Giuseppe Mannino - Academia.edu (original) (raw)

Papers by Giuseppe Mannino

European Journal of Ophthalmology, 2009

Zoonotic filarial infections in humans are relatively common and mostly due to parasites in the g... more Zoonotic filarial infections in humans are relatively common and mostly due to parasites in the genus Dirofilaria spp., in particular Dirofilaria immitis, D repens, D tenuis, and D ursi. In the United States, D tenuis, a parasite of raccoons, was established to be the primary agent, while in Europe, Middle Eastern countries, Africa, and Southest Asia, D repens was the most responsible parasite (1). D repens is a natural parasite of carnivores, primarily dogs, foxes, and cats (2). D repens infections are particularly common and often reported from European countries surrounding the Mediterranean, particularly Italy (168 cases), France (53 cases), and Greece (21 cases) (3). Related to the widespread presence of D repens in the usual reservoir (the dog) and of the possible carriers for humans (Culicidi species) , it is presumible that dirofilariasis in humans are more frequent than those published in literature (4).

Acta Ophthalmologica, 2017

Aim: To investigate the efficacy of intravitreal injection of ocriplasmin (JETREA ®) in the treat... more Aim: To investigate the efficacy of intravitreal injection of ocriplasmin (JETREA ®) in the treatment of vitreomacular traction (VMT). Materials and Methods: An 81-year-old man with VMT associated with central retinal vein occlusion in his left eye, was treated with a single intravitreal injection of ocriplasmin (25 μg). Best corrected visual acuity (BCVA), ocular fundus, and optical coherence tomography were examined before and after treatment. Results: Complete release of VMT produced a reduction of central macular thickness, ranging from 459 to 141 μm. BCVA remained stable. Discussion and Conclusions: The use of ocriplasmin was effective in the treatment of VMT. Ocriplasmin represents a valid alternative to conventional pars plana vitrectomy.

Case Reports in Ophthalmology, 2018

We report the case of a patient presented to the emergency department because of a contusive trau... more We report the case of a patient presented to the emergency department because of a contusive trauma from a pressurized bottled drink cap. During the visit, the patient indicated that he had been hit in his left eye by a cork while he was opening a sparkling wine bottle. He underwent a total ophthalmology examination. He had an important reduction of visual acuity, corneal swelling, Descemet’s folds, and hyphema. Therefore, we decided to perform ultrabiomicroscopy (UBM) of the anterior segment to study the endothelial damage and Descemet’s membrane. UBM images confirmed the direct biomicroscopy, highlighting the damaged location.

Ophthalmic surgery and lasers

In light of the research and the use of lasers in the therapy of xanthelasmas, the authors report... more In light of the research and the use of lasers in the therapy of xanthelasmas, the authors report their experience in the treatment of this pathology with Erbium:YAG laser. In 30 patients, all female, 70 xanthelasmas were treated with Erbium:YAG laser, 65 (93%) of which were on the upper eyelid and 5 (7%) on the lower eyelid, varying from 1 x 1.5 mm to 11 X 20 mm in size. Spots with a diameter of 1.6 mm, energy of 300 mJ, frequency of 1-5 Hz and in a number varying were used in relation to the extent of the pathology. In all cases, the appearance and functional results were good, without leaving scars and/or dyschromia. Erbium:YAG laser, in the treatment of xanthelasmas, is a parasurgical method that is simple to perform and because of the successful aesthetic and functional results, is a valid alternative to the more traditional treatment methods.

European Journal of Ophthalmology, 2015

Sturge-Weber syndrome is a phakomatosis with involvement of the eyelids, conjunctiva, choroid, an... more Sturge-Weber syndrome is a phakomatosis with involvement of the eyelids, conjunctiva, choroid, and retina. Congenital glaucoma is the most common ocular complication resulting from raised episcleral venous pressure. We present an unusual case of glaucoma induced by pupillary block in an 81-year-old woman with Sturge-Weber syndrome. The patient was referred for acute loss of vision OD and right-sided headache, pain, and nausea. The visual acuity was light perception OD with an intraocular pressure (IOP) of 41 mm Hg. Slit-lamp examination showed diffuse corneal edema OD associated with pupillary occlusion leading to angle closure and acute glaucoma attack. No pathologic changes were evidenced in the left eye. The raised IOP was partly relieved following administration of intravenous acetazolamide 250 mg, accompanied by relief of both pain and nausea. Laser iridotomy was performed OD, reducing the IOP to 22 mm Hg. The patient underwent cataract surgery with pupil membrane removal, leading to IOP of 17 mm Hg, but visual acuity remains unchanged due to optic nerve atrophy. This case supports the importance of involving an ophthalmologist in the management of Sturge-Weber syndrome, with monitoring of IOP, since early management of glaucoma can modify the visual outcome.

European journal of ophthalmology

The authors report a case of eyelid subcutaneous filariasis. Thorough history, eye examination, s... more The authors report a case of eyelid subcutaneous filariasis. Thorough history, eye examination, surgical intervention, and parasitologic analysis. An adult Dirofilaria repens worm was extracted from the right upper eyelid in a man living in Italy presenting to our department with lid swelling. Due to increasing migration of populations to Europe, rare manifestations of ocular filariasis are becoming more common. Surgery was both diagnostic and therapeutic.

Case reports in ophthalmology

We report the case of a 29-year-old female patient who presented with an acute onset of anisocori... more We report the case of a 29-year-old female patient who presented with an acute onset of anisocoria, blurred vision, nausea and severe left-sided headache. There was no history of trauma, drug abuse, or instillation of topical mydriatic compounds. The ocular history was negative for similar events. On presentation, her visual acuity was 0.2 in the left and 1.0 in the right eye with a +2.5 dpt sph. correction. Slit-lamp examination demonstrated a shallow anterior chamber as well as the presence of iris nodules in both eyes. These nodules were identified as Lisch nodules as the patient referred to the previous diagnosis as being neurofibromatosis type 1. A third nerve palsy was considered, but a brain MRI showed normal results. Her ocular motility was normal, but the left pupil was mydriatic and poorly reacting to light, with an associated raised intraocular pressure (IOP) of 38 mm Hg. An examination of the fellow eye was normal, with the IOP measuring 18 mm Hg. Gonioscopy of the right...

European journal of ophthalmology

Branch retinal artery occlusion caused by calcific embolization secondary to calcific aortic valv... more Branch retinal artery occlusion caused by calcific embolization secondary to calcific aortic valvulopathy. A 45-year-old woman came to our attention complaining a sudden painless loss of her peripheral superior visual field. Best visual acuity was 20/20. Fundus examination revealed the presence of a retinal arterial embolic occlusion of the inferior branch. Fundus retinography, visual field, and fluorescein angiography were performed and medical therapy was started. The echocardiography examination revealed a tricuspid and calcified aortic valve with moderate stenosis and regurgitation. Due to the heart pathology, the patient moved to the cardiosurgery department, where an aortic valve replacement was performed. Four months after cardiac surgery, visual acuity of both eyes was stable (20/20). Fundus examination showed a complete reabsorption of the retinal edema and the resolution of retinal pallor. Fluorescein angiography confirmed the delay of the arterial filling. No retinal isch...

Ophthalmologica, 2006

The purpose of our study was to compare the effects of systemically administered acetazolamide an... more The purpose of our study was to compare the effects of systemically administered acetazolamide and topical apraclonidine 0.5% in the control of intraocular pressure (IOP) following phacoemulsification of senile cataracts. The study was conducted on patients affected by cataract and followed at the Department of Ophthalmology. Seventy-eight eyes in 78 patients were selected. Twenty-six eyes were randomly assigned to postoperative treatment with topical apraclonidine 0.5%, 26 received oral acetazolamide and the remaining 26 received no hypotensive treatment (control group). Statistical analyses were performed mainly by means of analyis of variance. IOPs measured 24 h after surgery were significantly (p = 0.01) lower in the apraclonidine group compared to the control group. Our double-blind prospective study conducted on patients randomly assigned to treatment with apraclonidine or acetazolamide shows that the former drug is undoubtedly effective in the prevention of IOP increases following phacoemulsification. IOPs recorded in patients treated with this drug were lower than those observed in the acetazolamide and the control groups. Considering the lower risk of toxicity associated with topical administration, apraclonidine 0.5% seems to be preferable to oral acetazolamide in this postoperative setting.

Journal of Craniofacial Surgery, 2004

Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained cent... more Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained centrofacial trauma and can determine complexity in diagnosis and treatment. This article, based on a retrospective analysis of 58 patients with naso-orbitoethmoidal (NOE) trauma, reports the incidence of posttraumatic dacryostenosis and the evolution of such impairments in consideration of fracture type. Experience in diagnosis and treatment is illustrated, and surgical outcomes 6 months after external dacryocystorhinostomy (DCR) are reported. Posttraumatic epiphora was observed in 27 patients with NOE fractures (46.5%). In 10 cases, temporary epiphora was encountered and spontaneous recovery of lacrimal drainage within 5 months was observed. In the remaining 17 cases, permanent epiphora was registered and a frequent association with delayed treatment of facial fracture repair or bone loss in the lacrimal district was found. Surgical reconstruction of lacrimal pathways was performed 6 months after primary surgery, with external DCRs in all 17 patients with epiphora and the presence of nasolacrimal duct obstruction observed with dacryocystorhinography. External DCR with a large rhinostomy achieved a success rate of 94% in the reconstruction of lacrimal drainage. Such a technique proved to be effective in the treatment of posttraumatic dacryostenosis, although patients considered the temporary presence of external scars and stenting material to be a major problem.

Cornea, 2009

The purpose of this study was to report the progression of the iridocorneal endothelial syndrome ... more The purpose of this study was to report the progression of the iridocorneal endothelial syndrome during a 5-year period in a patient with the essential iris atrophy variant using confocal microscopy and ultrabiomicroscopy (UBM). A 47-year-old woman was referred to us in January 2002 with suspected iridocorneal endothelial syndrome. Examination of both eyes included visual acuity, biomicroscopy, intraocular pressure measurement, gonioscopy, visual field test, and UBM. Afterward, she was examined yearly and confocal microscopy performed. Visual acuity was 20/20 in both eyes. Examination of the right eye revealed endothelial degeneration, peripheral anterior synechiae, and iris atrophy around the pupil that appeared displaced to the temporal side. Biomicroscopy of the left eye was unremarkable. Posterior segment was normal in both eyes. UBM of the right eye showed thickening of the iris adherent to the corneal endothelium. Diagnosis of essential iris atrophy was confirmed. One year later, the right eye showed increasing iridoendothelial adherences confirmed by UBM. Confocal microscopy revealed endothelial cell abnormalities and groups of endothelial "epithelium-like" cells with hyperreflective nuclei. In April 2007, the pupil appeared more temporally dislocated. UBM showed more extended synechiae. Confocal microscopy displayed hyporeflective opacities in the endothelial layer and many grouped keratocytic clusters in the posterior stroma. No alteration of the intraocular pressure and visual field was found during the follow-up. UBM and confocal microscopy permit observation of any corneal and iridocorneal angle changes and evaluation of essential iris atrophy progression.

British Journal of Ophthalmology, 2001

To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with ... more To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with pars plana cysts using ultrasound biomicroscopy (UBM). 18 eyes of 12 patients with degenerative retinoschisis associated with pars plana cysts were selected through binocular indirect ophthalmoscopy and Goldmann three mirror lens examination, both with scleral depression. These patients were studied in detail with UBM. Study of the ciliary body with UBM showed pars plana cysts of different size and uneven shape. In cross sections the morphology of pars plana cysts in detail and the close relation of the cysts with the oral region and the peripheral retina, where areas of cystoid degeneration and retinoschisis were present, were observed. In transverse sections three main morphological aspects of pars plana cysts could be differentiated ("isolated," "confluent," and "clustered" cysts). Furthermore, ultrabiomicroscopy allowed differential diagnosis between retinoschisis and associated retinal detachment in six eyes. The study of peripheral degenerative retinoschisis and pars plana cysts is possible in vivo by means of UBM, showing the detailed morphology of the lesions (not otherwise evident through ophthalmoscopic examination) and the close relation between pars plana cysts, cystoid degeneration, and peripheral retinoschisis.

BMC Research Notes, 2012

Background: Hyphema is a complication that can occur after glaucoma filtering surgery. Biomicrosc... more Background: Hyphema is a complication that can occur after glaucoma filtering surgery. Biomicroscopic examination of the anterior segment is commonly used to diagnose it and gonioscopy may provide a useful support to find the source of the haemorrhage. Unfortunately, when the blood hides the structure of the anterior segment the gonioscopic examination fails. In this case we performed ultrabiomiscroscopy with 50-80 MHz probes to overcome the limits of gonioscopy. The use of this technique to study the anterior segment of the eye has previously been reported in literature, but we illustrates its importance for performing a correct diagnosis in a specific case of hyphema. Case presentation: We report a case of a sixty-year-old caucasian male with recurrent hyphema in the left eye. The episodes of hyphema were four in two years and the patient came to the hospital for the first time in the last occasion. The past episodes were managed with topical corticosteroids and mydriatic drops. He referred surgical trabeculectomy in both eyes 5 years before the first symptoms and no specific eye trauma before the first episode. The examination of the anterior segment revealed a 2 mm hyphema in the left eye due to blood leakage through the superior iridectomy. Gonioscopy could not identify the source of the haemorrhage. B-scan ultrasound and ultrabiomiscroscopy, with 50-80 MHz probes, were performed. Ultrabiomiscroscopy, mainly with the probe of 80 MHz, provided images of high resolution of the structures of the anterior segment and it allowed the visualization of an abnormal vessel at the inner margin of the trabeculectomy opening, probably responsible of the recurrent hyphema. Conclusion: Ultrabiomicroscopy proved to be a useful diagnostic technique for identifying the cause of the recurrent hyphema when other examination techniques are not applicable.

Archives of Ophthalmology, 2006

the perineural sheaths and separation of the retinal membranes at the outer nuclear layer.

Acta Ophthalmol Scandinavica, 2005

Case report: A 34-year-old man presented with anterior scleral thinning in the right eye (RE) and... more Case report: A 34-year-old man presented with anterior scleral thinning in the right eye (RE) and a painful nodular scleritis in the left eye (LE). Fundus examination showed a healed vasculitis and an inferior epiretinal neovascular membrane in the LE. Topical and systemic oral steroids and antiviral medication were prescribed. One year later, optic disc hyperaemia and swelling and macular oedema became apparent in the LE. Pulsed intravenous steroids were administered for 1 year, when a nasal septum perforation and vitreous haemorrhage in the LE were diagnosed. The eye was enucleated 3.5 years after the initial complaint. Necrotizing granulomatous tissue replacing the sclera and subconjunctival granulomatous tissue were observed. Six months later, oedema and neovascularization of the right optic disc were observed and cyclophosphamide was started, with regression of the clinical signs. No systemic abnormalities have so far become apparent. Discussion: Posterior scleritis is most often observed in patients with no signs of associated systemic autoimmune disease. The diagnosis in this case is most probably one of Wegener's granulomatosis (WG). In WG, the diagnosis is based on necrotizing granulomas of the respiratory tract, generalized focal necrotizing vasculitis and focal necrotizing glomerulonephritis. Eye involvement with WG has been reported in up to 58% of cases. Evaluation of the scleritis patient should include a detailed medical history, chest X-rays, blood tests, autoantibody serology and analysis of urinary sediment. Cyclophosphamide is the treatment of choice for patients with ocular manifestations of WG, polyarteritis nodosa or rheumatoid arthritis, either alone or in combination with systemic steroids. Visual loss is expected in 85% of individuals with severe necrotizing posterior scleritis.

European Journal of Ophthalmology, 2009

Zoonotic filarial infections in humans are relatively common and mostly due to parasites in the g... more Zoonotic filarial infections in humans are relatively common and mostly due to parasites in the genus Dirofilaria spp., in particular Dirofilaria immitis, D repens, D tenuis, and D ursi. In the United States, D tenuis, a parasite of raccoons, was established to be the primary agent, while in Europe, Middle Eastern countries, Africa, and Southest Asia, D repens was the most responsible parasite (1). D repens is a natural parasite of carnivores, primarily dogs, foxes, and cats (2). D repens infections are particularly common and often reported from European countries surrounding the Mediterranean, particularly Italy (168 cases), France (53 cases), and Greece (21 cases) (3). Related to the widespread presence of D repens in the usual reservoir (the dog) and of the possible carriers for humans (Culicidi species) , it is presumible that dirofilariasis in humans are more frequent than those published in literature (4).

Acta Ophthalmologica, 2017

Aim: To investigate the efficacy of intravitreal injection of ocriplasmin (JETREA ®) in the treat... more Aim: To investigate the efficacy of intravitreal injection of ocriplasmin (JETREA ®) in the treatment of vitreomacular traction (VMT). Materials and Methods: An 81-year-old man with VMT associated with central retinal vein occlusion in his left eye, was treated with a single intravitreal injection of ocriplasmin (25 μg). Best corrected visual acuity (BCVA), ocular fundus, and optical coherence tomography were examined before and after treatment. Results: Complete release of VMT produced a reduction of central macular thickness, ranging from 459 to 141 μm. BCVA remained stable. Discussion and Conclusions: The use of ocriplasmin was effective in the treatment of VMT. Ocriplasmin represents a valid alternative to conventional pars plana vitrectomy.

Case Reports in Ophthalmology, 2018

We report the case of a patient presented to the emergency department because of a contusive trau... more We report the case of a patient presented to the emergency department because of a contusive trauma from a pressurized bottled drink cap. During the visit, the patient indicated that he had been hit in his left eye by a cork while he was opening a sparkling wine bottle. He underwent a total ophthalmology examination. He had an important reduction of visual acuity, corneal swelling, Descemet’s folds, and hyphema. Therefore, we decided to perform ultrabiomicroscopy (UBM) of the anterior segment to study the endothelial damage and Descemet’s membrane. UBM images confirmed the direct biomicroscopy, highlighting the damaged location.

Ophthalmic surgery and lasers

In light of the research and the use of lasers in the therapy of xanthelasmas, the authors report... more In light of the research and the use of lasers in the therapy of xanthelasmas, the authors report their experience in the treatment of this pathology with Erbium:YAG laser. In 30 patients, all female, 70 xanthelasmas were treated with Erbium:YAG laser, 65 (93%) of which were on the upper eyelid and 5 (7%) on the lower eyelid, varying from 1 x 1.5 mm to 11 X 20 mm in size. Spots with a diameter of 1.6 mm, energy of 300 mJ, frequency of 1-5 Hz and in a number varying were used in relation to the extent of the pathology. In all cases, the appearance and functional results were good, without leaving scars and/or dyschromia. Erbium:YAG laser, in the treatment of xanthelasmas, is a parasurgical method that is simple to perform and because of the successful aesthetic and functional results, is a valid alternative to the more traditional treatment methods.

European Journal of Ophthalmology, 2015

Sturge-Weber syndrome is a phakomatosis with involvement of the eyelids, conjunctiva, choroid, an... more Sturge-Weber syndrome is a phakomatosis with involvement of the eyelids, conjunctiva, choroid, and retina. Congenital glaucoma is the most common ocular complication resulting from raised episcleral venous pressure. We present an unusual case of glaucoma induced by pupillary block in an 81-year-old woman with Sturge-Weber syndrome. The patient was referred for acute loss of vision OD and right-sided headache, pain, and nausea. The visual acuity was light perception OD with an intraocular pressure (IOP) of 41 mm Hg. Slit-lamp examination showed diffuse corneal edema OD associated with pupillary occlusion leading to angle closure and acute glaucoma attack. No pathologic changes were evidenced in the left eye. The raised IOP was partly relieved following administration of intravenous acetazolamide 250 mg, accompanied by relief of both pain and nausea. Laser iridotomy was performed OD, reducing the IOP to 22 mm Hg. The patient underwent cataract surgery with pupil membrane removal, leading to IOP of 17 mm Hg, but visual acuity remains unchanged due to optic nerve atrophy. This case supports the importance of involving an ophthalmologist in the management of Sturge-Weber syndrome, with monitoring of IOP, since early management of glaucoma can modify the visual outcome.

European journal of ophthalmology

The authors report a case of eyelid subcutaneous filariasis. Thorough history, eye examination, s... more The authors report a case of eyelid subcutaneous filariasis. Thorough history, eye examination, surgical intervention, and parasitologic analysis. An adult Dirofilaria repens worm was extracted from the right upper eyelid in a man living in Italy presenting to our department with lid swelling. Due to increasing migration of populations to Europe, rare manifestations of ocular filariasis are becoming more common. Surgery was both diagnostic and therapeutic.

Case reports in ophthalmology

We report the case of a 29-year-old female patient who presented with an acute onset of anisocori... more We report the case of a 29-year-old female patient who presented with an acute onset of anisocoria, blurred vision, nausea and severe left-sided headache. There was no history of trauma, drug abuse, or instillation of topical mydriatic compounds. The ocular history was negative for similar events. On presentation, her visual acuity was 0.2 in the left and 1.0 in the right eye with a +2.5 dpt sph. correction. Slit-lamp examination demonstrated a shallow anterior chamber as well as the presence of iris nodules in both eyes. These nodules were identified as Lisch nodules as the patient referred to the previous diagnosis as being neurofibromatosis type 1. A third nerve palsy was considered, but a brain MRI showed normal results. Her ocular motility was normal, but the left pupil was mydriatic and poorly reacting to light, with an associated raised intraocular pressure (IOP) of 38 mm Hg. An examination of the fellow eye was normal, with the IOP measuring 18 mm Hg. Gonioscopy of the right...

European journal of ophthalmology

Branch retinal artery occlusion caused by calcific embolization secondary to calcific aortic valv... more Branch retinal artery occlusion caused by calcific embolization secondary to calcific aortic valvulopathy. A 45-year-old woman came to our attention complaining a sudden painless loss of her peripheral superior visual field. Best visual acuity was 20/20. Fundus examination revealed the presence of a retinal arterial embolic occlusion of the inferior branch. Fundus retinography, visual field, and fluorescein angiography were performed and medical therapy was started. The echocardiography examination revealed a tricuspid and calcified aortic valve with moderate stenosis and regurgitation. Due to the heart pathology, the patient moved to the cardiosurgery department, where an aortic valve replacement was performed. Four months after cardiac surgery, visual acuity of both eyes was stable (20/20). Fundus examination showed a complete reabsorption of the retinal edema and the resolution of retinal pallor. Fluorescein angiography confirmed the delay of the arterial filling. No retinal isch...

Ophthalmologica, 2006

The purpose of our study was to compare the effects of systemically administered acetazolamide an... more The purpose of our study was to compare the effects of systemically administered acetazolamide and topical apraclonidine 0.5% in the control of intraocular pressure (IOP) following phacoemulsification of senile cataracts. The study was conducted on patients affected by cataract and followed at the Department of Ophthalmology. Seventy-eight eyes in 78 patients were selected. Twenty-six eyes were randomly assigned to postoperative treatment with topical apraclonidine 0.5%, 26 received oral acetazolamide and the remaining 26 received no hypotensive treatment (control group). Statistical analyses were performed mainly by means of analyis of variance. IOPs measured 24 h after surgery were significantly (p = 0.01) lower in the apraclonidine group compared to the control group. Our double-blind prospective study conducted on patients randomly assigned to treatment with apraclonidine or acetazolamide shows that the former drug is undoubtedly effective in the prevention of IOP increases following phacoemulsification. IOPs recorded in patients treated with this drug were lower than those observed in the acetazolamide and the control groups. Considering the lower risk of toxicity associated with topical administration, apraclonidine 0.5% seems to be preferable to oral acetazolamide in this postoperative setting.

Journal of Craniofacial Surgery, 2004

Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained cent... more Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained centrofacial trauma and can determine complexity in diagnosis and treatment. This article, based on a retrospective analysis of 58 patients with naso-orbitoethmoidal (NOE) trauma, reports the incidence of posttraumatic dacryostenosis and the evolution of such impairments in consideration of fracture type. Experience in diagnosis and treatment is illustrated, and surgical outcomes 6 months after external dacryocystorhinostomy (DCR) are reported. Posttraumatic epiphora was observed in 27 patients with NOE fractures (46.5%). In 10 cases, temporary epiphora was encountered and spontaneous recovery of lacrimal drainage within 5 months was observed. In the remaining 17 cases, permanent epiphora was registered and a frequent association with delayed treatment of facial fracture repair or bone loss in the lacrimal district was found. Surgical reconstruction of lacrimal pathways was performed 6 months after primary surgery, with external DCRs in all 17 patients with epiphora and the presence of nasolacrimal duct obstruction observed with dacryocystorhinography. External DCR with a large rhinostomy achieved a success rate of 94% in the reconstruction of lacrimal drainage. Such a technique proved to be effective in the treatment of posttraumatic dacryostenosis, although patients considered the temporary presence of external scars and stenting material to be a major problem.

Cornea, 2009

The purpose of this study was to report the progression of the iridocorneal endothelial syndrome ... more The purpose of this study was to report the progression of the iridocorneal endothelial syndrome during a 5-year period in a patient with the essential iris atrophy variant using confocal microscopy and ultrabiomicroscopy (UBM). A 47-year-old woman was referred to us in January 2002 with suspected iridocorneal endothelial syndrome. Examination of both eyes included visual acuity, biomicroscopy, intraocular pressure measurement, gonioscopy, visual field test, and UBM. Afterward, she was examined yearly and confocal microscopy performed. Visual acuity was 20/20 in both eyes. Examination of the right eye revealed endothelial degeneration, peripheral anterior synechiae, and iris atrophy around the pupil that appeared displaced to the temporal side. Biomicroscopy of the left eye was unremarkable. Posterior segment was normal in both eyes. UBM of the right eye showed thickening of the iris adherent to the corneal endothelium. Diagnosis of essential iris atrophy was confirmed. One year later, the right eye showed increasing iridoendothelial adherences confirmed by UBM. Confocal microscopy revealed endothelial cell abnormalities and groups of endothelial "epithelium-like" cells with hyperreflective nuclei. In April 2007, the pupil appeared more temporally dislocated. UBM showed more extended synechiae. Confocal microscopy displayed hyporeflective opacities in the endothelial layer and many grouped keratocytic clusters in the posterior stroma. No alteration of the intraocular pressure and visual field was found during the follow-up. UBM and confocal microscopy permit observation of any corneal and iridocorneal angle changes and evaluation of essential iris atrophy progression.

British Journal of Ophthalmology, 2001

To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with ... more To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with pars plana cysts using ultrasound biomicroscopy (UBM). 18 eyes of 12 patients with degenerative retinoschisis associated with pars plana cysts were selected through binocular indirect ophthalmoscopy and Goldmann three mirror lens examination, both with scleral depression. These patients were studied in detail with UBM. Study of the ciliary body with UBM showed pars plana cysts of different size and uneven shape. In cross sections the morphology of pars plana cysts in detail and the close relation of the cysts with the oral region and the peripheral retina, where areas of cystoid degeneration and retinoschisis were present, were observed. In transverse sections three main morphological aspects of pars plana cysts could be differentiated ("isolated," "confluent," and "clustered" cysts). Furthermore, ultrabiomicroscopy allowed differential diagnosis between retinoschisis and associated retinal detachment in six eyes. The study of peripheral degenerative retinoschisis and pars plana cysts is possible in vivo by means of UBM, showing the detailed morphology of the lesions (not otherwise evident through ophthalmoscopic examination) and the close relation between pars plana cysts, cystoid degeneration, and peripheral retinoschisis.

BMC Research Notes, 2012

Background: Hyphema is a complication that can occur after glaucoma filtering surgery. Biomicrosc... more Background: Hyphema is a complication that can occur after glaucoma filtering surgery. Biomicroscopic examination of the anterior segment is commonly used to diagnose it and gonioscopy may provide a useful support to find the source of the haemorrhage. Unfortunately, when the blood hides the structure of the anterior segment the gonioscopic examination fails. In this case we performed ultrabiomiscroscopy with 50-80 MHz probes to overcome the limits of gonioscopy. The use of this technique to study the anterior segment of the eye has previously been reported in literature, but we illustrates its importance for performing a correct diagnosis in a specific case of hyphema. Case presentation: We report a case of a sixty-year-old caucasian male with recurrent hyphema in the left eye. The episodes of hyphema were four in two years and the patient came to the hospital for the first time in the last occasion. The past episodes were managed with topical corticosteroids and mydriatic drops. He referred surgical trabeculectomy in both eyes 5 years before the first symptoms and no specific eye trauma before the first episode. The examination of the anterior segment revealed a 2 mm hyphema in the left eye due to blood leakage through the superior iridectomy. Gonioscopy could not identify the source of the haemorrhage. B-scan ultrasound and ultrabiomiscroscopy, with 50-80 MHz probes, were performed. Ultrabiomiscroscopy, mainly with the probe of 80 MHz, provided images of high resolution of the structures of the anterior segment and it allowed the visualization of an abnormal vessel at the inner margin of the trabeculectomy opening, probably responsible of the recurrent hyphema. Conclusion: Ultrabiomicroscopy proved to be a useful diagnostic technique for identifying the cause of the recurrent hyphema when other examination techniques are not applicable.

Archives of Ophthalmology, 2006

the perineural sheaths and separation of the retinal membranes at the outer nuclear layer.

Acta Ophthalmol Scandinavica, 2005

Case report: A 34-year-old man presented with anterior scleral thinning in the right eye (RE) and... more Case report: A 34-year-old man presented with anterior scleral thinning in the right eye (RE) and a painful nodular scleritis in the left eye (LE). Fundus examination showed a healed vasculitis and an inferior epiretinal neovascular membrane in the LE. Topical and systemic oral steroids and antiviral medication were prescribed. One year later, optic disc hyperaemia and swelling and macular oedema became apparent in the LE. Pulsed intravenous steroids were administered for 1 year, when a nasal septum perforation and vitreous haemorrhage in the LE were diagnosed. The eye was enucleated 3.5 years after the initial complaint. Necrotizing granulomatous tissue replacing the sclera and subconjunctival granulomatous tissue were observed. Six months later, oedema and neovascularization of the right optic disc were observed and cyclophosphamide was started, with regression of the clinical signs. No systemic abnormalities have so far become apparent. Discussion: Posterior scleritis is most often observed in patients with no signs of associated systemic autoimmune disease. The diagnosis in this case is most probably one of Wegener's granulomatosis (WG). In WG, the diagnosis is based on necrotizing granulomas of the respiratory tract, generalized focal necrotizing vasculitis and focal necrotizing glomerulonephritis. Eye involvement with WG has been reported in up to 58% of cases. Evaluation of the scleritis patient should include a detailed medical history, chest X-rays, blood tests, autoantibody serology and analysis of urinary sediment. Cyclophosphamide is the treatment of choice for patients with ocular manifestations of WG, polyarteritis nodosa or rheumatoid arthritis, either alone or in combination with systemic steroids. Visual loss is expected in 85% of individuals with severe necrotizing posterior scleritis.