Search

Fernanda Pacella,1 Francesco Mazzeo,1 Dario Giorgi,1 Francesco Cerutti,1 David Impallara,1 Giovanni Cuozzo,1 Maurizio Soldini,2 Elena Pacella11Department of Ophthalmology, 2Service Detachment of Internal Medicine and Cardiology, Department of Ophthalmology, Sapienza University, Rome, ItalyAbstract: This article describes the case of a 68-year-old patient suffering from giant cell arteritis (also known as Horton’s arteritis or temporal arteritis). The patient came to our attention due to a large and sudden visual loss caused by the occlusion of major retinal arteries. The patient had neuralgic pain in the face. The next day, for a thorough examination, the patient went to the day hospital with a further worsening of the visual loss which required immediate admission to the ophthalmological ward for hospitalization lasting 10 days. During the observation period it was difficult to make an instant diagnosis due to the absence of clinical signs or diagnostic tests for Horton’s arteritis. Only after the third day of hospitalization, when corticosteroid therapy was undertaken following the appearance of significant systemic symptoms, did the patient begin to show a gradual improvement in overall clinical status. The case highlights the difficulty in making a rapid diagnosis of giant cell arteritis and the efficacy of early steroid therapy in this vascular autoimmune disease that otherwise may result in irreversible functional and debilitating systemic damage.Keywords: temporal arteritis, Horton’s arteritis, corticosteroid

Fernanda Pacella, Paolo Turchetti, Valentina Santamaria, David Impallara, Gianpaolo Smaldone, Chiara Brillante, Aloisa Librando, Angela Damiano, Jose Pecori-Giraldi, Elena PacellaDepartment of Sense Organs, University of Rome "Sapienza", Roma, ItalyBackground: The purpose of this study was to demonstrate the hypotensive efficacy and tolerability of latanoprost when used as monotherapy and as polytherapy associated with antiglaucomatous medication proven to be ineffective in keeping intraocular pressure under control.Methods: Three hundred and thirty-seven patients (672 eyes) affected by primary open-angle glaucoma and intraocular hypertension were recruited over a period of 10 years from the Glaucoma Centre, Department of Ophthalmological Sciences, University of Rome "Sapienza", and treated, subject to informed consent, with latanoprost 0.005% alone or in combination with other ocular hypotensive drugs. The patients were followed during this period at regular intervals, with determination of visual field, fundus oculi, visual acuity, and eventual onset of local and systemic side effects.Results: Latanoprost used as monotherapy and as polytherapy renders possible optimal and durable control of intraocular pressure in the form of one antiglaucomatous drug because it can substitute for one or more drugs and obtain the same hypotensive effect.Conclusion: Latanoprost can be described as the ideal hypotensive drug, not only because of its ideal compliance profile (only one daily dose in the evening), excellent hypotensive effect, and, above all, few systemic side effects.Keywords: latanoprost, glaucoma, ocular hypertension, intraocular pressure

Aim: This observational study was performed to evaluate the efficacy and safety of intra-vitreal injections of pegaptanib during a 12-month follow-up period., Patients and Methods: Forty eyes (20 patients) affected by diabetic macular edema were monitored. Twenty were subjected to treatment, and 20 were controls. The treatment involved a cycle of three intravitreal injections of pegaptanib (0.3 mg every 6 weeks), at the end of which treated patients were submitted to a monthly follow-up for a period of 12 months. The aim was to evaluate the clinical condition of the eye after therapy and gauge the efficacy of the long-term use of this drug. Specific criteria were used to measure the efficacy and safety of pegaptanib. Regarding efficacy, we considered the following: an average improvement in the power of vision, or visual acuity, of →10 letters (2 lines), equivalent to an average logMAR score of →0.2, and a reduction in the central macular thickness of →250 μm. Regarding safety, we considered the occurrence of undesired eye and systemic side effects correlated to either the drug itself or the injection procedure., Results: The logMAR score for the measurement of visual acuity at T3 (third intra-vitreal injection at week 13) with respect to T0 decreased from 0.7 ± 0.277 to 0.445 ± 0.216, suggesting an improvement, while the mean Early Treatment Diabetic Retinopathy Study (ETDRS) score increased from 25.75 ± 13.046 to 34.300 ± 11.770 letters. The central macular thickness was reduced from the initial value of 746.95 ± 293.601 to 334.050 ± 93.997 μm. In seven controls, we registered a worsening both in terms of visual acuity and macular thickness in some eyes, justifying a continuation of therapy in eight eyes of the control group., Conclusions: Pegaptanib proved to be efficacious and safe for the treatment of diabetic macular edema throughout the 12-month followup. To evaluate its long-term efficacy, further studies are required with larger numbers of patients and longer observational follow-up periods.

Aims: To determine the effectiveness and safety of treatment of intravitreal Ranibizumab for Central Retinal Vein Occlusion., Patients and Methods: This non-randomized observational clinical study was comprised of a round of therapy with three IVI. Twenty eyes affected by CRVO were recruited. The average age was 65.06 +/- 15 years and criterion for inclusion: age >18 years, best Corrected Visual Acuity (BCVA) from 5 to 40 letters and macular edema with thickness greater than 275 micrometer. The criteria used for reinjection were: CMT> 150 micrometer, ETDRS <10 letters and LogMAR <0.2. The statistical analysis for continuous variables (ETDRS, logMar and CMT) was conducted calculating median and range (min-max), since these variables, due to sample size, were not normally distributed.Time trends of these variables were plotted with boxplot and differences. Events between T0 and T12 were assessed using the analysis of variance (ANOVA) for repeated measurements and the F test (Pillai's trace). The statistical significance was set at p <=0.05., Results: All of the patients showed improvement. In fact, the ETDRS went from a median of 20.00 to 28.50, LogMAR went from a median of 0.75 to 0.55 and the values for CMT went from a median of 556.00 micrometer to 390.00 micrometer. The drug reaches maximum effectiveness after two months of therapy, with T2 remaining constant from the third injection at T3 until the end of 12 months at T12., Conclusions: The results produced by our study indicate that Ranibizumab is a valid treatment for CRVO.