1,721,016 research outputs found
Trehalose/Hyaluronate eyedrops effects on ocular surface parameters, inflammatory markers and mucin expression in evaporative Dry Eye patients
No full textOcular-surface temperature modification by cataract surgery
Full text linkPurpose To analyze ocular-surface temperature changes after microincision cataract surgery and to correlate them with surgical, clinical, and laboratory parameters. Setting Ophthalmology Unit, Saint Orsola-Malpighi Hospital, Bologna, Italy. Design Prospective case series. Methods Patients affected by monolateral senile cataract were examined preoperatively and 7 days and 28 days postoperatively. Infrared thermography was used to measure the temperature soon after eye opening, the temperature after 10 seconds of sustained eye opening, and the difference between these 2 values in the central cornea, nasal limbus, and temporal limbus. The Ocular Surface Disease Index (OSDI), Schirmer test, vital staining, tear breakup time (TBUT), conjunctival scraping cytology, exudated tear-serum albumin, and laser flare–cell meter examinations were performed. Results The study comprised 26 patients (10 men, 16 women). The temperature changed significantly after surgery. The temperature soon after eye opening showed cooling in the central cornea and nasal limbus and heating in the temporal limbus. The temperature after 10 seconds of sustained eye opening minus the temperature soon after eye opening increased in all regions. The temperature after 10 seconds of sustained eye opening minus the temperature soon after eye opening in the central cornea was inversely related to the OSDI and directly related to TBUT. The temperature soon after eye opening increased in the temporal limbus and was directly related to inflammatory indices. Conclusions The ocular-surface temperature changed after cataract surgery depending on the region analyzed. The cooling in the central cornea could be related to the increased tear-film instability. The heating in the temporal limbus could be related to postoperative inflammation. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned
Trehalose/hyaluronate eyedrop effects on ocular surface inflammatory markers and mucin expression in dry eye patients
Full text linkAim: To assess the ocular surface parameters, inflammatory marker level in tears, and mucin expression in conjunctival epithelium before and after treatment with trehalose/hyaluronate tear substitute in dry eye (DE) patients. Patients and methods: Fifteen DE patients were evaluated in an open-label, pilot study at enrollment, after 2 days of washout (baseline) and after 1 and 2 months (endpoint) of treatment with a trehalose/hyaluronate tear substitute (one drop/eye/three times daily). Data for symptoms of discomfort (Ocular Surface Disease Index and Visual Analogue Scale pain score), tear film (Schirmer test I, tear film breakup time), ocular surface damage (corneal National Eye Institute) and conjunctival van Bijsterveld scores, impression cytology scored by Nelson’s grade and goblet cells (GCs) number/mm2 analysis, and MUC4 immunostaining, and inflammation (interleukin [IL]-1β, IL-6, and IL-8 levels) were measured. Results: Significant changes at endpoint as compared to baseline were found for Ocular Surface Disease Index score (respectively, mean±SD, 22.2±2.9 vs 38.7±12.7), Visual Analogue Scale score (3.4±1.3 vs 6.6±1.4), tear film breakup time (8.6±1.28 vs 6.17±1.9 seconds), corneal staining (National Eye Institute grade 1.23±0.64 vs 3.37±0.49), conjunctival staining (1.73±1.14 vs 4.17±0.91), impression cytology (Nelson grade 1.10±0.20 vs 1.63±0.54), and GC density (139.9±22.0 vs 107.8±16.2 GC/mm2). IL-1β, IL-6, and IL-8 tear levels showed a significant decrease at endpoint as compared to baseline (respectively, pg/mL tears: 12.3±6.9, 26.6±25.2, 743.5±477.7 vs 33.6±17.3, 112.0±24.3, 1,139.2±671.7). Conclusions: A decrease in ocular discomfort symptoms, surface damage, and tear cytokine levels was shown after 2 months’ treatment with trehalose/hyaluronate tear substitute in DE patients, along with a significant GC density recovery. These results may be associated with the synergic action of both trehalose and hyaluronic acid in targeting different entries of the DE vicious loop
Long-lasting corneal endothelial graft rejection successfully reversed after dexamethasone intravitreal implant
Full text linkGraft rejection is the most significant complication corneal transplantation and the leading indication for overall corneal transplantation. Corticosteroid therapy represents the mainstay of graft rejection treatment; however, the optimal route of administration of corticosteroid remains uncertain. We report herein for the first time the multimodal imaging of a case of long-lasting corneal endothelial graft rejection successfully reversed 3 months after dexamethasone intravitreal implant. A 29-year-old Asian female presented with a long-lasting corneal endothelial graft rejection in her left phakic eye. She underwent penetrating keratoplasty for advanced keratoconus 24 months before presentation. Hourly dexamethasone eyedrops, daily intravenous methylprednisolone, and one parabulbar injection of methylprednisolone acetate were administered during the 5 days of hospitalization. However, the clinical picture remained approximately unchanged despite therapy. By mutual agreement, we opted for the off-label injection of dexamethasone 0.7 mg intravitreal implant in order to provide therapeutic concentrations of steroid for a period of ~6 months. No other concomitant therapies were prescribed to the patient. Visual acuity measurement, slit lamp biomicroscopy, anterior segment photography, confocal microscopy, anterior segment optical coherence tomography, laser cell flare meter, intraocular pressure measurement, and ophthalmoscopy were performed monthly for the first postoperative 6 months. Three months after injection, both clinical and subclinical signs of rejection disappeared with a full recovery of visual acuity to 20/30 as before the episode. Currently, at the 12-month follow-up visit, the clinical picture remains stable without any sign of rejection, recurrence, or graft failure. Dexamethasone intravitreal implant seems to be a new potential effective treatment for corneal graft rejection, particularly in case of poor compliance or lack of response to conventional treatment. In addition, it could be especially useful in diabetic patients unable to receive systemic steroids
Subjective discomfort onset and intensity are correlated to low corneal temperature in dry eye patients
No full textPhotorefractive keratectomy in 22 adult eyes with infantile nystagmus syndrome
No full textPurpose To analyze visual and refractive outcomes of photorefractive keratectomy (PRK) in adult patients with infantile nystagmus syndrome. Setting Ophthalmology Unit, Department of Experimental Diagnostic and Specialty Medicine, Saint Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Design Retrospective case series. Methods Photorefractive keratectomy was performed in both eyes of patients with infantile nystagmus syndrome under topical anesthesia using an eye-tracking excimer laser. Patient satisfaction was tested using a questionnaire. The main outcomes were a decrease in refractive error, an improvement in postoperative corrected distance visual acuity (CDVA), and an uncorrected distance visual acuity (UDVA) equal to or better than the preoperative UDVA. Results Twenty-two eyes of 11 patients with infantile nystagmus syndrome were evaluated. The mean patient age was 30.82 years (range 22 to 42 years). All eyes had simple, compound, or mixed astigmatism (mean -3.40 D; range -0.75 to -6.00 diopters [D]). The mean postoperative astigmatism (-0.70 D ± 0.81 [SD]) and spherical equivalent (-0.420 ± 0.652 D) were statistically significantly better than the preoperative values (-3.40 ± 1.31 D and -3.426 ± 3.343 D, respectively (P <.0001 and P =.0002, respectively). The mean monocular postoperative CDVA (0.24 ± 0.19 logMAR) and UDVA (0.25 ± 0.18 logMAR) were better than the mean preoperative CDVA (0.32 ± 0.28 logMAR) (P =.0045 and P =.0338, respectively). The mean binocular postoperative UDVA was better than the mean preoperative CDVA (0.15 ± 0.14 logMAR versus 0.23 ± 0.23 logMAR) (P =.05). No patient required repeat surgery. Conclusions Nystagmus patients are eligible for PRK. The results were promising; gaining a few Snellen lines in visual acuity can be very important to these patients for their daily life. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned
Horner syndrome following thyroid surgery: The clinical and pharmacological presentations
Full text linkPurpose: To report the clinical and pharmacological findings of a patient with iatrogenic Horner syndrome (HS) which occurred after thyroid surgery.
Case Report: A 29-year-old man was referred to our emergency ward due to anisocoria and unilateral eyelid ptosis reported by the patient immediately after a recent thyroidectomy for a papillary carcinoma. Ophthalmologic examination revealed 3 mm ptosis of the right eyelid. In dim illumination, the right and left pupil size was measured 3 and 6 mm, respectively. In bright illumination, the amount of anisocoria decreased; the near pupillary reaction was intact. Brain and neck magnetic resonance imaging and chest radiography were normal. Pharmacological tests with 10% cocaine, 1% hydroxyamphetamine and 1% phenylephrine localized the interruption of the oculosympathetic pathway with postganglionic third-order neuron involvement. After 6 months of follow-up, no sign of recovery was recorded.
Conclusion: Despite HS could appear to be a rare complication of thyroid surgery, it is of importance for the neck surgeons to be aware that oculosympathetic pathway (OSP) is a potentially vulnerable structure with close anatomical relationship with the thyroid gland, and for the ophthalmologists that HS may occur secondary to neck surgery and taking an accurate history is mandatory
Accommodative spasm might influence surgical planning and outcomes in acute acquired distance esotropia in myopia
No full textIntroduction Acute acquired distance esotropia (AADE) is a poorly understood moderate-angle strabismus, affecting young adult myopes and determining bothersome diplopia. Symptoms can be intermittent in the early stages, becoming constant in long-lasting disease. Symptomatic therapy includes prism correction, while surgery is the only curative treatment. However, the latter is affected by high rate of symptoms recurrence with the frequent need for reoperation. Hypothesis We hypothesize that AADE could be caused by the increase of the accommodative demand, often secondary to a myopic overcorrection. This condition could determine an increase in induced hyperopia at near, dominated by an excess of accommodation and therefore of convergence. The latter cannot be relaxed at distance and diplopia develops. We speculate that early-stage AADE could be successfully treated by cycloplegic eye drops slowly tapered within three months. On the other hand, surgery remains the only option in long-lasting AADE. In these cases, we propose a new pre-operative assessment of esotropia by asking the patient to fix alternatively a stimulus at near and at distance in order to stimulate the accommodative convergence. This technique allows to unmask the total amount of the angle of deviation and to plan a wider bilateral medial rectus muscle recession avoiding long-term residual esotropia. Discussion Currently, AADE curative therapy is surgical regardless of onset time but it is usually affected by poor outcomes. If our hypothesis was to be confirmed, pharmacological treatment could solve early-stage AADE, avoiding any surgery. Furthermore, a wide bilateral medial rectus muscle recession, quantified on the basis of the above mentioned test for measuring the total amount of the strabismus angle, could improve outcomes eliminating the need for reoperation in long-lasting AADE
Subjective Discomfort Symptoms Are Related to Low Corneal Temperature in Patients with Evaporative Dry Eye
No full textPurpose: To measure the corneal temperature in patients with dry eye (DE) and to correlate the values with subjective discomfort symptoms. Methods: Twenty-four patients with DE (scored as DEWS severity grade 2 to 3) and 15 age-matched normal control subjects were enrolled. Subjective symptoms of discomfort were scored with an Ocular Surface Disease Index questionnaire, and a 100-mm horizontal visual analog scale (VAS) technique was used to measure symptom intensity. Schirmer I test, tear film breakup time (TFBUT), and Oxford grade scoring were performed in all subjects. Dynamic infrared noncontact thermal imaging (Tomey TG 1000) was used to measure the central corneal temperature (CCT). After training, subjects were asked to maintain their eyes forcedly open and to signal the discomfort onset time (DOT). The temperature was measured at eye opening (T 0) and every second during 10 seconds of sustained eye opening (T 10). The first discomfort sensation onset time (DOT) was also recorded. Temperature values were correlated with the clinical tests, Ocular Surface Disease Index, VAS, and DOT, and data were statistically evaluated (significance P < 0.05). Results: The corneal temperature immediately after eye opening was significantly lower in patients with DE than in controls, in correlation to the subject age, VAS, and TFBUT. A 3-phase cooling profile in patients with DE and a point of highest decrease (HD) in both groups were identified. DOT occurred earlier in patients with DE than in controls (5.9 vs. 15.9 seconds) and was strongly correlated to the VAS, TFBUT, and CCT-HD. Conclusions: Subjective sensation of discomfort occurred earlier in patients with DE than in controls, in correlation to low corneal temperatures and enhanced tear evaporation.
Photorefractive keratectomy influences the angle of ocular deviation in strabismus patients with hyperopia
No full textPurpose: To evaluate refractive, binocular vision and ocular alignment outcomes of photorefractive keratectomy (PRK) for the treatment of hyperopia in esotropic patients. Methods: Medical charts of hyperopic patients with full or partial accommodative esotropia (FAE or PAE) or consecutive exotropia (CE) undergone PRK from 2011 to 2014 were reviewed. The primary outcome was to assess the efficacy of PRK in improving ocular alignment. The secondary outcomes were the assessments of uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SE) and stereoacuity. Results: Sixty-four eyes of 32 hyperopic patients were included. Three patients were affected by FAE, 24 by PAE and 5 by CE. All FAE patients and 4 PAE patients underwent only PRK; the remaining 25 patients underwent PRK plus strabismus surgery. After PRK, the mean corrected esodeviation decreased significantly in the overall esotropic population [7.15 ± 9.42 prism diopters (PD) vs. 5.04 ± 8.83 PD; p = 0.03] and in particular in the group with small-angle esodeviation (< 20 PD). Conversely, the only 2 patients with an angle of strabismus ≥ 20 PD as well as all CE patients did not show any postoperative variation of the deviation angle. Mean preoperative BCVA did not differ from postoperative UCVA (p = 0.19), while the mean postoperative SE decreased significantly after PRK (p < 0.0001). Conclusions: Our study confirmed that PRK eliminates the accommodative component of the deviation. In addition, this procedure seems to reduce or eliminate also the non-accommodative component of esodeviation (especially in small-angle deviation), thus suggesting to postpone strabismus surgery after PRK when esotropia and hyperopia coexist
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