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Di Zazzo A, Spelta S, Micera A, De Gregorio C, Affatato M, Esposito G, Balzamino BO, Sgrulletta R, Coassin M, Bonini S. Prophylactic Therapy for Long-Term Ocular Discomfort After Cataract Surgery. Cornea 2024:00003226-990000000-00557. [PMID: 38759149 DOI: 10.1097/ico.0000000000003561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/21/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The cataract surgery dissatisfaction rate is 20% to 35% due to ocular surface discomfort. We investigate the ocular surface discomfort after surgical failure as a consequence of age-related parainflammation. We also aim to prevent it by immune-modulating prophylactic management. METHODS Monocentric clinical trial realized in a teaching hospital. Prospective, randomized, open-label, unmasked clinical trial. One hundred patients diagnosed with cataracts underwent phacoemulsification surgery. Groups A (<65 years; n = 25) and B (>75 years; n = 25) received surgery only. Groups C and D (both >75 years and both n = 25) used cyclosporine A 0.1% cationic emulsion (CE) eye drops or CE lubricating eye drops (both twice daily), respectively, for 30 days before surgery. Patients were followed up 90 days after surgery. The primary outcome was postoperative ocular surface failure; secondary outcomes examined the influence of prophylactic cyclosporine A 0.1% CE therapy on ocular surface outcomes. RESULTS Group B demonstrated greater severity regarding ocular surface signs and symptoms throughout the study period, versus all other groups. Signs/symptoms were typically lower in Group A. Group C achieved significant reductions in conjunctival Symptom Assessment in Dry Eye values ( P < 0.05), conjunctival hyperemia severity ( P < 0.01), and meibomian gland dysfunction ( P < 0.001) at Day 45, versus Group B, and tear break-up time was increased ( P < 0.001). Ocular surface inflammatory marker transcription (HLADR, intercellular adhesion molecule 1 [ICAM-1], and interleukin 6 [IL-6]) was significantly downregulated in Group C, versus Group B, at 90 days ( P < 0.05). CONCLUSIONS Cataract surgery induced ocular surface system failure with a clinically significant persistent inflammatory status (InflammAging) in patients older than 75 years. Prophylactic cyclosporine A 0.1% CE eye drops were associated with improved ocular surface homeostasis and reductions in inflammatory markers.
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Affiliation(s)
- Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Campus Bio-Medico Foundation, Rome, Italy
- University Campus Bio-Medico, Rome, Italy; and
| | - Sara Spelta
- University Campus Bio-Medico, Rome, Italy; and
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS-Fondazione Bietti, Rome, Italy
| | | | | | - Graziana Esposito
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS-Fondazione Bietti, Rome, Italy
| | - Bijorn Omar Balzamino
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS-Fondazione Bietti, Rome, Italy
| | - Roberto Sgrulletta
- Ophthalmology Complex Operative Unit, Campus Bio-Medico Foundation, Rome, Italy
- University Campus Bio-Medico, Rome, Italy; and
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, Campus Bio-Medico Foundation, Rome, Italy
- University Campus Bio-Medico, Rome, Italy; and
| | - Stefano Bonini
- Ophthalmology Complex Operative Unit, Campus Bio-Medico Foundation, Rome, Italy
- University Campus Bio-Medico, Rome, Italy; and
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dell'Omo R, Cucciniello P, Affatato M, Rapino G, D'Albenzio A, Venturi F, Campagna G. Influence of Vitreous Cortex Remnants on Normal Retinal Anatomy in Eyes with Primary Rhegmatogenous Retinal Detachment. Ophthalmol Retina 2024:S2468-6530(24)00190-8. [PMID: 38657953 DOI: 10.1016/j.oret.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To investigate the influence of vitreous cortex remnants (VCRs) removal on normal retinal anatomy in eyes with rhegmatogenous retinal detachment (RRD). DESIGN Prospective cohort study. SUBJECTS Patients with primary RRD operated with pars plana vitrectomy (PPV). METHODS Blue fundus autofluorescence and spectral-domain OCT were obtained preoperatively, and at 1 and 6 months after operation. MAIN OUTCOME MEASURES Primary outcomes: rate of retinal displacement and outer retinal folds (ORFs) at 1 month after operation. SECONDARY OUTCOMES continuity of the external limiting membrane (ELM) and ellipsoid zone (EZ), and the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at 6 months after operation. RESULTS One hundred three eyes were included. Intraoperatively, peripheral VCRs (pVCRs) were found in 42 eyes (40.8%) and successfully peeled off from ≥2 quadrants in 37 eyes. Macular VCRs (mVCRs) were detected in 37 (35.9%) and successfully peeled off in 29 eyes. At the end of operation 44.7% and 55.3% of the eyes were tamponaded with 20% sulfur hexafluoride gas and silicone oil 1000 centistokes, respectively. The only variable significantly associated with displacement was the use of gas tamponade versus silicone oil (P = 0.001), whereas no significant association was found between retinal displacement and pVCRs (P = 0.58) or number of quadrants from which pVCRs were peeled off (P = 0.39). At 1 month postoperatively, ORFs were globally detected in 24 eyes (23.3%). Regression analysis showed a direct correlation between ORFs and the intraoperative detection of mVCRs (P = 0.02) and an indirect correlation between ORFs and mVCRs peeling (P = 0.004). Macular VCRs peeling did not influence the continuity of ELM and EZ at the 6-month follow-up (FU). Intraoperative absence of mVCRs (P = 0.0016) and peeling of mVCRs (P = 0.003) were associated with logMAR BCVA ≤0.3 at the 6-month FU. CONCLUSIONS Peeling of pVCRs did not seem to influence the rate of retinal displacement, whereas peeling of mVCRs was associated with a reduced risk of developing ORFs without detrimental effect on the continuity of ELM/EZ at 6-month FU. The patients without mVCRs detected intraoperatively, or who underwent mVCRs peeling during operation, showed a significantly better visual acuity at the 6-month FU. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Roberto dell'Omo
- Department of Medicine and Health Sciences "V. Tiberio" University of Molise, Campobasso, Italy.
| | - Pasquale Cucciniello
- Department of Medicine and Health Sciences "V. Tiberio" University of Molise, Campobasso, Italy
| | - Marzia Affatato
- Department of Medicine and Health Sciences "V. Tiberio" University of Molise, Campobasso, Italy
| | - Giuseppe Rapino
- Department of Medicine and Health Sciences "V. Tiberio" University of Molise, Campobasso, Italy
| | - Andrea D'Albenzio
- Department of Medicine and Health Sciences "V. Tiberio" University of Molise, Campobasso, Italy
| | - Federico Venturi
- Department of Medicine and Health Sciences "V. Tiberio" University of Molise, Campobasso, Italy
| | - Giuseppe Campagna
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "La Sapienza", Rome, Italy
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Carosielli M, Carnevali A, Fallico M, Pirozzi E, Chiosi F, Chronopoulos A, Cucciniello P, Affatato M, Rapino G, dell'Omo R. Intravitreal Brolucizumab for Pachychoroid Neovasculopathy Associated With Chronic Central Serous Chorioretinopathy. Transl Vis Sci Technol 2023; 12:17. [PMID: 38112497 PMCID: PMC10732086 DOI: 10.1167/tvst.12.12.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
Purpose To evaluate the anatomical and functional outcomes of intravitreal brolucizumab in eyes with chronic central serous chorioretinopathy complicated by pachychoroid neovasculopathy. Methods Retrospective analysis of 34 eyes treated with intravitreal brolucizumab. Twenty-five eyes (73.5%) had been treated with other anti-vascular endothelial growth factor agents before switching to brolucizumab, whereas nine eyes were naïve. Outcome measures included the change of central foveal thickness and subfoveal choroidal thickness, evaluation of sub/intraretinal fluid on optical coherence tomography, and change in best-corrected visual acuity. Results Before starting brolucizumab, 23 eyes showed subretinal fluid, 8 both subretinal and intraretinal fluid, and 3 intraretinal fluid only. At the last visit, 22 eyes (64.7%) showed complete reabsorption of both intraretinal and subretinal fluid, whereas subretinal fluid was still present in 8 eyes (23.5%), and both intraretinal and subretinal fluid in 4 eyes (11.8%). The mean number of brolucizumab injections required to achieve complete fluid reabsorption was 2.8 ± 1.8. central foveal thickness decreased from 317.8 ± 109.3 µm to 239.8 ± 74.8 µm (P = 0.0005) and subfoveal choroidal thickness decreased from 399.3 ± 86.2 µm to 355.5 ± 92.7 µm at the end of the follow-up period (P = 0.0008). The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.4 ± 0.2 to 0.3 ± 0.2 at 1 month after the first injection and remained stable at the same values at the end of the follow-up period (P = 0.04). Conclusions Intravitreal brolucizumab is effective for the treatment of naïve and recalcitrant pachychoroid neovasculopathy. Translational Relevance Intravitreal brolucizumab may represent an option in patients with pachychoroid neovasculopathy complicating chronic central serous chorioretinopathy.
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Affiliation(s)
- Marianna Carosielli
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Adriano Carnevali
- Department of Ophthalmology, University Magna Græcia, Catanzaro, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Enza Pirozzi
- Department of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Flavia Chiosi
- Department of Ophthalmology, Azienda Ospedaliera dei Colli-Ospedale Monaldi, Naples, Italy
| | | | - Pasquale Cucciniello
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Marzia Affatato
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Giuseppe Rapino
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Roberto dell'Omo
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - on behalf of the BROCS study group, BROCS (BROlucizumab for the treatment of Central Serous chorioretinopathy) study group†
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
- Department of Ophthalmology, University Magna Græcia, Catanzaro, Italy
- Department of Ophthalmology, University of Catania, Catania, Italy
- Department of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy
- Department of Ophthalmology, Azienda Ospedaliera dei Colli-Ospedale Monaldi, Naples, Italy
- Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
- Department of Experimental Biomedicine and Cnilical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
- Eye Clinic, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
- Eye Unit, Department of Medicine Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
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dell'Omo R, Carosielli M, Rapino G, Affatato M, Cucciniello P, Virgili G, Filippelli M, Costagliola C, Campagna G. Biomarkers of Vitreous Cortex Remnants in Eyes With Primary Rhegmatogenous Retinal Detachment. Transl Vis Sci Technol 2023; 12:24. [PMID: 37367719 DOI: 10.1167/tvst.12.6.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Purpose The purpose of this study was to identify pre-operative biomarkers of vitreous cortex remnants (VCRs) in eyes with rhegmatogenous retinal detachment (RRD). Methods Prospective case series of 103 eyes treated with pars plana vitrectomy (PPV) to repair RRD. Pre-operatively, optical coherence tomography (OCT) and B-scan ultrasonography (US) were used to study the vitreo-retinal interface and vitreous cortex status. If detected during PPV, VCRs were removed. Images acquired pre-operatively were compared with intra-operative findings and with postoperative OCT images taken at 1, 3, and 6 months of follow-up. Multivariate regression analyses were performed to determine associations between VCRs and pre-operative variables. Results The presence of VCRs at the macula (mVCRs) and at the periphery (pVCRs), was ascertained intra-operatively in 57.3% and 53.4% of the eyes, respectively. Pre-operatively, a preretinal hyper-reflective layer (PHL) and a saw-toothed aspect of the retinal surface (SRS) were identified with OCT in 73.8% and 66% of the eyes, respectively. US sections showed a vitreous cortex running close and parallel to the detached retina upon static and kinetic examination (the "lining sign") in 52.4% of the cases. Multivariate regression analyses showed an association between PHL and SRS and intra-operative evidence of mVCRs (P = 0.003 and < 0.0001, respectively) and between SRS and "lining sign" and pVCRs (P = 0.0006 and 0.04, respectively). Conclusions PHL and SRS on OCT and the "lining sign" on US appear to be useful pre-operative biomarkers of the intra-operative presence of VCRs. Translational Relevance Preoperative identification of VCRs biomarkers may help to plan the operating strategy in eyes with RRD.
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Affiliation(s)
- Roberto dell'Omo
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Marianna Carosielli
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Giuseppe Rapino
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Marzia Affatato
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Pasquale Cucciniello
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Gianni Virgili
- Eye Clinic, AOU Careggi Teaching Hospital, University of Florence, Florence, Italy
| | - Mariaelena Filippelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Ciro Costagliola
- Department of Ophthalmology, University of Naples "Federico II," Naples, Italy
| | - Giuseppe Campagna
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza," Rome, Italy
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