PURPOSE: To report a case of sympathetic ophthalmia (SO) after a severe Acanthamoeba keratitis. METHODS/DESIGN: Interventional case report. RESULTS: A 59-year-old white woman, wearing contact lenses, developed a severe Acanthamoeba keratitis in the left eye, which involved the limbus, and required 8 months of intensive antiamoeba therapy; the condition resolved leaving a painful, phthisical eye with complete corneal neovascularization. Six months later, the patient presented with pain, blurred vision, and photophobia in the right eye. Slitlamp examination of the right eye revealed granulomatous uveitis. On the suspicion of an SO, treatment with high-dose topical and oral corticosteroids and immunosuppressants was started. After 3 months, the eye is stable, with a visual acuity of 20/50, and the patient is taking prednisolone 7.5 mg per day and cyclophosphamide 50 mg per day. CONCULSIONS: Development of SO in the absence of previous trauma or surgery is rare. Our case is the first report of a clinically diagnosed SO after an episode of severe Acanthamoeba keratitis.

PURPOSE: To assess the therapeutic noninferiority of 0.005% latanoprost ophthalmic solution versus Xalatan in the treatment of patients with primary open-angle glaucoma or ocular hypertension. PATIENTS AND METHODS: This was a double-masked, randomized, multicenter study. A total of 184 patients with a diagnosis of unilateral or bilateral primary open-angle glaucoma or ocular hypertension were randomly assigned to either 0.005% latanoprost ophthalmic solution or Xalatan for 12 weeks. The primary end-point was the change in intraocular pressure (IOP) at 12 weeks in the 2 groups. Noninferiority was reached if the 2-sided 95% confidence intervals (CI) for the difference between adjusted treatment means were entirely within the interval from -1.5 to +1.5 mm Hg. RESULTS: The difference between treatments in the change of IOP from baseline to the end of treatment was 0.12 mm Hg (95% CI: -0.47, 0.71) in the intention-to-treat population and 0 mm Hg (95% CI: -0.58, 0.57) in the per protocol population. There was no statistically significant difference between the 2 groups in terms of drug-related adverse events. The most commonly reported drug-related local adverse events were: ocular hyperemia, eyelashes growth, and eye irritation. CONCLUSIONS: This study demonstrates that 0.005% latanoprost ophthalmic solution is noninferior to Xalatan in lowering IOP and is generally well tolerated

Purpose: To report a case of Wernicke’s encephalopathy in a nonalcoholic woman with secondary hypoadrenalism. Methods: A 58-year-old Italian woman developed Wernicke’s syndrome secondary to recurrent vomiting due to secondary hypoadrenalism. Results: Recurrent vomiting and resulting malnutrition caused a depletion of the patient’s body stores of thiamine and the development of mental confusion and an oculomotor deficit. On the diagnostic suspicion of encephalitis in this patient with immunosuppression due to prolonged cortisone-based therapy, she underwent magnetic resonance imaging (MRI), which showed typical bilateral abnormal lesions pathognomonic of Wernicke’s encephalopathy. The patient improved after parenteral administration of vitamin B1. Conclusions: Wernicke’s encephalopathy must be regarded as a medical emergency that should be suspected in all cases presenting with a sudden deficit or lack of coordination of the ocular movements associated with ataxia and general degeneration of the mental faculties, in patients who have suffered recurrent vomiting or malnutrition for different reasons.

Background: Refractive laser surgery induces substantial changes in corneal structure, causing inaccurate intraocular pressure (IOP) readings. Pascal dynamic contour tonometry (PDCT) and Icare rebound tonometer (RBT) are two novel devices that do not depend on applanation to measure IOP. Purpose of this prospective study was to compare PDCT and rebound tonometry versus Goldmann tonometry (GAT) in a group of patients who underwent photorefractive keratectomy (PRK). Methods: Central corneal thickness and IOP were measured in 54 eyes before and after PRK. All IOP measurements were taken by the same examiner, using PDCT, RBT and GAT in a randomised, masked fashion. Results: After excimer laser surgery, PDCT measurements were higher than GAT (p<0.0001) and RBT (p=0.0012). Multiple linear regression analysis indicated that size of contact area was significant (b=-0.504; p<0.0001) while corneal thickness was not (b=0.003; p=0.169). Bland-Altman test showed that there was good agreement between RBT and PDCT (p=0.454), whereas GAT gave lower IOP values than both RBT (p=0.0103) and PDCT (p=0.0031). Conclusion: PDCT and RBT are less dependent on iatrogenic corneal changes than GAT and this might be related to their small contact area. In order to minimise IOP underestimation after excimer laser surgery, the clinician should consider adopting non-applanation tonometers like RBT and PDCT as an alternative to GAT.

Background: Tight control of intraocular pressure (IOP) is still the only therapeutic approach available for the treatment of primary open angle glaucoma (POAG). However, some patients do not respond adequately to hypotonising drugs, and despite multiple drug combinations they cannot reach their target IOP. Forskolin is a natural compound that has already shown efficacy in IOP reduction following topical application. Purpose: The aim of this study was to evaluate the effects on the IOP of a food supplement containing forskolin and rutin when administered to POAG patients under maximum tolerated medical therapy (MTMT) and on a waiting list for filtrating surgery to further decrease their IOP. Methods: The design of the study was open and case-controlled. Ninety-seven (52 in the treatment group, and 45 in the reference group) patients were enrolled in 8 different glaucoma centers in Italy, all under MTMT and with IOP enrollment values above their target pressure. During the 30 days before surgery, patients in the treatment group were prescribed 2 tablets per day of a food supplement containing rutin and forskolin in addition to their usual topical drug treatment. Their IOP values were measured at 3 time points during the day, at enrollment and once a week until surgery. Control patients continued only with their normal topical therapy. Results: All patients in the treatment group, independently of the combination drug therapy that they were taking, showed a further 10% decrease (P<0.01) of their IOP, starting from 1 week after introduction of the oral supplement and lasting until the last evaluation before surgery. This decrease was more evident (15% of the enrollment value; P<0.01) in those subjects with high (IOP≥21 mmHg) enrollment values rather than in those with low (IOP<21) enrollment values (9%; P<0.01). On the contrary, IOP values in the control group remained stable from the beginning to the end of the observation period, independently of their enrollment values. Conclusions: Forskolin and rutin given as oral treatment appear to contribute to a better control and a further small reduction of IOP in patients who were poorly responsive to multitherapy treatment.

PURPOSE: To present a technique of surgical reposition of the Ex-PRESS miniature glaucoma device when dislocated in corneal limbus. METHODS: A 54-year-old woman diagnosed with glaucoma, with a 3-month history of Ex-PRESS miniature implant, was referred to our department because of progressive intraocular pressure (IOP) rise. Slit-lamp biomicroscopy showed the posterior flange of the implant located in the corneal limbus; IOP was 34 mmHg. Surgical technique consisted of reopening of the conjunctiva and the scleral flap, excision of the corneal tissue covering the flange, and stitching the implant to the sclera with polyprolene suture. RESULTS: Postoperatively, IOP rapidly reduced to 5 mmHg and was balanced to 10 mmHg in the follow-up. CONCLUSIONS: Corneal dislocation of the Ex-PRESS implant, when associated with ocular hypertension, needs surgical treatment. Before considering a trabeculectomy, it could be valuable to attempt an implant reposition.

PURPOSE: To report ultrabiomicroscopy (UBM) evidence of choroid effusion as a cause of acute transient myopia in the onset of systemic lupus erythematosus. DESIGN: Observational case report. METHODS: A Caucasian 16-year-old girl was referred to the Hematology Department for progressive anemia, intermittent fever, and blurred vision. RESULTS: Systemic lupus erythematosus was confirmed by hematological investigations. UBM examination evidenced choroid effusion as the cause of a transient myopic shift. CONCLUSIONS: Early diagnosis, thanks to the performance of an ultrasound examination, enabled the timely institution of therapy and hence a rapid resolution of the symptoms.

A valve device for use in glaucoma surgery comprises at least one aqueous humor feeding duct (2) having a first end (2a) designed to fit into the anterior chamber of the eyeball, a balancing chamber (3) communicating with a second end (2b) of the feeding duct (2) and having an inner volume ranging from 2 mm3 to 6 mm3, and designed to be introduced into a surgical groove in the sclera, a retainer member (6) placed within the feeding duct (2) to allow fluid transfer from the first end (2a) toward the second end (2b) of the feeding duct (2) and to inhibit fluid transfer in the opposite direction. A plurality of aqueous humor outflow ducts (5) extend from the balancing chamber (3) to allow outflow of aqueous humor from the balancing chamber (3) to an outside space.