spots on ICGA, that occurred at 4-week control, a precise distinction between them and real persistent CNV can be made. Three main patterns of R-CNV on ICGA were identified. Focal R-CNV has the best visual acuity at the onset time, probably due to smaller size, and anular R-CNV the worst, but at follow-up end mean BCVA is similar in the 3 patterns. Focal and plaque R-CNV lose an avarage of about 3 lines, whereas anular R-CNV retains its BCVA nearly unmodified.

Purpose To compare the effects of subthreshold laser treatment (STLT) with threshold laser treatment (TLT) in patients affected by symptomatic retinal arterial macroaneurism (RAM). Methods The trial was registered at Clinicaltrail.gov (number NCT01301326 ). Patients affected by symptomatic RAM, characterized by exudative manifestations involving the fovea and best corrected visual acuity (BCVA) worse than 20/80 Snellen equivalent, were recruited. Patients were randomly assigned to STLT or TLT and regularly followed up for 12 months. Primary outcome measures: Changes in central point thickness (CPT) at the end of the follow-up. Secondary outcome measures: Changes in mean BCVA at the end of the follow-up, and identification of post-laser alterations. Results In this single centre, randomized, clinical trial, 12 patients were randomized to STLT and 13 to TLT. CPT at baseline was 332μm and 341μm, changing to 249μm and 226μm at the 12-month examination, in STLT and TLT, respectively, with a statistically significant difference (p

Purpose Retinal dystrophies show a considerably wide phenotypic variability which can make the diagnosis and the clinical staging difficult. Aim of the study is to analyze the contribution of retro-mode imaging (RMI) and fundus autofluorescence to the characterization and the staging of the retinal dystrophies. Methods Eighteen patients affected by retinal dystrophies (2 patients with Best Vitelliform Macular Dystrophy (BVMD), 5 patients with autosomal recessive Stargardt Disease-Fundus Flavimaculatus (STGD1), 8 patients with Pattern Dystrophy, 2 patients with Choroideremia (CHM), and 1 patient with Benign Concentric Annular Macular Dystrophy (BCAMD) were recruited for the study. All the patients underwent a complete ophthalmological examination, including best corrected visual acuity with ETDRS charts, blue-light autofluorescence, (BL-AF), near-infrared autofluorescence (NI-AF), and RMI. Results Overall, the main feature of RMI is represented by a pseudo-3D pattern of all the lesions at the posterior pole. More specifically, any accumulation of material within the retina appear as an area of elevation with different shape and sizes, showing irregular and darker borders. BL-AF reveals the deposition of lipofuscin, whereas NIR-AF shows alterations in the melanin distribution. Conclusions There is no precise correlation among RMI, BL-AF, and NIR-AF imaging. RMI and fundus autofluorescence appear as useful tools for the identification and follow-up of retinal dystrophies. Non-invasive diagnostic tools may yield additional information in the clinical setting and the monitoring of the patients.

Purpose To report on the rebound effect of macular edema (ME) following dexamathasone implant for the treatment of non-ischemic central retinal vein occlusion (CRVO). Methods Twenty-one patients affected by ME secondary to CRO underwent intravitreal implant of dexamethasone (700micrograms) on compassionate use program. The patients were followed up monthly. ETDRS best corrected visual acuity (BCVA), central foveal thickness (CFT) on OCT, and intraocular pressure were monthly registered. Results BCVA improved in all the cases as well as CRT at months 1, and 2. Interestingly, CFT turned out to be double with respect to the baseline value at the month-3 examination visit in 1 case, and another 2 cases at month-4 examination visit. Visual acuity reduced accordingly to the worsened CFT values. Additional treatment with intravitreal dexamethasone implant allowed both visual acuity recovery, and CFT reduction. Conclusions Rebound effect can develop after intravitreal dexamethasone implant for the treatment of ME related to CRVO. Rebound effect does not affect functional or anatomical recovery when re-treatment is provided. Re-treatment rate with intravitreal desamethasone implant should be customized according to the patient’s response.

Purpose To assess the effects of intravitreal bevacizumab injections in the treatment of juxtafoveal choroidal neovascularization (CNV) associated with multifocal choroiditis (MC). Methods Non-randomized interventional case series with fourteen patients (14 eyes) affected by juxtafoveal CNV secondary to MC. All patients underwent a complete ophthalmologic examination, including ETDRS best corrected visual acuity (BCVA) measurement, optical coherence tomography and fluorescein angiography. The protocol treatment included a first injection, followed by repeated injections over a 12-month follow-up period on the basis of OCT parameters and angiographic features. Primary outcome measures: mean changes in BCVA and proportion of eyes gaining at least 15 letters (3 ETDRS lines) at the end of the follow-up. Secondary outcomes: mean changes of central macular thickness (CMT) and extension to the fovea. Results Mean BCVA changed from 0.41 Log MAR at baseline to 0.16 Log MAR at the 12-month examination (p

Purpose Dexamethasone intravitreal implant (DEX implant 0.7 mg; OZURDEX®, Allergan, Inc.) is a FDA-EMA approved therapy for the treatment of macular edema (ME) secondary to Branch and Central retinal vein occlusion (BRVO and CRVO) and intermediate and posterior non-infectious uveitis. Aim of the study is to report the adverse events related to this treatment in the clinical practice. Methods We reviewed the charts of all consecutive patients affected by ME secondary to different pathologies, who had undergone DEX implant 0.7 mg.Patients were instructed to use antibiotics postoperatively and followed up for at least 4 months after injections. Adverse events following DEX implant were recorded. Results Forty-three eyes of 42 patients were included for analysis. ME was related to BRVO (15 eyes), CRVO (14 eyes) and diabetes (14 eyes). Overall, 45 injections (mean 1,1 injections/patient) were performed. The mean follow-up was 6,1 months. Most common adverse events were related to the injection, and included mild and transient foreign body sensation (77,8%), conjunctival hyperemia (71,1%), conjunctival edema (53,3%), conjunctival haemorrhage (53,3%), eye pain (28.9%). Increased intraocular pressure (

Purpose To evaluate the agreement between fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) in detecting the activity of myopic choroidal neovascularization (CNV) during the treatment with intravitreal bevacizumab injection (IVBI). Methods Patients affected by myopic subfoveal CNV were prospectively enrolled in the study; at baseline and at all planned monthly visit, each patient underwent a complete ophthalmological examination, including BCVA assessment on ETDRS charts, slit lamp examination, FA and SD-OCT examination. After the first IVBI (1.25mg), additional injections were performed on the basis of the detection of any type of fluid on SD-OCT and/or presence of leakage or progression on FA. Inter-rater agreement kappa analysis was performed to examine the concordance between FA and SD-OCT in assessing CNV activity. Moreover, considering FA as standard reference examination, sensitivity and specificity were calculated. Results Thirty-four eyes were included in the study. At the baseline, FA and SD-OCT achieved an agreement in 26/34 cases (X%) with a k value of 0.23; sensitivity and specificity were respectively 77.4 and 66.7. The remaining eight cases, 7 eyes presented leakage on FA and absence of fluid on SD-OCT examination, whereas 1 case showed intraretinal fluid on SD-OCT and absence of leakage on FA. At 1-month examination, specificity and K value improved and a concordance was reached in 30/34 cases. At 3- and 4-month examination a discordance was noted in 6 case and the k values were 0.60 and 0.51, respectively. From 5-month examination on, a consensus was achieved in at least 30/34 cases (88%) and reached a complete agreement in 9 sessions. Conclusions The present study reveals that FA still plays a main role in the diagnosis of CNV in myopic eyes. However, it seems possible to hypothesize a role of SD-OCT for monitoring the anti-VEGF treatment over the follow-up.

Purpose To record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists. Methods Collaborative multicenter case series (41 cases), literature review (15 cases), and reports to the FDA (46 cases) of cases that had ocular vascular occlusions during anti-VEGF therapy. Results 102 cases had ocular vascular events diagnosed a median of 14 days after anti-VEGF injection. A majority of patients had preexistent risk factors for cardiovascular events and 6 patients had prior history of glaucoma. Mean visual acuity dropped by 5 lines with severe visual loss after injection to NLP (2 eyes), LP (6 eyes), and HM (2 eyes). The overall risk of ocular vascular events was 0.087%, with predilection for eyes with advanced retinal ischemia like proliferative diabetic retinopathy and ocular ischemic syndrome. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation=27%) and mean venous constriction was 8% (standard deviation=30%). Conclusions The ocular vascular events during anti-VEGF therapy are rare, can lead to severe visual loss, and may be of multifactorial etiologies: vasoconstrictor effect of the drug, post-injection rise of intraocular pressure, stress of the procedure, and the natural history of underlying ocular or systemic diseases.

Purpose To investigate the characteristics of blue light (BL) and near infrared (NIR) fundus autofluorescence (FAF) in patients affected by Best vitelliform macular dystrophy (BVMD). Methods Clinical data (visual acuity -VA-, red free and colour photos, BL and NIR FAF) of 13 patients (25 eyes) with BVMD were retrospectively reviewed. The diagnosis of BVMD was based on the presence of a positive family history and an abnormally low to absent electrooculogram light rise (Arden ratio

Purpose To evaluate the long-term efficacy and safety of intravitreal bevacizumab injection (IVBI) for the treatment of extrafoveal choroidal neovascularization (CNV) secondary to pathologic myopia. Methods The design of the study was an open-label prospective nonrandomized interventional case series. Seven eyes from 7 patients with extrafoveal CNV secondary to pathologic myopia were recruited. All patients underwent a complete ophthalmologic examination,including ETDRS visual acuity, optical coherence tomography, and fluorescein angiography. The protocol required 3 monthly consecutive IVBI (1,25 mg), followed by repeat injections on the basis of OCT parameters and angiographic features over the 24-month follow-up. Results Three eyes underwent previous photodynamic therapy, whereas the remaining 4 eyes were naive. All patients completed follow-up at 24 months. The mean baseline best corrected visual acuity was 0.6 logMAR, which improved to 0.43 logMAR at 24 months (p

Purpose To evaluate the long-term clinical outcomes of subfoveal choroidal neovascularization (CNV) secondary to pathological myopia (PM) treated with intravitreal bevacizumab injections (IVBI) on variable monthly regimen guided by fluorescein angiography (FA) and optical coherence tomography (OCT) [an as per needed basis]. Methods Eyes with subfoveal myopic CNV were treated with IVBI on an as per needed basis till the end point of CNV inactivity.All patients underwent a complete ophthalmologic examination, including visual acuity assessment on ETDRS charts, optical coherence tomography, and fluorescein angiography assessment. The protocol required monthly IVBI on the basis of persistent intraretinal or subretinal fluid detected on OCT scan and on the presence of leakage on FA.Primary outcome was the change in mean best corrected visual acuity (BCVA) and the proportion of eyes improving in BCVA by 3 lines. Secondary outcome measures was the evaluation of the agreement between FA and OCT in detecting of the CNV activity. Results 30 patients completed the scheduled visits over the 24-month follow-up. At the baseline, the mean BCVA was 0.6±0.3 (LogMAR±SD); at 3 months of follow-up, the mean BCVA improved to 0.54±0.4. Subsequently, at 12 and 24-month examination, the mean BCVA was 0.54±0.4 and 0.50±0.4, respectively. No statistically significant difference was detected in any time-point in comparison to the baseline value.At the end of the follow-up, 36.6% of cases showed a visual improvement of 3 or more lines. Thirteen eyes (43.3%) gained at least 1 line, 5 (16%) showed a BCVA stabilization and 6 eyes (20%) lost at least 1 line.Inter-rater agreement examination between FA and OCT evidenced a good correlation. During the first year of follow-up, OCT and FA provided a consensus of 89% in identification of IRF/SF on OCT and of leakage on FA (kappa=0,68). The agreement increased to 98% during the second year (kappa=0,92) .No significant ocular or systemic adverse effect was reported. The mean injection rate over 2 years was 5.26. Conclusion IVBI for PM-related subfoveal administered on an as per needed basis over 24 months of follow-up shows promise in stabilization of vision. OCT and FA showed similar proprieties in the ability to detect CNV activity and to guide the re-treatment.

Purpose To assess the efficacy and safety of intravitreal ranibizumab (IVR) in patients with sub or juxtafoveal choroidal neovascularization secondary to pathologic myopia (mCNV), naïve or unresponsive to prior photodynamic therapy (PDT) or intravitreal bevacizumab (IVB). Methods :23 eyes of 23 patients with sub or juxtafoveal mCNV treated with IVR, were retrospectively studied. Patients were divided in two groups. In group 1 (10 patients) patients were treated with three consecutive IVR performed on a monthly basis in contrast to group 2 (13 patients) that underwent a single IVR. Thereafter the need for additional injections was based on predefined retreatment criteria: persistence or increase of fluorescein leakage, new hemorrhage, persistence or appearance of sub/intraretinal fluid on OCT. Main outcome measures were changes in best corrected visual acuity (BCVA) and OCT thickness change at 12 months. Safety was tested by noting treatment-related ocular or systemic complications Results Overall, mean BCVA increased significantly from month 1 to 12. In both groups a significant decrease in OCT thickness and GLD was noted. At the end of the follow-up only 2 of the 23 patients of both groups showed a persistence of CNV, with a mean number of 1,3 IVR (range 1-2) in group 2 and 4,3 in group 1(range 3-6). Conclusions Short-term results suggested that IVR provides significant functional and important anatomical improvement with no significant adverse events in patients with sub or juxtafoveal mCNV naïve or unresponsive to prior PDT or IVB. Despite the small sample of eyes, the effectiveness of intravitreal ranibizumab was found to be encouraging. Further prospective long-term studies are necessary to evaluate safety and efficacy of intravitreal ranibizumab in the treatment of myopic CNV.

Purpose To report visual acuity change and central retinal thickness (CRT) variation after intravitreal injections of bevacizumab (IVB) in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods 18 eyes of 18 patients with ME secondary to BRVO were retrospectively reviewed. Mean disease duration was 14.3 months. Four patients were refractory to previous laser treatment or intravitreal injection of triamcinolone acetonide, 14 had not received previous treatments. All patients underwent a complete examination including ETDRS visual acuity measurement, fluorescein angiography and OCT. The patients received 3 monthly consecutive IVB, followed by repeated injections, laser treatment or no treatment on the basis of OCT parameters and angiographic patterns over the 12-month follow-up. Results Mean best corrected visual acuity (BCVA) was 0.94 ± 0.49 LogMar at baseline, 0.84 ± 0.45 logMar at three-month follow-up and 0.7 ± 0.42 LogMar at 1 year follow up. CRT was 536 ± 194 µm at baseline, 436 ± 167 µm at three-month follow-up and 471 ± 175 LogMar at 1 year follow up. No complications related neither to injection procedure nor to drug occurred. Seven eyes did not receive any further treatment, 4 eyes were treated with laser photocoagulation, 6 eyes were reinjected with bevacizumab (1 eye had one reinjection, 3 eyes three reinjections, 2 eyes six reinjections), 1 eye received one reinjection and laser treatment. Conclusions IVB alone or associated with laser photocoagulation is effective in improving BCVA and CRT in patients with ME secondary to BRVO over a12-month follow-up. The use of IVB in ME secondary to BRVO is promising. However, further studies are needed to assess the best treatment regimen and real efficacy.

Purpose To assess the efficacy and safety of intravitreal injection of ranibizumab (IVR) in patients with retinal angiomatous proliferation (RAP) Methods 22 eyes of 22 patients with RAP were retrospectively enrolled in the study. Patients were divided into 2 groups depending on prior treatment history: 12 eyes with newly diagnosed RAP, treatment naïve were included in group A, and 10 patients who had undergone previous therapy (intravitreal bevacizumab/triamcinolone acetonide monotherapy or combined with photodynamic therapy) were included in group B. All patients underwent visual acuity (VA) measurement using Snellen charts (converted into LogMAR for statistical analysis), complete ophthalmic examination, fluorescein and indocyanine-green angiography (FA and ICGA), and optical coherence tomography (OCT) at baseline, 3 and 5 months. All patients received three consecutive IVR (0.5 mg) on a monthly basis. The need for additional injections was based on the presence or recurrence of fluorescein leakage, evidence of RAP on ICGA, persistent or recurrent intra/subretinal fluid on OCT, new hemorrhage. Main outcome measures were changes in VA and central retinal thickness (CRT) on OCT. Results Baseline VA was 0.68±0.48 LogMAR (mean±SD) in group A and 0.74±0.33 LogMAR in group B. Eyes in group A exhibited a mean visual improvement of 0.08±0.16 LogMAR (p=0.11) and 0.07±0.19 LogMAR (p=0.25) at 3 and 5 months FU, compared to a mean variation of 0.0±0.27 LogMAR (p=1.0) and 0.01±0.28 LogMAR (p=0.91) in group B. In both groups changes in VA were not significant. Baseline CRT, 398±150 µm and 389±110 µm in group A and B respectively, decreased significantly in both groups (p

Purpose To assess the effects of intravitreal bevacizumab (Avastin) injections in the treatment of choroideal neovascularization (CNV) associated with multifocal choroiditis (MC). Methods Prospective interventional case series. Patients with MC complicated by subfoveal CNV underwent a complete ophthalmologic examination, including ETDRS visual acuity, optical coherence tomography (OCT), fluorescein angiography, and indocyanine green angiography. The protocol required 3 monthly consecutive injections, followed by repeated injections as needed. The planned follow-up was 12 months. Results Ten patients were enrolled in the study and prospectively followed up. Mean visual acuity and mean foveal thickness (FT) at the baseline were 0.58±0.48 (logMAR±SD) and 290±92µm SD, respectively. At the 3-month examination, mean visual acuity improved to 0.42±0.48 and mean FT decreased to 298±172µm SD. At the 12-month examination, mean visual acuity was 0.40±0.49, and mean FT was 255±163µm. No side-effect or complication was registered. Conclusion Intravitreal bevacizumab is a safe and beneficial treatment for CNV associated with MC in a short-term follow-up. A longer follow-up and a larger sample of patients are required to validate the results.

Purpose : To assess the effects of intravitreal bevacizumab (Avastin) injections in the treatment of choroideal neovascularization (CNV) associated with pattern distrophy (PD) of the retinal pigment epithelium. Methods Prospective interventional case series. Patients with PD complicated by CNV were considered. All patients underwent a complete ophthalmologic examination, including ETDRS visual acuity, electroretinogram, electrooculogram, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. The protocol required 3 monthly consecutive injections, followed by repeat injections over the 12-month follow-up on the basis of OCT parameters, angiographic features, visual acuity response. Results Eight patients were enrolled in the study and prospectively followed up. Mean visual acuity and mean foveal thickness (FT) at the baseline were 0.74±0.42 (logMAR±SD) and 277±117µm SD, respectively. At three-month examination, mean visual acuity improved to 0.51±0.31 and mean FT decreased to 225±88µm SD. At 12-month examination, mean visual acuity was 0.49±0.26, and mean FT 222±87µm. No side-effect or complication was registered. Conclusions Intravitreal bevacizumab seems to be a beneficial treatment for CNV associated with PD in a short term follow-up. However, a longer follow-up is necessary to validate our results, bearing in mind that CNV related to PD is a quite rare association, and that a randomized clinical trial on this topic is unlikely.

Purpose To evaluate the effectiveness of the therapy with subthreshold grid laser treatment with infrared micropulse 810 nm diode laser for clinically significant macular edema in diabetic retinopathy (DR). Methods Prospective interventional case series, including 11 patients (11 eyes) with macular edema in DR. All the patients were treated with infrared subthreshold (no intraoperative visible endpoint) grid laser treatment. The laser was applied in the area of edema in a grid pattern over the leaking or capillary occlusion area while sparing the central of the foveal avascular zone. The patients underwent an ophthalmologic examination icluding best-corrected visual acuity (BCVA) with ETDRS charts, contrast sensitivity with Pelli-Robson chart, digital stereo fundus photography, and foveal thickness measurements by Optical coherence tomography. The planned follow-up was 12 months. Results Mean BCVA improved from 20/40 at baseline to 20/32 at 1 year control. Mean foveal thickness changed from 416µ initially to 301µ, and total macular volume from 8,45mm3 to 7,75 mm3. At the end of the follow-up 3 patient (27%) maintained the initial VA, six (55%) obtained improvement of at least 1 line, with two of them gaining two lines (18%). Conclusions Subthreshold grid laser treatment with infrared micropulse 810 nm diode laser is an effective treatment in improving and maintaining visual function in patients affected by macular edema in diabetic retinopathy for 1 year follow-up. Randomized controlled trials with longer follow up and larger number of patients are necessary to compare the effectiveness as against conventional grid laser photocoagulation.

Purpose: Natural history of choroidal neovascularization (CNV) associated with angioid streaks (AS) is unfavourable; the disease was reported to lead to legal blindness in half of eyes within one year. We describe the outcome of photodynamic therapy (PDT) for CNV associated with AS. Methods: Twenty-one patients (28 eyes) were included. Inclusion criteria were actively leaking CNV associated with AS. Results: Mean age was 63 years (44-81y). The CNV was subfoveal in 22 eyes and extrafoveal in 6. Nineteen eyes (17 patients) with subfoveal lesions and visual acuity (VA) of at least 20/200 (median: 20/60) were followed for 9.6 months on average (3-20 months). The Kaplan-Meyer estimate of the proportion of eyes which lost less than 3 lines was 69% between 7.5 and 12 months; however the 95% confidence interval of the estimate is large (46%-92%). In one eye of 3 different patients, who showed subfoveal CNV with VA between 20/400 and 20/800, VA improved by 3 to 6 lines. In 6 eyes (4 patients) with extrafoveal CNV (follow-up: 6-20 months), VA was 20/20-20/25 before PDT; progression to subfoveal CNV was avoided in 4 eyes of 2 patients, who retained baseline VA bilaterally. The CNV was smaller than 500 microns at the first PDT in these eyes. In 2 eyes which developed subfoveal involvement, final VA was 20/60 after 4 and 6 months respectively. Conclusion: About 70% of eyes (and at least 50% based on the Kaplan-Meyer estimate lower limit) are likely to have mild or no visual loss during the first year of PDT treatment for subfoveal CNV associated with AS. This outcome might be favourable given the aggressive untreated course of these lesions. PDT can avoid subfoveal invasion in some eyes with small extrafoveal CNV. Long term observation is needed.

The usefulness of applying digital processing to eye-fundus images in order to obtain an accurate temporal monitoring of the pathology under examination is evaluated. In particular, an automatic segmentation algorithm that makes it possible to extract specific features for the pathology and then to characterize it in terms of dimensional parameters is presented. Some results for a case of type-2 Hayreh vasculity are reported and discussed.

PURPOSE. The ferning test involves a process of crystallization achieved simply by removing water and is feasible for all ocular fluids. The ferning test of subretinal fluid (SRF) from patients with rhegmatogenous retinal detachment (RRD) reveals three different patterns: type 1 showing thin crystals, type 2 with larger crystals and type 3 with small, curvilinear structures with no tree-like appearance. The present study was designed to determine whether the SRF ferning test is correlated with the clinical features and the surgical outcome of RRD. METHODS. A series of 65 consecutive patients with RRD at the first onset were considered. Particular attention was paid to duration, extension, and surgical outcome of RRD. SRF samples were collected during scleral buckling surgery. The fluid was dropped onto the slide of a light microscope, left to dry, and examined under the microscope. RESULTS. There was a significant difference between SRF ferning types 1 and 2 as regards duration and extension (both p < 0.001). There was also a significant difference between SRF ferning types 2 and 3 as regards duration (p