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Purpose Dyslexia is a reading disorder with neurological deficit of the magnocellular pathway. The aim of our study was to evaluate the functionality of the magnocellular-Y (M-Y) retinal ganglion cells in adult dyslexic subjects using steady-state pattern electroretinogram and frequency doubling perimetry. Methods Ten patients with dyslexia (7 females and 3 males), mean age 28.7 ± 5.9 years, and 10 subjects without dyslexia (6 females and 4 males), mean age 27.8 ± 4.1 years, were enrolled in the study and underwent both steady-state pattern-electroretinogram examination and frequency doubling perimetry. Results There was a significant difference in the amplitude of the steady-state pattern electroretinogram of the dyslexic group and the healthy controls (0.610±0.110 μV vs 1.250±0.296 μV; p=0.0001). Furthermore, in the dyslexic group we found a significant difference between the right eye and the left eye (0.671±0.11 μV vs 0.559±0.15 μV; p=0.001). With frequency doubling perimetry, the pattern standard deviation index increased in dyslexic eyes compared to healthy controls (4.40±0.81 dB vs 2.99±0.35 dB; p=0.0001) and in the left eye versus the right eye of the dyslexic group (4.43±1.10 dB vs 3.66±0.96 dB; p=0.031). There was a correlation between the reduction in the wave amplitude of the pattern electroretinogram and the simultaneous increase in the pattern standard deviation values (r=0.80; p=0.001). This correlation was also found to be present in the left eye (r=0.93; p

Costantino Schiavi, Filippo Tassi, Alessandro Finzi, Ernesto Strobbe, Mauro Cellini Department of Experimental, Diagnostic, and Specialty Medicine, Ophthalmology Service, University ofBologna, Bologna, Italy Background: Steady-state pattern electroretinogram (PERG) and frequency doubling technology (FDT) perimetry can be used to selectively investigate the activity of the M-Y ganglion cells in adult anisometropic amblyopes. Methods: Fifteen normal subjects (mean 27.8±4.1 years) and 15 adults with anisometropic amblyopia (mean 28.7±5.9 years) were analyzed using steady-state PERG and FDT. Results: The amplitude of steady-state PERG was significantly different not only among the control group and both the amblyopic eye (P=0.0001) and the sound eye group (P=0.0001), but also between the latter two groups (P=0.006). The difference in FDT mean deviation was statistically significant not only between the control group and amblyopic eye group (P=0.0002), but also between the control group and the sound eye group (P=0.0009). The FDT pattern standard deviation was significantly higher in the control group rather than in the amblyopic eye (P=0.0001) or the sound eye group (P=0.0001). A correlation was found between the reduction in PERG amplitude and the increase in FDT-pattern standard deviation index not only in amblyopic (P=0.0025) and sound (P=0.0023) eyes, but also in the healthy control group (P=0.0001). Conclusion: These data demonstrate that in anisometropic amblyopia, there is an abnormal functionality of a subgroup of the magnocellular ganglion cells (M-Y), and the involvement of these cells, together with the parvocellular pathway, may play a key role in the clinical expression of the disease. Keywords: pattern electroretinogram, frequency doubling technology perimetry, retinogeniculate pathways, amblyopia

Corrado Gizzi, Mauro Cellini, Emilio C Campos Department of Experimental, Diagnostic and Speciality Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy Purpose: To investigate the biomechanical response of the cornea, lamina cribrosa (LC), and prelaminar tissue (PT) to an acute intraocular pressure (IOP) increase in patients with markedly asymmetrical glaucoma and in healthy controls.Patients and methods: A total of 24 eyes of 12 patients with markedly asymmetrical primary open-angle glaucoma (POAG) and 12 eyes of 12 healthy patients were examined with spectral-domain optical coherence tomography (SD-OCT) and ocular response analyzer (ORA) at baseline and during acute IOP elevation by means of an ophthalmodynamometer. The displacement of the LC and PT and the change in corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated.Results: Following a mean IOP increase of 12.3±2.4 mmHg, eyes with severe glaucoma demonstrated an overall mean anterior displacement of the LC (-6.58±26.09 µm) as opposed to the posterior laminar displacement in eyes with mild glaucoma (29.08±19.28 µm) and in healthy eyes (30.3±10.9; p≤0.001 and p=0.001, respectively). The PT displaced posteriorly during IOP elevation in all eyes. The CH decreased in eyes with severe glaucoma during IOP elevation (from 9.30±3.65 to 6.92±3.04 mmHg; p=0.012), whereas the CRF increased markedly in eyes with mild glaucoma (from 8.61±2.30 to 12.38±3.64; p=0.002) and in eyes with severe glaucoma (from 9.02±1.48 to 15.20±2.06; p=0.002). The increase in CRF correlated with the anterior displacement of the LC in eyes with severe glaucoma.Conclusion: Eyes with severe glaucoma exhibited a mean overall anterior displacement of the anterior laminar surface, while eyes with mild glaucoma and healthy eyes showed a posterior displacement of the LC during IOP elevation. The CH decreased significantly from baseline only in eyes with severe glaucoma, but the CRF increased significantly in all glaucomatous eyes. The CRF increase correlated with the anterior displacement of the LC in eyes with severe glaucoma. Keywords: glaucoma, lamina cribrosa, cornea, hysteresis, ophthalmodynamometer, biomechanics, asymmetry&nbsp

The purpose of this study is to evaluate the intraocular inflammation at a sub clinical level, in patients suffering from Sjogren's syndrome (SS-I) and Rheumatoid Arthritis (RA), to relate it with the ocular surface status and to verify the diagnostic performance of the method. Twenty-eight patients suffering from SS-I, 31 patients suffering from RA and 31 normal subjects matched in age and gender were included in the study. A Kowa 500F laser cell flare meter was utilized to quantify the aqueous cells and flare in vivo, ocular surface inflammation was graded by conjunctival cytology and dosage of serum albumin in tears, eye dryness was scored with Tear Function Index. All data resulted significantly different in both SS-I and RA patients vs. control group and also different comparing SS-I vs. RA patients group, except for the Flare values. A blood-aqueous barrier breakdown occurs either in SS-I and RA patients; the degree of the damage is related with ocular surface inflammation and dryness. We recommend the aqueous flare be analysed in those rheumatic patients where an ocular surface inflammation has been documented.

Purpose To evaluate biomechanical properties in eyes of patients affected by primary open angle glaucoma (POAG) with marked asymmetrical defects by means of Ocular Response Analyzer (ORA) and Spectral Domain OCT with Enhanced Depth Imaging (EDI SD-OCT) function. Methods We studied 20 patients (mean age: 56 ± 12) with asymmetrical POAG. One eye was classified as mild glaucoma (MG) and the sound eye as severe glaucoma (SG) by visual field indexes: MD −4.21 ± 1.51 vs −16.56 ± 5.76 dB; p = 0.011 and PSD 3.54 ± 0.87 vs 10.95 ± 3.51 dB; p = 0.007. An EDI SD-OCT centered on the optic nerve head and an ORA examination were performed on each eye of every subject before and during a IOP increase of 12.5 ± 2.1 mm/Hg induced by a compression of the globe with an ophthalmodinamometer. Corneal histeresis (CH), corneal resistence factor (CRF) and laminar displacement (LD) were statistically analyzed by Wilcoxon's rank sum test and Spearman's correlation test considering significant a p

PURPOSE: To study in ocular hypertension (OH) the retinal nerve fibre layer (RNFL) with optical coherence tomography (OCT) and the neuronal function with frequency-doubling technology (FDT) to assess which of the two methods was more sensitive in detecting early glaucomatous damage. Furthermore, a colour Doppler imaging (CDI) of the optic nerve was carried out to highlight any correlation with RNFL thickness and FDT abnormality. MATERIALS AND METHODS: We enrolled 28 ocular hypertensive patients who underwent OCT of the RNFL and FDT. Moreover, we performed a CDI of the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary arteries (PCAs). RESULTS: The patients with OH following OCT revealed a significant thinning in the RNFL as compared to the control group only in the inferior quadrant: 122.250+/-14.091 vs131.750+/-10.729 mum (P

ObjectiveTo evaluate the diagnostic performance of the tests included in primary Sjogren's syndrome (SS-I) diagnostic criteria (Schirmer I, break-up time, vital dye staining) and to compare them with other examinations related to the ocular surface status.MethodsClinical and cytological data were collected from 177 patients (62 SS-1, 56 non-SS autoimmune diseases, 59 Sicca syndrome). Tear tests included: a validated questionnaire on symptoms, Schirmer I, Jones test, Ferning test, BUT, corneal aesthesiometry, tear clearance test, lissamine green staining, impression conjunctival cytology. Data were statistically evaluated and sensitivity, specificity, likelihood ratio (LR+), receiver-operating characteristics (ROC) curves were calculated for each test.ResultsData showed a poor diagnostic performance of Schirmer test I (sensitivity 0.42; specificity 0.76; LR+1.75) and BUT (sensitivity 0.92; specificity 0.17; LR+1.11) (area under the curve in ROC analysis 0.70). Lissamine green staining exhibited the best performance (sensitivity 0.63; specificity 0.89; LR+5.72) but the result could be distorted by an incorporation bias.ConclusionsOur data suggest to implement the items for ocular signs and symptoms contained in many SS-I diagnostic criteria with the use of a validated questionnaire, performance of Jones test, corneal aesthesiometry measurement, and tear clearance rate evaluation.

Background: Recent studies have shown how the topical application of nerve growth factor (NGF) has led to the repair of neurotrophic corneal ulcers with recovery of corneal surface sensitivity. The biological effect of NGF, at a corneal level, is mediated by the presence of specific receptors localized on the surfaces of the corneal and conjunctival cells. Objectives: To evaluate the efficacy of NGF to promote corneal wound healing after cataract surgery. Methods: Thirty patients were divided into two groups (groups A and B) and underwent cataract surgery. After surgery patients in group A received 1 drop of NGF solution (10 µg of NGF dissolved in 50 µl of saline solution, 0.9% of sodium chloride) in the conjunctival fornix every 2 h (from 6 a.m. to 12 p.m.) for 2 weeks and then 4 times a day for another week. The patients in group B received 1 drop of hyaluronic acid 0.2% eye drops in the conjunctival fornix every 2 h for 2 weeks and then 4 times a day for another week. With optical coherence tomography (OCT) we evaluated the corneal thickness at the side of the surgical wound, the endothelial cell count and the incision line in the stroma 1, 7 and 21 days after surgery. Results: Before surgery in group A and in group B, the endothelial cell count was 2,607.4 ± 261.0 versus 2,602.0 ± 266.6 (p < 0.991), and the temporal cornea edge thickness was 639.2 ± 24.7 versus 644.4 ± 31.9 µm (p < 0.605), respectively. At 24 h after surgery, the results were: 2,523.2 ± 280.5 versus 2,528.2 ± 235.7 (p < 0.988) and 804.4 ± 29.5 versus 802.6 ± 35.0 µm (p < 0.953). After 7 days the cell count values were: 2,511.4 ± 229.8 versus 2,490.0 ± 230.4 (p < 0.361) and corneal thickness 713.6 ± 16.5 versus 771.4 ± 36.5 µm (p < 0.047). Finally, 21 days after surgery, the number of endothelial cells was 2,540.2 ± 237.3 versus 2,503.4 ± 224.5 (p < 0.382) and corneal thickness 645.2 ± 22.6 versus 704.2 ± 11.8 µm (p < 0.002). In the patients treated with NGF, on day 21, we found with OCT a complete wound healing, and the stromal incision was not visible. Conclusions: This clinical experience shows that the topical administration of NGF is effective in accelerating the healing of surgical corneal wounds.

Alessandro Finzi, Ernesto Strobbe, Filippo Tassi, Michela Fresina, Mauro Cellini Department of Specialized, Diagnosticand Experimental Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy Background: To assess the sensitivity and specificity of hemifield pattern electroretinogram (HF-PERG) for detecting early retinal ganglion cell (RGC) damage in ocular hypertensive (OH) patients.Methods: Fifty-two OH patients (mean age 56±9.6 years) with an intraocular pressure (IOP) >21 mmHg were assessed. All subjects underwent HF-PERG, optical coherence tomography (OCT), and frequency doubling technology (FDT) visual field.Results: OH patients showed a significant increase of peak-time of the N95 (P=0.027) compared to controls. The amplitude of the N95 of the lower and upper HF-PERG showed significant differences (P=0.037 and P=0.023, respectively) between the two groups. A significant intraocular (P=0.006) and interocular (P=0.018) asymmetry of N95 amplitude was found. Receiver operating characteristic (ROC) curve analysis revealed a sensitivity of 93% for the N95 of the lower HF-PERG, whereas full-field pattern electroretinogram (PERG) N95 peak-time had a sensitivity of 88%. In OH patients, we found a thinning of OCT - retinal nerve fiber layer (RNFL), especially in the superior and inferior quadrant, although not statistically significant, and a significantly higher FDT pattern standard deviation (FDT-PSD; P=0.001). In the OCT-RNFL inferior quadrant, a sensitivity of 82% was recorded. Finally, the sensitivity of the FDT-PSD was 92%.Conclusion: Our study shows that HF-PERG is a very sensitive test for detecting early damage of the RGC. Keywords: ocular hypertension, hemifield pattern electroretinogram, optical coherence tomography, frequency doubling technology&nbsp

Purpose To assess which is the most sensitive and specific exam for detecting an early retinal ganglion cells (RGC) damage between hemifield test pattern electroretinogram (PERG HF) and the posterior pole asymmetry analysis with optical coherence tomography (OCT-PPAA) in ocular hypertensive patients (OH). Methods Forty-two OH patients (mean age of 56.0±5.6 yrs.) with an intraocular pressure (IOP)>21mmHg and forty healthy controls (mean age of 55.2±6.4 yrs.) with IOP

PURPOSE: The aim of this study was to assess corneal hysteresis (CH) and corneal resistance factor (CRF) in healthy subjects, to evaluate the relationship with age, and to investigate possible associations with other ocular factors. METHODS: Four hundred Italian subjects (male-to-female ratio, 168:232; mean age, 58.8 ± 17.2 years) were included and divided into 5 subgroups based on age. CH, CRF, and central corneal thickness (CCT) were measured by using the Ocular Response Analyzer and the integrated handheld pachymeter, and their relationship with gender, age, and ocular factors was evaluated. RESULTS: The mean CH, CRF, and CCT values were 10 ± 1.6 mm Hg, 10.5 ± 1.7 mm Hg, and 532.2 μm, respectively. Women had a lower mean CH (9.9 vs. 10.2 mm Hg; P = 0.04) and CRF (10.3 vs. 10.8 mm Hg; P = 0.03) than did men. The youngest subjects had the highest CH (11.2 ± 1.5 mm Hg), whereas the oldest patients had the lowest CH values (9 ± 1.1 mm Hg). No significant differences in CRF were observed between age groups. CH and CRF showed a positive correlation (r = 0.58; P < 0.001), and both had a positive association with CCT (r = 0.27; P < 0.001 and r = 0.57; P < 0.001, respectively). The strongest correlations were observed between Goldmann-correlated intraocular pressure (IOP) and corneal-compensated IOP (r = 0.68; P < 0.001) and between Goldmann-correlated IOP and Goldmann applanation tonometry (r = 0.88; P < 0.001). CONCLUSIONS: Gender and advancing age may influence corneal biomechanical properties. In our population, CH decreased with aging, and men demonstrated a higher CH and CRF than women did. Further, CH, CRF, and CCT were significantly related.

Purpose: To report the diagnostic and therapeutic data obtained from 1,200 patients suffering from dry eye symptoms not due to Sjögren’s syndrome or other auto-immune diseases. Methods: Schirmer test I, ferning test, breakup time, vital dye staining, brush and imprint cytology were performed; data were grouped into diagnostic profiles, and the therapy was prescribed according to these. Results: Eight diagnostic profiles were identified. Dry eye was diagnosed in 57.1% of patients; the remaining 42.9% were found to suffer from eye discomfort or conjunctivitis of different aetiologies. Conclusions: Subjective symptoms of dryness can hide diseases other than dry eye; combined clinical and laboratory tests are requested to make a diagnosis. Our experience indicates that a therapy prescribed on the basis of diagnostic profiles provides relief in 79.1% of cases.

Purpose: To investigate the interactions occurring at the interface between some currently used vitreous tamponading substances and the ocular tissues, in an early follow-up after surgery. Methods: Adult albino rabbit eyes underwent vitrectomy and were injected intravitreally with silicone oils at 1,000 or 3,000 cSt, fluorosilicone oil and perfluorodecalin. Different morphological techniques (light microscopy, scanning and electron microscopy, immunohistochemistry) were applied. Results: All the tested materials, although non-toxic, penetrate the ocular tissues also at the anterior segment level, and in the long-term follow-up this can yield functional impairment. No massive inflammation has been detected in the zones in contact with the materials, but immunoglobulins and complement fractions are anyway present in the stroma of various tissues and around the droplets of emulsified materials, suggesting a local immune reaction. Conclusions: Data from this study confirmed that a permanent vitreous substitute, showing a perfect biocompatibility, still does not exist. The indication to remove the tamponading substance within 2 months after the surgery emerges from this investigation, confirming previous studies. Despite some negative features, silicone oil still appears the most biocompatible material for vitreous replacement.

Discomfort eye syndrome (DES) comprises a series of ‘minor’ subjective symptoms in patients where no relevant clinical signs are observed suggesting ocular disease. Our study includes 100 DES patients, excluding video terminal users, selected from the First Aid Service of our Department over two peak periods in both winter and summer time. The Schirmer test I, ferning test, breakup time and conjunctival cytology (scraping and imprint) were performed and data were related to sex, age and air pollution indexes, recorded in the patients’ living zones. Our results demonstrate that: (i) the ocular surface cytology and the analysis of tear film changes provide significant information in those patients where no other clinical signs are evident; (ii) DES symptoms are more frequent in women than in men (ratio about 2:1), both with ages over 51 years; (iii) DES is significantly associated with ocular surface inflammation, as detected by cytological methods, and (iv) ocular surface subclinical inflammation and ocular dryness are related to high concentrations of atmospheric polluters, in both sexes.

The authors investigated the effect of ketanserin 0.5% eye drops on intraocular pressure and orbital blood flow in some healthy volunteers. Ketanserin is a selective antagonist of serotonin S2 receptors; moreover, it produces an α1-blocking effect. It causes a systemic reduction of blood pressure and capillary vasodilatation. Three hours after topical administration of ketanserin 0.5%, the intraocular pressure was decreased by about 14% from the baseline. At the same time, we observed by color Doppler imaging that the mean percent increase in the peak systolic velocity in the ophthalmic artery (OA) was 5.18% (p < 0.161) and 23.18% (p < 0.001) in the posterior ciliary arteries (PCAs). The mean resistance index of the OA was in contrast reduced by 1.16% (p < 0.669) and by 32.14% (p < 0.003) in the PCAs. These data show that ketanserin 0.5% eye drops may be useful not only to decrease intraocular pressure but also to improve blood flow in the PCAs that supply the optic nerve head.

Purpose To assess which is the most sensitive and specific exam for detecting early glaucomatous damage in ocular hypertensive patients (OH) among hemifield test pattern electroretinogram (PERG HF), frequency doubling technology (FDT) and optical coherence tomography retinal nerve fiber layer (OCT RNFL). Methods Fifty-two OH patients (mean age of 56±9.6 yrs) with an intraocular pressure (IOP)>21mmHg and 52 healthy controls (mean age of 54.8±10.4 yrs) with IOP

Purpose: The aim of this study was to assess (i) whether pupil dilation with tropicamide influences subfoveal choroidal blood flow, as assessed by continuous laser Doppler flowmetry (LDF) and (ii) if this is the case, whether the effect is due to a haemodynamic response of the drug-induced dilation. Methods: Following the instillation of one drop of 1% tropicamide in one eye of 18 healthy, nonsmoking volunteers (age 20–25 years), the subfoveal choroidal LDF parameters (Vel, Vol and ChBF) were recorded during 30 min, at 3-min intervals under two paradigms: through an artificial pupil (4 mm diameter) placed in front of the cornea (P1) and without this artificial pupil (P2). Results: Tropicamide increased the pupil diameter from 3.3 ± 0.4 mm (mean ± SD) to 8.3 ± 0.4 mm. Full dilation was reached at ∼24 min. During this period of time, linear regression analysis demonstrated that none of the LDF parameters varied significantly (p > 0.05), either under P1 or P2. Based on a group of 12 subjects, the smallest (%) change in the mean value of ChBF (ChBFm) that would be detectable (sensitivity of the method, S) was found to be 2% for P1 and 6% for P2. The average coefficient of variation of ChBFm based on eight measurements during dilation was greater for P2 than for P1 by a factor of approximately 2. Conclusion: Tropicamide had no significant influence on the subfoveal choroidal LDF parameters measured by continuous LDF during pupil dilation. Furthermore, pupil dilation did not affect ChBFm by more than the calculated minimum percentage change of 6% detectable with our method.

Purpose To assess corneal hysteresis (CH) and corneal resistance factor (CRF) in keratoconic eyes before and after corneal cross-linking (CXL) with riboflavin/ultraviolet-A and to evaluate the correlation between these biomechanics values and central corneal thickness (CCT). Methods 22 eyes of 12 patients (mean age 25.3±5.9) were evaluated before and 1, 6 and 12 months after CXL. At each visit best corrected visual acuity (BCVA), CCT , CH and CRF using ocular response analyzer-ORA (Reichert Ophthalmic Instruments, Buffalo, NY) were assessed. Data were analyzed using Friedman and Spearman tests. Results BCVA, expressed in LogMAR, significantly improved 1 year after CXL (0.31±0.05 vs 0.27±0.04, p

Purpose We decided to investigate the effects of an acute induced IOP elevation on the prelaminar tissue and on the lamina cribrosa in glaucomatous eyes and in healthy eyes by means of an high resolution Spectral Domain (SD) OCT. Methods We enrolled 10 patients (mean age 70.2 years) affected by primary open angle glaucoma (POAG) and 10 healthy subjects (mean age 70.8 years) as controls. All the subjects were scanned with a SD-OCT with real-time eye tracking at baseline and in the same exact position during IOP elevation performed with an ophthalmodynamometer. The IOP was measured with a Tono-Pen at baseline and during IOP elevation. The SD-OCT images acquired were processed with a computer graphical suite to determine the prelaminar tissue displacement (PTD) and the laminar displacement in the two groups. An analysis of variance was used for evaluating group differences considering statistically significant a P < 0.05. Results Baseline IOP was significantly different in the two groups, with higher values in patients compared to controls: 18.9(4.3) vs. 15.7(2.6) mmHg (P

The measurement of blood flow in the ocular fundus is of scientific and clinical interest. Investigating ocular blood flow in the choroid may be important to understand the pathogenesis of numerous ocular diseases, such as glaucoma or agerelated macular degeneration (AMD). Laser Doppler flowmetry (LDF) was applied to measure relative velocity, volume and flux of red blood cells in the tissues of human eye. Its main application lies in the possibility of assessing alterations in blood flow early in the course of diseases. The purpose of the present study was to investigate the effect of pupil dilatation with one drop of 1% tropicamide on blood flow in the foveal region of the choroid of the human fundus. The blood flow parameters were measured in 24 eyes during 30 minutes (one measurement in every 3 minutes) after the application of the drop. Since the Doppler parameters depend on the scattering geometry, which may change as the pupil dilates; an artificial pupil of 4mm in diameter was placed directly in front the eye. Following the administration of tropicamide the mean pupil diameter was increased from 3.29 mm to 8.25 mm (P

AIMS: To assess the relationship between endothelial dysfunction, endothelin 1 (ET-1) plasma levels and subclinical inflammation in primary open angle glaucoma (POAG) patients. MAIN METHODS: We enrolled 40 POAG patients with progressive visual field damage, although well controlled intraocular pressure (IOP) and compared to age and sex matched healthxy subjects. Each patient underwent an ophthalmological examination, a standard achromatic perimetry (SAP), blood sampling to assess ET-1 plasma levels, an objective assessment of cellularity within the anterior chamber (FLARE) and measurement of flow mediated dilation (FMD) with high resolution 2-dimensional ultrasonographic imaging of the brachial artery. KEY FINDINGS: At baseline, POAG patients, compared to healthy controls, showed an increase of ET-1 plasma levels: 2.83 ± 0.28 pg/ml vs. 1.75 ± 0.25 pg/ml (p0.001). SIGNIFICANCE: The increase of ET-1 in POAG patients is related to vascular dysfunction (r=0.942; p=0.001) and vascular dysfunction is related to sub-clinical intraocular inflammation (r=0.968; p=0.001). Thus ET-1 and vascular dysfunction related to sub-clinical inflammation may play a key role in determining a progressive visual field damage in POAG patients who present a well-controlled IOP.

Phacoemulsification and the contemporary implantation of intraocular lens (IOL) within the capsular bag represent the standard of care in cataract surgery, but sometimes a primary IOL implant is not possible due to intraoperative complications or preexisting conditions so that a secondary implantation of IOL within the anterior or posterior chamber is necessary. The aim of our study was to assess the degree of inflammation due to a secondary implant of claw lenses, angle-supported IOLs, and scleral-fixated IOLs by means of an objective, repeatable, and noninvasive device, the laser flare cell meter, which evaluates aqueous flare and cells within the anterior chamber in vivo and to show the contribution of the single IOLs to the genesis of inflammation.

Background To assess which of three methods, namely, optical coherence tomography (OCT), pattern electroretinogram (PERG) or frequency-doubling technology (FDT), is the most sensitive and specific for detecting early glaucomatous damage in ocular hypertension (OH). Methods Fifty-two patients with OH (24 men and 28 women, mean age of 56 ± 9.6 years) with an intraocular pressure (IOP) > 21 mmHg and fifty-two control patients (25 men and 27 women, mean age of 54.8 ± 10.4 years) with IOP All subjects underwent OCT, FDT and PERG. Data were analyzed with unpaired t-tests, Chi-square test and Receiver Operating Characteristic (ROC) curve analyses. Results In patients with OH, OCT showed retinal nerve fiber layer (RNFL) thinner than in control group in the superior quadrant (130.16 ± 10.02 vs 135.18 ± 9.27 μm, respectively; p Conclusions FDT is the most sensitive and specific method for detecting early glaucomatous damage in eyes with OH, and together with OCT, can be useful in identifying those patients who may develop glaucoma. Trial registration ISRCT number: ISRCTN70295497

Purpose To evaluate the effect of subtenon injection of natural leucocytic interferon-α (IFN-α) on visual acuity (VA), macular thickness (MT) and membrane size in patients affected by type II age-related choroidal neovascularization (CNV) refractory to intravitreal injection of bevacizumab Methods 20 patients (male:female=8:12; mean age: 77.7±6.6) were evaluated, including best-corrected visual acuity (BCVA), fluorescein angiography, indocianin angiography and SD-OCT, preoperatively and after 1 month and 4 months following the last injection. Patients received a parabulbar subtenonian injection of IFN-α (1x106 UL/ml, Alfaferone, AlfaWassermann) 3 times a week for 4 consecutive weeks. Results BCVA, expressed in LogMAR, significantly improved after the first month (0.88±0.49vs0.65±0.52; p

Purpose To report the effect of subtenon injection of natural leucocytic interferon-α (IFN-α) on visual acuity (VA) and macular thickness (MT) in diabetic macular edema (DME). Methods 3 patients affected by diabetic macular edema refractory to intravitreal injection of bevacizumab received a complete ophthalmic examination including best-corrected visual acuity (BCVA )and spectral domain ocular coherence tomography (SD-OCT) before and after 1 week, 1 month and 4 months of a cycle of 3 parabulbar subtenonian injections in a week of IFN-α (1x106 UL/ml, Alfaferone, AlfaWassermann). Results BCVA and MT significantly improved after a week in patient 2 (male, age 66): 20/50 vs 20/30 and 498μm vs 237μm. The result was stable during the third and fourth visits (299μm and 254 μm). BCVA and MT improved after a week in patient 1 (male, age 64): 20/40 vs 20/32 and 467μm vs 244μm, respectively; BCVA was stable during the follow up period, but MT increased significantly (610 μm and 603μm during the third and fourth visits). BCVA improved in patient 3 (female, age 75) after one week (20/50 vs 20/32) and was stable during the follow up period, but she had only a little improvement in MT (533μm, 483μm, 498μm and 493μm during the 4 visits). Conclusion BCVA improved in all the patients, and was stable after 4 months. MT greatly improved in two patients after 1 week but only in one patient was the result stable. IFN-α, with its immunomodulatory, antiproliferative and antiangiogenic actions, was effective in improving VA and reducing macular thickness in DME. Randomized controlled studies will be useful to understand how long the effect of IFN-α lasts, how many injections are needed and which patients might have the best results.

Laser Doppler flowmetry (LDF) is a technique used to measure relative average velocity, number and flux (number times velocity) of red blood cells in vessels or capillaries. In this study, the effect of topical timolol on the choroidal circulation was investigated in 12 healthy subjects. Maximum velocity of red blood cells and volumetric blood flow rate in sub-foveal choroids are determined in each eye just before instillation of drops and then every 30 min upto 2 hours. Average intraocular pressure (IOP) decreased significantly in the timolol-treated eyes compared to that of placebo-treated eyes. Nevertheless no significant differences in choroidal blood hemodynamic between timolol and placebo-treated eyes were observed.

Purpose To compare the corneal hysteresis (CH) and the corneal resistance was increase force (CRF) of patients with age-related macular degeneration (ARMD) and control subjects. Methods The CH and the CRF were compared among 20 patients with ARMD (ARMD group: 10 with neovascular and 10 with non-neovascular ARMD) aged from 54 yrs to 78 yrs (68.9±15.9 yrs) and 20 age-matched control patients (control group). In ARMD and control group the eye's axial length was: 23.14 ±0.95 mm vs. 23.04 ±1.16 mm (p

Many drugs, including quinolone antibiotics, have been implicated in the aetiology of pseudotumour cerebri. We here report the case of an 18-year-old male of high body mass index who developed pseudotumour cerebri after treatment with oral levofloxacin for broncho-pneumonia. After 5 days of treatment, his general condition improved but he started to complain of headache, intermittent vomiting, tinnitus in the left ear, blurred vision, photophobia, and intermittent horizontal diplopia. The fundus oculi examination revealed bilateral papilloedema. All the symptoms resolved within 2 weeks after levofloxacin withdrawal. This case raises the possibility that quinolone antibiotics can cause pseudotumour cerebri.

Introduction: Mooren's ulcer is a rare disorder of unknown etiology that is refractory to treatment. It can affect not just the cornea but also the scleral tissue and can involve both eyes. Case presentation: We report a case of a 74-year-old man with a history of bilateral and malignant Mooren's ulcer. The patient had undergone an exenteratio bulbi of the left eye because of the perforation of a Mooren's corneal ulcer. The perforated Mooren's corneal ulcer also presented in the right eye and involved the adjacent scleral tissue. It was decided to perform a corneal-scleral graft to preserve the anatomical integrity of the eye. Conclusion: This report highlights how a corneal-scleral graft followed by systemic and local immunosuppressive treatment should be considered in monocular patients with malignant Mooren's ulcer where there is serious damage to the corneal and scleral tissue. © 2009 Cellini et al; licensee BioMed Central Ltd.

Purpose Glaucomatous optic neuropathy (GON) is related not only to elevated intraocular pressure (IOP) but also to an insufficient ocular blood supply related to a vascular dysregulation. We evaluated peripheral vascular endothelial function in primary open-angle glaucoma (POAG) with a non-invasive endothelium flow mediated vasodilatation (FMD). Methods We studied 20 POAG patients. The diagnostic criteria for POAG was an IOP exceeded 22 mm/hg before treatment, open anterior chamber angle, cup/disc ratio >0.7 and optic nerve related visual field loss (MD>6 dB, SF>2.5 dB and CPSD>3 dB). Patients with systemic diseases such hypertension, heart failure and diabetes mellitus were excluded. All patients and 20 normal controls underwent measurement of FMD with high-resolution 2-dimensional ultrasonographic imaging of the brachial artery by a Philips ENVISOR echographic machine. To induce iperemia a sphygmomanometer cuff was inflated to 250 mm/hg for 5 minutes. The cuff then was deflated rapidly and at 60 seconds after cuff deflation 2-D images of the brachial artery were recorded for 5 seconds. A statistical analysis was made of the FMD in POAG and in normal control patients using the Student “t” test for unpaired data and the Pearson correlation test to show the correlation between the endothelial dysfunction and the visual field indexes. Results Patients affected by POAG exhibit lower values of FMD compared with healthy people In POAG patients we found an FMD 4,28%±2,49 vs. 8,66%±3,02 (p

Background The aim of this study was to assess changes in metalloproteinases (MMP-2) and tissue inhibitor of metalloproteinases (TIMP-2) following selective laser trabeculoplasty (SLT) in patients with pseudoexfoliative glaucoma (PEXG). Methods We enrolled 15 patients with PEXG and cataracts (PEXG-C group) and good intraocular pressure (IOP) controlled with β-blockers and dorzolamide eye drops who were treated by cataract phacoemulsification and 15 patients with pseudoexfoliative glaucoma (PEXG-SLT group). The PEXG-SLT patients underwent a trabeculectomy for uncontrolled IOP in the eye that showed increased IOP despite the maximum drug treatment with β-blockers and dorzolamide eye drops and after ineffective selective laser trabeculoplasty (SLT). The control group consisted of 15 subjects with cataracts. Aqueous humor was aspirated during surgery from patients with PEXG-C, PEXG-SLT and from matched control patients with cataracts during cataract surgery or trabeculectomy. The concentrations of MMP-2 and TIMP-2 in the aqueous humor were assessed with commercially available ELISA kits. Results In PEXG-SLT group in the first 10 days after SLT treatment a significant reduction in IOP was observed: 25.8 ± 1.9 vs 18.1.0 ± 1.4 mm/Hg (p < 0.001), but after a mean time of 31.5 ± 7.6 days IOP increased and returned to pretreatment levels: 25.4 ± 1.6 mm/Hg (p < 0.591). Therefore a trabeculectomy was considered necessary. The MMP-2 in PEXG-C was 57.77 ± 9.25 μg/ml and in PEXG-SLT was 58.52 ± 9.66 μg/ml (p < 0.066). TIMP-2 was 105.19 ± 28.53 μg/ml in PEXG-C and 105.96 ± 27.65 μg/ml in PEXG-SLT (p < 0.202). The MMP-2/TIMP-2 ratio in the normal subjects was 1.11 ± 0.44. This ratio increase to 1.88 ± 0.65 in PEXG-C (p < 0.001) and to 1.87 ± 0.64 in PEXG-SLT (p < 0.001). There was no statistically significant difference between the PEXG-C and PEXG-SLT ratios (p < 0.671). Conclusion This case series suggest that IOP elevation after SLT can be a serious adverse event in some PEXG patients. The IOP increase in these cases would be correlated to the failure to decrease the TIMP-2/MMP-2 ratio. Trial registration Current Controlled Trials ISRCTN79745214

BACKGROUND: To assess the efficacy of the intravitreal (IVT) injection of Triamcinolone Acetonide (TA) as compared to posterior subtenon (SBT) capsule injection for the treatment of cystoid diabetic macular edema. METHODS: Fourteen patients with type II diabetes mellitus and on insulin treatment, presenting diffuse cystoid macular edema were recruited. Before TA injection all focal lakes were treated by laser photocoagulation. In the same patients one eye was assigned to 4 mg IVT injection of TA and the fellow eye was then treated with 40 mg SBT injection of TA. Before and one, three and six months after treatment we measured visual acuity with ETDRS chart as well as thickness of the macula with optical coherence tomography (OCT) and intraocular pressure (IOP). RESULTS: The eyes treated with an IVT injection displayed significant improvement in visual acuity, both after one (0.491 +/- 0.070; p < 0.001) and three months (0.500 +/- 0.089; p < 0.001) of treatment. Significant improvement was displayed also in eyes treated with an SBT injection, again after one (0.455 +/- 0.069; p < 0.001) and three months (0.427 +/- 0.065; p < 0.001). The difference between an IVT injection (0.809 +/- 0.083) and SBT injection (0.460 +/- 0.072) becomes significant six months after the treatment (p < 0.001).Macular thickness of the eyes treated with IVT injection was significantly reduced both after one (222.7 +/- 13.4 microm; p < 0.001) and after three months (228.1 +/- 10.6 microm; p < 0.001) of treatment. The eyes treated with SBT injection displayed significant improvement after one (220.1 +/- 15.1 microm; p < 0.001) and after three months (231.3 +/- 10.9 microm; p < 0.001). The difference between the eyes treated with IVT injection (385.2 +/- 11.3 microm) and those treated with SBT injection (235.4 +/- 8.7 microm) becomes significant six months after the treatment (p < 0.001).Intraocular pressure of the eyes treated with IVT injection significantly increased after one month (17.7 +/- 1.1 mm/Hg; p < 0.020), three (18.2 +/- 1.2 mm/Hg; p < 0.003) and six month (18.1 +/- 1.3 mm/Hg; p < 0.007) when compared to baseline value (16.1 +/- 1.402 mm/Hg). In the SBT injection eyes we didn't display a significant increase of intraocular pressure after one (16.4 +/- 1.2 mm/Hg; p < 0.450), three (16.3 +/- 1.1 mm/Hg; p < 0.630) and six months (16.2 +/- 1.1 mm/Hg; p < 0.720) when compared to baseline value (16.2 +/- 1.3 mm/Hg). CONCLUSION: The parabulbar subtenon approach can be considered a valid alternative to the intravitreal injection. TRIAL REGISTRATION: Current Controlled Trials ISRCTN67086909.

Purpose We studied the subclinical ocular inflammation by laser flare-cell meter in patients with choroideal neovascularisation (CNV) in age related maculopathy (AMD) and in high myopia (HM). Methods We enrolled 22 patients (12 males and 10 females) without diabetes, systemic inflammatory disease or previous ocular surgery or laser therapy, aged between 65 and 89 years (mean 78,2±6,3) with macular CNV. Twelve of these patients have an age related maculopathy (AMD) and ten have an high myopia (HM). The myopia was mean -14,25 D. We made an indocyanine angiography and measured the extension of neovascularization with the Heidelberg Eye Explorer analysis program. The flare was measured with laser flare-cell meter (FM-500, Kowa, Tokio, Japan) in both eyes of the same patient. Subsequently we compared the flare data of AMD-patients that had an CNV with an area similar of the CNV of the HM-patients. Statistical analysis was performed considering significant a p

Purpose: The cataract surgery consist in phacoemulsification of the lens and implant of an intraocular lens (IOL). In some cases when the capsular support is absent we must use an anterior-chamber IOL (ACIOL’s) or a posterior-chamber IOL (PCIOL’s) transclerally sutured. We studied the intraocular inflammation after secondary implant of iris-fixated ACIOL, angle-supported anterior-chamber (AC)IOL and transcleral-fixated PCIOL. Methods: We enrolled 60 patients with post-surgery aphakia, for a total of 60 eyes. Twenty patients received an ACIOL (Artisan), in twenty patients was implanted PCIOL. (PC 279Y) and in the last twenty patients was implanted an (AC)IOL. Twenty patients with PCIOL in the bag were used as control group. We performed an evaluation of anterior chamber cellularity with a laser flare-cell meter (Kowa 500) 30 and 90 days after secondary implants. Results: The anterior chamber flare-cell, after 30 days, was 15,442 ± 10,435 photon/ms in ACIOL group, 22,716 ± 6,634 photon/ms in PCIOL group and 14,11 ± 7,087 photon/ms in the (AC)IOL group. (ACIOL vs PCIOL p

Purpose: Corneal conjunctival squamous carcinoma is a rare form of slowly progressive carcinoma of low malignant potential. Mitomycin C (MMC) is a chemiotherapic antibiotic isolated from Streptomyces Caespitosus and medical literature reports efficacy of MMC in the treatment of squamous cell carcinoma. We present a case of conjunctival and corneal squamous cell carcinoma which was treated with both surgical excision and topical use of MMC 0.02%. Methods: A 78-year old man with a red-grey vascularized elevated epithelial lesion that started at the conjunctiva and extended past the corneoscleral limbus on to the cornea for about 1.5 mm. The patient was given surgical exeresis of the conjunctival neoformation and the histological exam highlighted a corneal conjunctival squamous cell carcinoma. after three monthes a recurrence of the neoformation was displayed and we therefore decided to start topical MMC 0.02% eye drops treatment four times daily for 7 days. Four cycles of treatment were done with a one-week interval during which only sodium hyaluronate 0.4% lubricant eye drops were administered. Results: During the period of treatment with the MMC 0.02% eye drops, the patient did not display any adverse systemic or ocular reactions. At the end of the treatment we found a complete regression of the disease. Twelve months after treatment he was without conjunctival and corneal epithelial dysplasia. Conclusions: This case highlights the efficacy of MMC 0.02% eye drops in the treatment of conjunctival and corneal squamous cell carcinoma that can avoid the topical use with sponge of MMC at higher concentration that it would present a not predictable long term effects on the conjunctival fornix and on lachrymal secretion.

Purpose: Corneoscleral grafts have been used in the past for anterior segment reconstruction after extensive infection of the cornea. The aim of this study is to present the results of a series of ten consecutive anterior segment reconstruction using corneaoscleral grafts. Methods: We studied ten patients with widespread corneal infection and coagulative necrosis of the cornea. Common features of the surgical technique included a total limbal peritomy in an endeavor to save possible limbal stem cells. To mark the scleral surface and partially trephine this tissue we used trephines of 14-15 mm. After a careful haemostasis we entered the anterior chamber with a diamond knife. The entire cornea was removed and the donor corneoscleral graft was sutured into place onto the scleral ledge using interrupted 8.0 silk or 9.0 nylon sutures. The anterior chamber was filled with viscoelastic material and the conjunctiva was then closet to cover the peripheral part of the graft. Postoperative steroid therapy was methylprednisolone (1gr/kg of body weight) and betametasone 1% eye drops every two hours for 4 weeks and then every four-hour for long term. Results: After a mean time of 15 months after corneoscleral grafts four patients maintain a clear graft. Six patients could be defined as having typical rejection episodes with the corneas becoming opaque Conclusions: The technique of corneaoscleral transplantation can salvage otherwise end stage eye disease, but the results are poor with respect to maintenance of vision. These patients need careful follow up because of potential complications especially graft rejection and recurrence of disease.

Background We evaluate the role of nerve growth factor (NGF) eye drops to treat a herpetic corneal ulcer resistant to systemic and local acyclovir treatment in an HIV-positive patient. Case Presentation A 68 year old HIV-positive male presented with a herpetic corneal ulcer which was treated unsuccessfully with acyclovir. Acyclovir sensitivity of herpes simplex virus was tested with a dye uptake assay and we found that the herpes simplex virus isolated was resistant to acyclovir. We started eye drop therapy with NGF and the corneal herpetic ulcer healed in 23 treatment days. Conclusion The case presented here is the first described in the literature in which a herpetic corneal ulcer was successfully treated with NGF. We recommend that trials of NGF therapy in herpetic keratitis should be carried out on a larger number of acyclovir resistant cases.

To assess any alteration of the blood flow in the ophthalmic artery, in the posterior ciliary arteries and in the choroid of the glaucomatous eye.We studied 15 patients, 11 males and 4 females (mean age 62.4 years), with chronic open-angle glaucoma in good tonometric control by medical therapy. All patients underwent colour Doppler examination of the ophthalmic artery, posterior ciliary artery and choroid. The data for peak systolic velocity (Pv) and resistance index (RI) were compared with those of healthy control subjects.The Pv in the ophthalmic artery of glaucomatous patients was 32.961 +/- 3.045 cm/s (p0.033) and RI 0.789 +/- 0.018 (p0.001). The Pv of posterior ciliary arteries was 8.720 +/- 1.645 cm/s (p0.001) and RI 0.722 +/- 0.024 (p0.005). In the choroid the Pv was 10.637 +/- 1.401 cm/s (p0.001) and RI 0.643 +/- 0.051 (p0.022).Our data indicate that in a chronic open-angle glaucoma there is an alteration in the eye blood flow especially in the posterior ciliary arteries and the choroid.

Purpose: To study, with an objective method, inflammation of the anterior segment of the glaucomatous eye after treatment with latanoprost, travoprost and bimatoprost. Materials and Methods: Sixty patients with chronic open-angle glaucoma aged between 38 and 76 years (mean 64.0 ± 12.2) were randomly assigned to latanoprost 0.005, travoprost 0.004 and bimatoprost 0.03%. The study period lasted 6 months. Intraocular pressure (IOP) was measured every 2 weeks. We studied the intraocular inflammation before and after 3 and 6 months of therapy with an instrument composed of a He-Ne laser beam system, a photomultiplier mounted on a slitlamp microscope and a computer. This flare meter allows objective determination of the flare and the number of cells in the aqueous of the anterior chamber. Results: At the baseline, IOP was 26.4 ± 3.6 mm Hg. After 3 months of treatment, mean IOP in the latanoprost group was 17.9 ± 0.3 mm Hg (p < 0.001) with a mean cellularity of 12.638 ± 3.284 photons/ms (p < 0.001). The travoprost group had an IOP of 17.2 ± 0.3 mm Hg (p < 0.001) with a cellularity of 9.719 ± 1.927 photons/ms (0.001). Finally, IOP in the bimatoprost group was 17.6 ± 0.5 mm Hg (p < 0.001) with a cellularity of 6.138 ± 1.475 photons/ms (p < 0.032). After 6 months of treatment, IOP in the latanoprost group was 18.1 ± 0.3 (p < 0.001), in the travoprost group 17.3 ± 0.3 (p < 0.001) and in the bimatoprost group 17.7 ± 0.5 mm Hg (p < 0.001), whereas cellularity was 11.838 ± 3.218 (p < 0.001), 8.950 ± 3.692 (p < 0.001) and 7.617 ± 2.603 photons/ms (p < 0.001), respectively. After 3 months, the travoprost (p < 0.013) and the bimatoprost groups (p < 0.001) had less flare compared with the latanoprost group and this remained so even at 6 months. When we compared the travoprost group with the bimatoprost group, we found significantly less flare at 3 months in the bimatoprost group (p < 0.001) but not at 6 months (p < 0.246). Conclusions: The flare meter analysis shows that the eyes treated with bimatoprost and travoprost have a less significantly broken blood-aqueous barrier and their anterior chamber is also significantly less inflamed.

Pseudodoubling of the optic disc is a rare clinical presentation. In these cases it is necessary to exclude retinal coloboma or atrophy following vascular or infectious diseases. We present a case of pseudodoubling of the optic disc in a woman with type 2 diabetes and arterial hypertension. Ophthalmoscopic examination of the fundus showed a disc-like lesion in the right eye and a diabetic retinopathy in the left eye. The lesion was evaluated with fluorescein angiography, neuroradiological and colour Doppler imaging investigations. Colour Doppler imaging confirmed the angiographic findings of anomalous vascularisation of the pseudopapilla and provides an analysis of the choroidal vessel anastomosis between the optic disc and the retinal lesion, revealing that the pseudodoubling in this patient was the result of a chorioretinal coloboma.

We analyzed tear film changes, ocular surface tissue alterations and inflammatory conditions in Frequent Replacement Soft (FRS) Contact Lens (CL) or Conventional Soft (CS)-CL wearers suffering from eye discomfort, by applying complementary diagnostic tests. Our data suggest the following conclusions: i) eye discomfort symptoms begin after 1–3 years of successful wear, mainly in FRS-CL wearers; ii) tear film stability is affected by CL wear, mainly in FRS-CL wearers; iii) CL wear produces a subclinical moderate inflammation based on mononuclear cell recruitment in 3 out of 4 patients of both types of lenses; iv) CL wear induces dry eye conditions, more pronounced in FRS-CL users; v) discomfort symptoms, presence of subclinical inflammation, degree of dryness are not directly related to a clinical presentation of intolerance, mainly in FRS-CL wearers; vi) CL wear-related discomfort symptoms should never be underestimated, since a hidden inflammation or dryness can be present beyond an apparently good clinical picture.

Summary The authors evaluated the possible variations of endothelin-1 (ET-1) levels in plasma and aqueous humour in patients suffering from chronic open angle glaucoma (COAG) and low tension glaucoma (LTG). Radioimmunoassay was used to assess the level of ET-1 in plasma and aqueous humour in two groups of patients with COAG and LTG. The ET-1 plasma level was higher in LTG cases (2.950±0.211 pg/ml vs 1.770±0.211 pg/ml; p

The effect of topically administered cyclosporin A (CyA) was evaluated in this experimental study by means of transmission and scanning electron microscopy, and immunohistochemistry. CyA dissolved in sterile olive oil was injected in the retrobulbar area and in the subconjunctival space, or administered as eyedrops in both non-grafted and corneal xenografted rabbit eyes. The vehicle rather than the drug was thought to be responsible for the inflammatory reaction observed in the conjunctiva of the injected eyes as well as for the surface epithelial defects developing in the cornea of the topically administered eyes. CyA was found to be effective in prolonging the survival of the xenografts after 1 month follow-up. The immunohistochemistry indirectly demonstrated the CyA effectiveness in impairing the T-cell function, and this is, to our knowledge, the first documented report on this subject. We conclude that another type of vehicle for the drug has to be introduced and that the administration of CyA as eyedrops is the best route to provide fast diffusion and to avoid adverse side effects.

Background the purpose of this study was to report a binocular photic retinal injury induced by plasma arc welding and the follow-up after treatment with vitamin supplements for a month. In our study, we used different diagnostic tools such as fluorescein angiography (FA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG). Case presentation in the first visit after five days from arc welding injury in the left eye (LE) the visual acuity was 0.9 and 1.0 in the right eye (RE). FA was normal in both eyes. OCT in the left eye showed normal profile and normal reflectivity and one month later, a hyperreflectivity appeared in the external limiting membrane (ELM). The mfERG signal in the LE was 102.30 nV/deg2 five days after the injury and 112.62 nV/deg2 after one month and in the RE respectively 142.70 nV/deg2 and 159.46 nV/deg2. Conclusions in cases of retinal photo injury it is important for the ophthalmologist to evaluate tests such as OCT and the mfERG in the diagnosis and follow-up of the patient because the recovery of visual acuity cannot exclude the persistence of phototoxic damage charged to the complex inner-outer segment of photoreceptors.

BACKGROUND: To report the effect of subtenon injections of natural leukocyte interferon α-2a (IFNα) on best corrected visual acuity (BCVA) and central macular thickness (CMT) in a patient with diabetic macular edema (DME). CASE PRESENTATION: A 66-year-old man affected by DME, with glycated hemoglobin (HbA1c) at 6.9%, refractory to laser grid treatment and intravitreal injections of triamcinolone, was selected to receive a cycle of three subtenon injections/week of IFNα (1×106 IU/ml). BCVA and CMT, using spectral domain ocular coherence tomography (SD-OCT), were evaluated preoperatively and at 1 week, 1 month, 4 months, and 1 year postoperatively. BCVA and CMT were significantly improved at 1 week after the three injections (20/200 vs. 20/40 and 498 μm vs. 237 μm, respectively). BCVA remained stable during the 1-year follow-up. CMT was slightly increased, but was still lower than the baseline value (215 μm, 255 μm, and 299 μm during the follow-up visits). No adverse events were recorded, with the exception of mild subconjunctival hemorrhage at the injection site. CONCLUSIONS: IFNα, with its immunomodulatory, anti-proliferative and anti-angiogenic actions, was effective in improving BCVA and reducing CMT in refractory DME. Further randomized controlled studies are required to assess the effect of IFNα alone or in combination with other therapies for DME treatment.