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Aim: Our purpose was to assess fundus autofluorescence (FAF) images in patients with diabetic retinopathy and cystoid macular edema (CME) and their correlation with fluorescein angiography (FA) and optical coherence tomography (OCT) findings. Methods: Sixty-eight eyes of 34 consecutive patients with diabetic retinopathy were examined with autofluorescence imaging using a confocal scanning laser ophthalmoscope, FA and OCT. The eyes were divided into 2 groups, group 1 with CME and group 2 without. Results: In the 44 eyes of group 1 (65% of the series), we identified 3 patterns of FAF: (1) multicystic increased FA (57%), (2) a single cyst of increased FAF (16%), (3) combined single- and multicystic increased FAF (27%). FA and OCT gave a positive correlation between cystic increased FAF and CME (r = 0.95; p = 0.001). Visual acuity loss was not correlated with the size of the cystic area (p = 0.83), but it was related to significant macular thickening (p = 0.007). Conclusions: Confocal scanning laser ophthalmoscopy can selectively visualize autofluorescent, multilobulated spaces in eyes with diabetic CME. Even if OCT remains preferable for evaluating macular thickening and cysts, FAF might be another useful easy test to rapidly distinguish this entity noninvasively and with no risk.

To evaluate efficacy of laser photocoagulation and pars-plana vitrectomy in patients with FDR. Eighty-eight patients (155 eyes) with FDR were retrospectively evaluated (mean age 27 +/- 6.0 years; proportion of females 66%; insulin-dependent diabetes 100%; mean duration of diabetes 16.5 +/- 5.8 years; poor metabolic control 83%). The eyes were divided in two groups: group I: 136 eyes amenable to laser photocoagulation and, when necessary, to vitrectomy afterwards (45/136); group II: 19 eyes subjected directly to vitrectomy. In group I (mean follow-up 54.2 +/- 38.7 months) the initial visual acuity (IVA) was 0.61 +/- 0.30 and the final visual acuity (FVA) was 0.47 +/- 0.34; in the 45 vitrectomized eyes IVA was 0.15 +/- 0.24 and FVA was 0.19 +/- 0.25. FDR regressed in 75% and worsened in 25% of the cases. In group II (mean follow-up 46.4 +/- 36.3 months) IVA was 0.1 +/- 0.14 and FVA 0.14 +/- 0.22. FDR regressed in 32% and worsened in 68% of cases. FDR remains a cause of severe visual impairment in diabetics. Patients at risk of FDR are young females with long-standing, poorly controlled insulin-dependent diabetes. Panretinal laser photocoagulation prior to vitrectomy is beneficial; information on this severe form of retinopathy is essential to ensure prompt diagnosis and improve its unfavorable clinical course.

To assess whether a chemical debridement method for excimer laser photorefractive keratectomy may lead to better refractive and visual results than the standard method which involves the use of a blunt blade to scrape off the epithelium. Ninety-three eyes with a mean attempted correction of -5.72 +/- 2.47 D were debrided using a surgical microsponge after epithelial melting by 20% ethanol solution applied for 20 seconds, and treated by PRK. Results were compared to those from 97 eyes with a mean attempted correction of -6.05 +/- 2.46 D, deepithelialized using a Desmarres blade. Debridement time was faster in the eyes where alcohol was used (P = .04). During a 6-month follow-up, we found no significant differences in refractive error, uncorrected, and spectacle-corrected visual acuity. However, haze rates at were lower (1 month, P = .04), and corneal regularity index was better (3 months, P = .01) in the eyes deepithelialized using alcohol. Epithelial debridement using a 20% alcohol solution was faster to perform, and provided sharper edges and a smoother Bowman's layer surface than mechanical debridement. This may explain the better results in terms of haze and corneal regularity.

Background: Mutations in the retina-specific ABC transporter (ABCA4) gene have been associated with several forms of macular degenerations. Because the high complexity of the molecular genotype makes scanning of the ABCA4 gene cumbersome, we describe here the first use of denaturing HPLC (DHPLC) to screen for ABCA4 mutations. Methods: Temperature conditions were designed for all 50 exons based on effective separation of 83 samples carrying 86 sequence variations and 19 mutagenized controls. For validation, samples from 23 previously characterized Stargardt patients were subjected to DHPLC profiling. Subsequently, samples from a cohort of 30 patients affected by various forms of macular degeneration were subjected to DHPLC scanning under the same conditions. Results: DHPLC profiling not only identified all 132 sequence alterations previously detected by double-gradient denaturing gradient gel electrophoresis but also identified 5 sequence alterations that this approach had missed. Moreover, DHPLC scanning of an additional panel of 30 previously untested patients led to the identification of 26 different mutations and 29 polymorphisms, accounting for 203 sequence variations on 29 of the 30 patients screened. In total, the DHPLC approach allowed us to identify 16 mutations that had never been reported before. Conclusions: These results provide strong support for the use of DHPLC for molecular characterization of the ABCA4 gene.

ABSTRACT PURPOSE: To assess the refractive outcomes and videokeratographic patterns in photorefractive keratectomy (PRK) of two last-generation excimer lasers: broad beam and flying spot lasers. METHODS: Forty eyes were treated for a mean myopic correction of -5.59 ± 2.17 D with a Ladarvision excimer laser (Autonomous Technology Corp). We compared the refractive outcomes and the videokeratographic patterns with those of 40 eyes treated with the Summit Apex Plus laser (Summit Technology Ine) for a mean myopic correction of -5.60 ± 2.24 D. RESULTS: During the 6-month follow-up, we found no significant difference in uncorrected and spectacle-corrected visual acuity, haze grade, regularity index, or decentration. The eyes treated by Ladarvision showed a lower refractive error at 1 month (P - .04), a lower incidence of central islands at 1 (P = .003) and 3 months (P = .04), a wider mean effective ablation area at 1 (P = .0004), 3 (P = .0000009), and 6 months (P = .0000000004), a less steep ablation edge at 1 (P = .0026), 3 (P = .015), and 6 months (P = .011). CONCLUSIONS: The small beam excimer laser provides better videokeratographic outcomes, which lead to quicker refractive stability and better visual performance. [J Refract Surg 2001;17: 534-541]

Purpose: To evaluate the optical coherence tomography (OCT) findings in patients with solar retinopathy after watching a solar eclipse. Methods: Complete ocular examinations and OCT were done in 4 patients presenting with acute solar retinopathy soon after observation of an eclipse. All 4 patients repeated the examinations about 1 month and 1 year after the first visit. Results: The symptoms and fundus findings were similar in all patients; all eyes were emmetropic. However, the OCT images were different in all patients, and the alterations were at different levels. The most evident alterations shown by OCT were: a reduction in the intensity of reflectivenesss of the retinal pigment epitelium in 3 cases; intraretinal nonreflective spaces between the inner retinal layers in 2 cases; increased reflectiveness of the inner retinal layers in 2 cases, and a round hyperreflective formation in the vitreous just in front of the fovea in 1 case. All these OCT alterations disappeared after 1 month. Conclusions: The retinal damage arising soon after exposure to sunlight showed many different aspects in the OCT images of the 4 cases examined. All retinal layers seemed to be altered, but these alterations disappeared after 1 month, and the OCT findings remained the same after 1 year.

Objective: Apolipoprotein E (apoE) is an important regulator of cholesterol and lipid transport during compensatory synaptogenesis. Our purpose was to investigate the role of apoE gene polymorphisms in Italian patients with age-related macular degeneration (AMD). Methods: We used the polymerase chain reaction technique to analyze apoE genotypes in 87 patients with AMD, in 47 age-matched controls and in 1,287 individuals from a general reference population. Results: The frequency of allele Ε4 carriers was significantly higher (p = 0.002) in the general population than in AMD patients, while the frequency of allele Ε2 was higher in the patients (p = 0.069) with an increased risk for AMD in the patients versus the population-based controls (odds ratio = 1.7; 95% confidence interval: 1.0–2.9). Allele Ε4 was associated with a decreased risk for AMD in the patients versus the population-based controls (odds ratio = 0.3; 95% confidence interval: 0.1–0.8). Clinical Relevance: These data suggest that apoE testing may represent a tool for the evaluation of the relative risk of AMD. Consequently, a preventive strategy can be initiated at an early stage of the disorder. Conclusion: The apoE gene polymorphism showed a significant association with the risk of AMD. The lower frequency of the Ε4 allele in AMD patients suggests that the apoE gene could play a protective role in the pathogenesis of the disease. In contrast, the Ε2 allele was found associated with a slightly increased risk of AMD, although we did not find a statistically significant effect.

ABSTRACT Fifty-nine children 1 to 24 months of age with congenital nasolacrimal duct obstruction (CNDO) were treated with local hydrostatic massage and antibiotic eye drops. Children 1 to 12 months of age showed a cure rate of 93.3%; only two of them underwent nasolacrimal probing. Children 13 to 24 months of age had a cure rate of 79.3%, and six underwent probing. The initial probings were successful in both age groups. Fifty-one children (86.4%) were thus spared nasolacrimal probing.

AIMS Ultrasound biomicroscopy was used to study the shape of the iris and the iridolenticular contact in pigment dispersion syndrome (PDS) eyes, to compare them with matched normal eyes, and to assess the morphological effects of laser iridotomy in PDS eyes. METHODS 50 eyes of 50 patients suffering from PDS (group 1), and 15 normal eyes of 15 subjects matched for age and refraction (group 2), were studied by ultrasound biomicroscopy (UBM, Humphrey-Zeiss). Nd:YAG laser iridotomy was proposed to the 30 PDS patients with concave iris and 18 underwent the treatment. RESULTS The iris was concave in 27 eyes in group 1, and three more eyes showed a concave iris during accommodation. Among normals, iris concavity was present in two eyes. The height of the iris convexity was −0.15 (0.24) mm (range −0.65 to +0.21), in the eyes of group 1, whereas it was +0.07 (0.10) mm (range −0.21 to +0.16) in group 2 (p<0.0012). Group 1 had greater iridolenticular contact than group 2: 1.55 (0.78) mm (range 0.30–2.88) and 1.07 (0.61) (range 0.30–2.50; p=0.0304). After laser iridotomy, only one eye still had a concave iris. Pre- and post-treatment deflections were −0.35 (0.18) mm (range −0.61 to -0.05) and +0.01 (0.06) mm (range −0.12 to +0.17), respectively (p<0.0001). Pre- and post-treatment iridolenticular contact was 2.10 (0.65) mm (range 0.70–2.88) and 0.93 (0.38) mm (range 0.4–1.75), respectively (p<0.0001). After laser iridotomy, the treated irises were flatter than normal (p=0.0207), whereas the iridolenticular contact was not significantly different. CONCLUSIONS Laser iridotomy can restore a normal iris shape and iridolenticular contact in eyes suffering from PDS.