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OBJECTIVE: To compare the performance and safety in cataract surgery of two ophthalmic viscoelastic devices (OVDs), each having separate dispersive and cohesive characteristics and different concentrations. METHODS AND ANALYSIS: In this prospective, randomised, controlled clinical study, one eye of each patient was injected with OVD1 (Viscopack14) or OVD2 (DuoVisc) during phacoemulsification and intraocular lens implantation. Endothelial cell count, intraocular pressure (IOP), central corneal thickness (CCT), intraocular inflammation and corrected distance visual acuity (CDVA) were compared 3 months postoperatively. RESULTS: The study enrolled 127 patients. Randomisation assigned 50 eyes of as many patients to each arm of the study. The postoperative mean endothelial cell loss was 14.4% and 7.1% from baseline in the OVD1 and OVD2 groups, respectively (p=0.08). The incidence of IOP spikes at 2 hours was 0% and 8%, respectively (p=0.02). There were intergroup differences in postoperative IOP values, the OVD2 group showed significantly higher values at all of the follow-up visits starting from the 24 hours examination (p<0.05). There was no statistically significant difference in the CCT, intraocular inflammation and CDVA at the end of follow-up. CONCLUSION: Both OVDs showed similar clinical performances and were equally effective during cataract surgery. Viscopack14 showed more corneal endothelial cell reduction, while DuoVisc had more occurrences of IOP values and spikes. Future studies are mandatory to support these preliminary results.

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PURPOSE: To compare the visual outcomes and quality of vision of 2 new diffractive multifocal intraocular lenses (IOLs) with those of a monofocal IOL. SETTING: Fatebenefratelli e Oftalmico Hospital, Milan, Italy. DESIGN: Prospective case series. METHODS: Patients had bilateral cataract surgery with implantation of a trifocal IOL (Panoptix), an extended-range-of-vision IOL (Symfony), or a monofocal IOL (SN60WF). Postoperative examinations included assessing distance, intermediate, and near visual acuity; binocular defocus; intraocular and total aberrations; point-spread function (PSF); modulation transfer function (MTF); retinal straylight; and quality-of-vision (QoV) and spectacle-dependence questionnaires. RESULTS: Seventy-six patients (152 eyes) were assessed for study eligibility. Twenty patients (40 eyes) in each arm of the study (60 patients, 120 eyes) completed the outcome assessment. At the 4-month follow-up, the trifocal group had significantly better near visual acuity than the extended-range-of-vision group (P = .005). The defocus curve showed the trifocal IOL had better intermediate/near performance than the extended-range-of-vision IOL and both multifocal IOLs performed better than the monofocal IOL. Intragroup comparison of the total higher-order aberrations, PSF, MTF, and retinal straylight were not statistically different. The QoV questionnaire results showed no differences in dysphotopsia between the multifocal IOL groups; however, the results were significantly higher than in the monofocal IOL group. CONCLUSIONS: Both multifocal IOLs seemed to be good options for patients with intermediate-vision requirements, whereas the trifocal IOL might be better for patients with near-vision requirements. The significant perception of visual side effects indicates that patients still must be counseled about these effects before a multifocal IOL is implanted.

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The aim of the study was to compare, in a randomized prospective study, the efficacy and safety of intraorbital administration of low doses of RTX versus intravenous glucocorticoids (GCs) to treat patients affected by moderately severe thyroid-associated active orbitopathy. Twenty patients with active, moderately severe TAO, whose mean age was 56.7 years±10.2 SD participated in the study. Patients were randomly selected and treated with intraorbital injections of RTX or with i.v. GCs. Disease activity and severity were assessed by the Clinical Activity Score (CAS) and the NOSPECS. Computed tomography or magnetic resonance scans were performed in all patients. In the RTX group, full blood cell count and flow cytometric analysis on peripheral blood lymphocytes were done. The patients were followed for 20 months. In both groups, CAS and NOSPECS indexes were significantly reduced (p<0.005). In particular, CAS reduction was evident since the first follow-up with both treatments. Proptosis decreased significantly only in group B and diplopia showed no significant changes during follow-up times in both groups. Neither of the treatments affected the peripheral TRab. In group A, 5 weeks after the first injection, the CD20+ peripheral lymphocytes value was nearly zero. One patient treated with rituximab progressed to severe TAO (optic neuropathy) following the second injection so the treatment was discontinued. The data confirm the therapeutic efficacy of RTX in active TAO, even in low doses and locally administered. The efficacy on the inflammatory component of the disease is comparable to that of steroids and seems to be related with the reduction of peripheral CD20+ lymphocytes. Caution should be given to an accurate patient selection.

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PURPOSE: We recently reported on the efficacy of intralesional rituximab for treating primary ocular adnexal lymphoma in a pilot study. After treatment, a complete response was observed in two of five patients, a partial response in one patient, and lesion recurrence in two patients. In this study, we evaluate the long-term follow-up of the five previously treated patients as well as the response of two new patients to an augmented dose of rituximab. METHODS: We followed up the five patients who were treated with rituximab during the initial pilot study. Two additional patients were also enrolled and treated with four intraorbital injections of 10 mg rituximab once a week for 1 month (total dose of 40 mg). Median follow-up period was 4 years for the first five patients and 1 year for the last two patients. RESULTS: Lymphoma did not relapse in the two patients who originally responded immediately to treatment. Of the initial partial responders, one became disease-free after additional rituximab treatment, and one experienced a standardized uptake value reduction, as measured with positron emission tomography-CT. One patient who experienced abdominal and pulmonary localization 7 months later showed no local recurrence. The two newly enrolled patients had complete remission after the first cycle of treatment and no disease recurrence eight and 11 months later, respectively. CONCLUSIONS: This study suggests that intralesional administration of rituximab for treating localized ocular adnexal CD20+ lymphomas could be an effective front-line therapeutic option with negligible side effects and a good response rate and duration.

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PURPOSE: To report longitudinal evaluation of morphology and function, by spectral-domain optical coherence tomography and Early Treatment Diabetic Retinopathy Study visual acuity, respectively, in patients with cystoid macular edema after cataract surgery (Irvine-Gass syndrome). METHODS: Fifteen eyes (15 patients) with a diagnosis of cystoid macular edema related to Irvine-Gass syndrome underwent ocular ophthalmologic examinations including Early Treatment Diabetic Retinopathy Study visual acuity and macular morphology assessment by spectral-domain optical coherence tomography. An observational period of 3 months after surgery was considered before starting therapy with oral acetazolamide and topical indomethacin. Patients' eyes were tested at baseline and at 3, 6, and 12 months posttreatment by spectral-domain optical coherence tomography and Early Treatment Diabetic Retinopathy Study visual acuity. Repeated measures analysis of variance was used to compare mean values. RESULTS: Mean (±SD) central macular thickness by spectral-domain optical coherence tomography was 530 (±98.1), 385.6 (±55.1), 339 (±32.3), and 316.2 (±27.0) µm at baseline, 3, 6, and 12 months of follow-up, respectively (P < 0.001). Mean (±SD) Early Treatment Diabetic Retinopathy Study visual acuity was 0.6 (±0.2), 0.2 (±0.1), 0.16 (±0.1), and 0.09 (±0.07) logarithm of the minimum angle of resolution at baseline, 3, 6, and 12-month follow-up, respectively (P < 0.001). Macular thickness changes were positively correlated (r = 0.75; P < 0.001) with visual acuity changes. Eyes with interruption of inner segment/outer segment junction at baseline (n = 3, 20%) showed a persistent damage of the photoreceptor junction and incomplete visual acuity recovery at the end of follow-up. CONCLUSION: Spectral-domain optical coherence tomography detects retinal findings, including photoreceptor inner segment/outer segment junction abnormalities that are correlated with visual acuity changes in treated patients with Irvine-Gass syndrome.

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