Effectiveness of the expressive writing on the psychological distress and traumatic symptoms of the migrants: A prospective study multiarm randomized controlled trial

OBJECTIVE

Migration is a phenomenon related to adverse impacts, including higher risk for psychological distress and trauma symptoms, highlighting the strong need for effective psychological treatments to help migrants. However, the use of expressive writing intervention (EW) has not been examined in this population. The aims of the study were to evaluate: (a) the effectiveness of a trauma-focused EW on psychological distress, trauma symptoms, alexithymia, and hope for the future in migrants, and (b) the role of alexithymia and hope for the future in the association with the EW and the psychological symptoms.

METHOD

Twenty-eight migrants were enrolled in a multiarm double-blind randomized controlled trial (RCT) that included three groups: (a) trauma-focused EW, (b) neutral EW, and (c) control. Participants completed self-report measures at pretreatment, immediately after the intervention, and at 1 month follow-up. The study complied with the guidelines of Consolidate Standard of Reporting Trials (CONSORT) checklist and was retrospectively recorded on ClinicalTrials.gov.

RESULTS

Trauma-focused EW was related to an immediate improvement in phobic anxiety and positive total symptoms and improvement in somatization, global severity index, and hope for the future at follow-up. Trauma symptoms and alexithymia did not show significant effects. Factorial regressions showed that the interaction group per time per hope for the future was a significant predictor on the phobic anxiety.

DISCUSSION

EW may be an effective tool for reducing migrant's distress and may have long-term improvements in mental health. Moreover, the results suggest the potential influence of the hope for the future on anxiety in migrants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychosocial treatment on psychological symptoms, adherence, and physiological function on transplanted patients: A systematic review and metanalysis

OBJECTIVE

Transplantation represents an important source of hope for the candidates and produces an intense emotional effect. Psychosocial interventions can be helpful in all transplantation stages to better manage this extraordinarily stressful situation. Aim of the work is to verify the effects of the psychosocial interventions on recipients on psychological symptoms, medical adherence and transplanted solid organ functioning.

METHODS

This work adhered to PRISMA, STROBE, Cochrane and New Castle Ottawa bias scales and it is registered in PROSPERO. Inserting "Transplant" and "Psychological intervention" as key words in PubMed, Psycinfo, Cochrane database resulted 977 studies from 2001 to 2021. A systematic review and metanalyses were processed on nineteen randomized controlled trials and observative prospective cohort studies. The difference between pre- and post- psychosocial intervention assessment on the psychological variables, medical adherence, and organ functioning outcome was processed.

RESULTS

Main findings showed that the psychosocial interventions were effective on depression (0.62; CI: 0.32-0.92) and anxiety on kidney recipients (0.49; CI: 0.17-0.81), and on anxiety on heart recipients, mainly when administrated after the surgery (0.68; CI: 0.30-1.06). Moreover, the findings showed a lack of studies on the effectiveness of the psychosocial intervention on organ functioning.

CONCLUSION

The work highlighted the effectiveness of the psychosocial interventions on psychological outcome, particularly after the surgery and the need to address the research on the evaluation of the effectiveness of the psychosocial interventions on the organ functioning. The findings suggest to integrate the transplantation procedures with psychosocial interventions considering the different needs of recipients in relation to the specific transplanted organ.

Telematics pre-operative psychological and nutritional assessment in candidates for bariatric surgery during COVID-19 phase 2: a pilot prospective observational study

BACKGROUND

Obesity represents a risk factor for COVID-19 infection. Therefore, in order to reduce COVID-19 related comorbidities in obese population a continuation of obesity treatment is needed. However, bariatric procedures were postponed because of COVID-19 restrictions, delaying treatment for obese patients seeking for surgery. This study aimed to test the feasibility of a telematics pre-operative psychological and nutritional assessment as an alternative tool during COVID-19 outbreak.

METHODS

Twenty-six patients were contacted. The pre-operative assessment consisted in 3-weekly one-to-one online sessions and a final in-person multidisciplinary session. The protocol feasibility has been evaluated on the following outcome: rejection rate (%), dropout rate (%), compliance and satisfaction's degree.

RESULTS

Eighteen participants completed the whole protocol and 10% dropped-out. Seventy-two percent of participants obtained an excess weight loss ≥5%. All participants were satisfied of the telematics assessment.

CONCLUSIONS

COVID-19 emergency has changed standard hospital procedures and this study could represent a landmark for an online pre-operative assessment method to adopt in case of new restrictions.

Psychological, emotional and social impairments are associated with adherence and healthcare spending in type 2 diabetic patients: an observational study

OBJECTIVE

The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients.

PATIENTS AND METHODS

Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending.

RESULTS

Mathematical linear regressions models were performed showing the predictive effects of: anxiety and social support scores (RSAS) on adherence levels (respectively p =. 019; p =. 016); adherence levels on anxiolytic use (p =.04); aggressiveness scores (RSAS) on the number of general check-ups (p =.031); TAS-20 and physician-patient communication (IPC) on the number of hospitalization days (respectively p=.001; p=.008); physician patient decision making (IPC) scores on physical activity (IPAQ) levels (p=.025); physical activity (IPAQ) on the number of medical examinations (p=.039).

CONCLUSIONS

An association among psychosocial impairment, adherence and healthcare spending was found. Future studies should investigate the effect of a brief psychological intervention in increasing adherence levels and reducing the healthcare spending in this clinical population.

SAT0162 WITHDRAWAL OF LOW-DOSE STEROIDS IN SYSTEMIC LUPUS ERYTHEMATOSUS IN REMISSION: PREDICTORS OF FLARES AND DIFFERENCE IN OUTCOMES IN SEROLOGICALLY ACTIVE CLINICALLY QUIESCENT PATIENTS

Background:

According to the recent recommendations for Systemic Lupus Erythematosus (SLE), a progressive tapering until withdrawal of glucocorticoids (GC) is considered one of the main goals of SLE management (1). However, which patient may be a candidate for safe GC withdrawal has not been determined yet and a proportion of patients are kept on long-term low-dose prednisone despite clinical remission.

Objectives:

to evaluate the rate of low-dose GC withdrawal in SLE patients in remission and to identify predictors of flares.

Methods:

Eligible patients were SLE patients according to the ACR criteria (2) who were in prolonged clinical remission defined by a cSLEDAI=0 for at least 2 years and on a stable SLE treatment (immunosuppressive drugs and/or hydroxychloroquine (HCQ) and daily 5 mg prednisone). A SACQ period was defined as at least 1-year period with persistent serologic activity without clinical manifestations. Flares were defined by SELENA-SLEDAI Flare Index (3). Damage was assessed by SLICC damage index (SDI). Data were compared by the unpaired student’s t test or chi-squared test as appropriate. Predictors of flares after GC withdrawal were analyzed by Cox regression.

Results:

Out of 246 SLE patients registered in the Naples Lupus Clinic database, 132 eligible patients were identified. Among them, we selected 57 (43%) patients in whom a GC withdrawal was attempted. 75 (57%) patients were in the prednisone maintenance group.

There were no significant differences between the two treatment groups (table 1). The proportion of patients experiencing a flare was not significantly lower in the maintenance group than in the withdrawal group (15/75 vs 16/57; p=0.28). Moreover, the proportion of patients who had an increase in the SDI at the end of follow up was similar between the two groups (14/75 vs 8/57; p=0.48). However, among the withdrawal group, the rate of flares was significantly higher in SACQ patients (10/22 vs 6/35; p=0.02), while the majority of serologically inactive patients (82%) successfully stopped GCs without subsequent flares. At Cox regression analysis (Table 2), duration of HCQ therapy and >4 year remission at withdrawal were protective factors, while a SACQ disease and history of lupus nephritis (LN) increased the risk of disease flare.

Table 1.

Baseline characteristics of 132 patients at study entry

CharacteristicsWithdrawal group (n=57)Maintenance group (n=75)p-valueFemale, no. (%)54 (94)70 (93)0.73Age, years26.7±10.128.5±11.70.37Disease duration, years8.5±2.99.1±12.90.73History of lupus nephritis, no. (%)13(22)22(29)SDI score0.40±0.70.57±0.80.26Immunosuppressive drugs, no. (%)31 (54)33(44)0.16HCQ, no. (%)52 (91)66 (88)0.06Low C3, no. (%)28 (49)41(54)0.52Increased dsDNA Ab, no. (%)11 (19)19 (25)0.41Table 2.

Factors predicting lupus flares during follow-up at Cox regression analysis

VariablesHR95% CIp valueSACQ2.991.08 – 8.250.03Age0.970.93 – 1.020.29Disease duration0.990.94 – 1.040.84History of LN3.381.22-9.330.01SDI score1.130.63 – 2.010.66Immunosuppressive drugs2.390.86 – 6.620.09HCQ, ever2.920.43 – 35.20.95Duration of HCQ0.840.72 – 0.980.035years remission0.120.04 – 0.390.0003

Conclusion:

GC withdrawal is an achievable target in SLE and may be attempted in patients in complete remission. In SACQ patients, maintenance of 5mg prednisone is superior to its withdrawal in order to prevent flares. Long-term HCQ therapy and prolonged remission can significantly reduce the risk of disease relapse after GC withdrawal.

References:

[1]Fanouriakis A, et al. Ann Rheum Dis. 2019;78(6):736–45.

[2]Tan EM, et al. Arthritis Rheum. 1982;25(11):1271–7.

[3]Petri M, et al. Lupus. 1999;8(8):685–91.

Disclosure of Interests:

Serena Fasano: None declared, Luciana Pierro: None declared, Melania Alessia Coscia: None declared, laura Bucci: None declared, silvia scriffignano: None declared, Antonella Riccardi: None declared, francesco ciccia Grant/research support from: pfizer, novartis, roche, Consultant of: pfizer, novartis, lilly, abbvie, Speakers bureau: pfizer, novartis, lilly, abbvie

The association between duration of remission, fatigue, depression and health-related quality of life in Italian patients with systemic lupus erythematosus

OBJECTIVE

To evaluate the impact of duration of remission on the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE).

METHODS

We conducted a 5-year retrospective study on two Italian cohorts. Remission was defined as a continuative period of no clinical disease activity, according to the Systemic Lupus Erythematosus Disease Activity Index 2 K, and a permitted maximum prednisone dose of 5 mg/day. HRQoL was measured using the 36-Item Short-Form Health Survey (SF36) during the last visit.

RESULTS

We enrolled 136 female SLE patients. During observation, 15 (11%) patients had been in remission for ≥1 and <2 years, 15 (11%) for ≥2 and <3 years, 19 (14%) for ≥3 and <4 years, 9 (7%) for ≥4 and <5 years, and 53 (39%) had been in prolonged remission for ≥5 years. In the multivariate model, considering depression and fatigue as covariates, patients in prolonged remission showed significantly better scores in the physical functioning (p = 0.039), role physical (p = 0.029), bodily pain (p = 0.0057), general health (p = 0.0033) and social functioning (p = 0.0085) components of the SF36, compared with those in remission <5 years or unremitted. Subsequent mediation analyses found that these effects were partly influenced by depression.

CONCLUSION

Lupus remission could improve the HRQoL of SLE patients, particularly when associated with appropriate management of depression and fatigue.

Therapeutic Alliance in a Single Versus Group Rehabilitative Setting After Breast Cancer Surgery: Psychological Profile and Performance Rehabilitation

The survival rate of women after breast cancer has improved significantly worldwide. More attention should be paid to the rehabilitation intervention after surgery. Cancer rehabilitation helps breast cancer survivors maintain the highest possible physical, social, psychological, and vocational function in the limits that are imposed by the cancer and its treatments. The aim of our research was to determine the rehabilitative setting that promotes greater efficacy of the rehabilitation. A double-blind, randomized controlled trial with 45 patients enrolled was conducted. All participants were randomized into two groups: single rehabilitative training (N = 22) and group rehabilitative training (N = 23). Outcomes were assessed for each group before treatment (T0), after first 6 weeks of rehabilitative treatment (T1), and after 3 months (T2). All patients underwent the same rehabilitation treatment, but the setting differed between single and group rehabilitative training, which included four to five patients each and evaluated using Minnesota Multiphasic Personality Inventory (MMPI-2), Working Alliance Inventory Patient form (WAIP), Disabilities of Arm, Shoulder and Hand Questionnaire (DASH), and visual analog scale (VAS). Two patients dropped out in the single treatment group. In the within-group analysis at the three evaluation times, on the VAS, a significant reduction in pain was reported and maintained at the follow-up, as was observed for the DASH and WAIP scales. In the between-group analysis WAIP and Bond scale scores differed significantly in favor of the single treatment. In the group treatment, the Psychopathic Deviate, Masculine/Feminine, and Social Discomfort scales of the MMPI-2 correlated with WAIP Tot at T1. There was an association between the Correction, Hysteria, Paranoid, and Schizophrenia MMPI-2 scales and Δ VAS T0T1 in the total sample. Proposing the same rehabilitative intervention in both breast cancer groups, our results showed significant reduction in pain and good functional recovery of the upper limb, which did not depend on the setting (single or group). However, with single rehabilitation treatment, patients developed a better therapeutic alliance and experienced a more comfortable environment.

Reliability of Preoperative Ultrasonography Evaluation for Vitreoretinal Surgery

To evaluate the present level of reliability of common ultrasonography prior to vitreoretinal surgery, we carried out a prospective study to compare preoperative ultrasonography data with direct intraoperative findings. A total of 228 eyes with different vitreoretinal disorders and opaque or clear media were studied. In the group of 187 eyes with fractional retinal detachment (group I), the percentage of agreement between the ultrasonography data and the surgical fingings ranged from 77.1% to 92.2%, depending on the pathology. In the group of 41 eyes without retinal detachment (group II), agreement ranged from 90.4% to 100%. The most frequent causes of failure of preoperative ultrasonography were incorrect prediction of macular detachment, partial posterior vitreous detachment, posterior vitreoschisis and vitreoretinal adhesions. The main cause of failure was the presence of multiple complicated echos in group I, particularly in fractional diabetic retinal detachment. To achieve maximum benefits from ordinary preoperative ultrasonography, the vitreoretinal surgeon must be fully aware of its present level of reliability and general limitations.

Oct Images and Surgery of Juvenile Macular Retinoschisis

We describe three cases of X-linked juvenile retinoschisis confined to the posterior pole of the eye, one of which surgically treated. In the first two cases, in vivo optical coherence tomography (OCT) had revealed a cleavage plane in both nerve fiber and outer retinal layers. In the two similar operated eyes of the third case, postoperative OCT had revealed the disappearance of macular schisis in the eye with good recovery of visual function after surgery. On the contrary, it had revealed a persistent splitting of the retina in the other eye, not clinically visible, which explained the poor recovery of visual function after surgery. In cases with progressive worsening of macular involvement in X-linked juvenile retinoschisis, highly accurate surgery may be considered, and the pre- and postsurgical OCT monitor of these patients is indicated.

Optical Coherence Tomography (OCT) in Retinal Angiomatous Proliferation (RAP)

Purpose

To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD).

Methods

Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA).

Results

RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70.7%]). All eyes had either no or only a low-reflecting OCT signal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization.

Conclusions

OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.

Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review

Background

Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series.

Methods

A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000–2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events.

Results

The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged.

Conclusion

Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

Management of atrial fibrillation in patients undergoing percutaneous coronary intervention

Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 1-2% of overall population, involving more than 6 millions of European people. It is associated to a reduced quality of life and an increased morbidity and mortality. The Framingham study showed the link between angina and AF. The same risk factors, such as hypertension, diabetes and obesity promote both AF and coronary artery disease (CAD). About 1/4 of AF patients develop a CAD and, in this setting, about 1/5 undergoes a percutaneous coronary intervention (PCI). In patients with both AF and CAD, the optimal medical strategy is challenging and it is still debated in cardiological community, since patients treated by dual (two antiplatelets drugs ore one antiplatelets drug and an oral anticoagulant drug) or triple therapy (two antiplatelets drugs and an oral anticoagulant drug) are exposed to divergent risk of bleeding or thromboembolic and ischemic complications. Aim of this paper is to focus the attention on the different problems arising from the presence of AF in patients undergoing PCI, such as the risk of stroke, bleeding and stent thrombosis.

Capillary and cavernous hemangioma of the optic disc. Echographic and histological findings

The ultrasonography features of optic disc hemangioma have been described in various reports but the extreme rarity of this ocular tumour makes any univocal interpretation of echographic findings difficult. The two cases of hemangioma of the optic disc described here, one of capillary hemangioma and the other of cavernous hemangioma, presented different echographic patterns. In the capillary hemangioma B-scan showed a mass lesion with smooth anterior border, acoustic solidity and no choroidal excavation. With A-scan there was an initial high spike with low/medium internal reflectivity. In the cavernous hemangioma, B-scan showed an elevated dome-shaped mass, with an anechoic area inside, and no choroidal excavation. With A-scan there was a high initial spike and irregular reflectivity. The eyes were enucleated for intractable neovascular glaucoma. Histological examination of the lesion explained the different echographic patterns. Ultrasonography is useful in the differential diagnosis of capillary and cavernous hemangioma.

OCT-guided photodynamic therapy for angiographic occult CNV in pathologic myopia

PURPOSE

Pathologic myopia (PM) is frequently complicated by choroidal neovascularization (CNV). Diagnosis is mainly clinical and angiographic but in recent years optical coherence tomography (OCT) has been noted to add important information. The authors report on the successfully OCT-guided photodynamic therapy (PDT) of an angiographic occult CNV complicating PM.

METHODS

Observational case report. Fluorescein angiography with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT Stratus (Carl Zeiss Meditec, Inc.) imaging were used for diagnosis and monitoring of the CNV. Standard PDT was performed.

RESULTS

A highly myopic 17-year-old girl complained of a drop in visual acuity (VA) in left eye (LE), dating back a few weeks. Her best-corrected (BC) VA was 20/40 in the LE, with some metamorphopsia. No hemorrhage or evident signs of CNV were visible either at fundus or at dynamic fluorescein angiography. OCT scans indicated a slight elevation of the RPE-choriocapillary complex with rarefaction of neuroretinal tissue that has been interpreted as CNV. PDT was then performed. LE BCVA had improved to 20/25, metamorphopsias disappeared, and at OCT examination no retinal morphologic modification was evident. Nine months later, BCVA and ophthalmoscopy are still stable.

CONCLUSIONS

In this case, OCT was the fundamental tool for the correct diagnosis and posttherapymonitoring of CNV-complicated PM. The CNV, not clearly detectable using angiographic imaging, was treated with PDT, and results in terms of VA and anatomic resolution were good.

Observation or surgical excision of bilateral subfoveal choroidal neovascularization in Best disease

The purpose of this article is to describe a case of bilateral neovascularization complicating Best Disease. A 12-year-old patient with bilateral neovascularization was managed with observation in the right eye and surgical removal in the other eye. Visual acuity, biomicroscopy and fluorangiography were carried out from 1997 to 2005. The right eye did not experience any change in visual acuity from baseline (20/50) while left eye varied from 20/200 to 20/32. Macular exudative-hemorrhagic manifestations resolved bilaterally. Eight years later, VA and retinal findings were unchanged. In this case, although VA was reasonably good in both eyes, it is difficult to assess the prognosis of surgically excised neovascularization vs natural history, also considering that nowadays photodynamic therapy and antiangiogenetic drugs are considered the therapy of choice in subfoveal neovascularization.

Optical coherence tomography (OCT) angiomatous prolifieration (RAP) in retinal

PURPOSE

To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD).

METHODS

Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA).

RESULTS

RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70. 7%]). All eyes had either no or only a low-reflecting OCTsignal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization.

CONCLUSIONS

OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.

Macular thickness measured by optical coherence tomography (OCT) in diabetic patients

PURPOSE

1) To compare macular thickness (MT) by optical coherence tomography (OCT) in diabetics and controls; 2) to assess the relationship between MT and stage of diabetic retinopathy (DR) and macular edema (ME); 3) to quantify MT changes after laser treatment for ME.

METHODS

One-hundred and thirty-seven patients with diabetes mellitus (216 eyes) were admitted to the study and examined by stereo-color fundus photos, retinal fluorangiography and OCT. DR was classified as: 1) no DR (46 eyes: 21.3%); 2) background DR (66 eyes: 30.6%); 3) pre-proliferative DR (50 eyes: 23.1%); 4) proliferative DR (54 eyes: 25%). The study group was then divided into three ME groups: 1) no edema (65 eyes: 30.1%); 2) not clinically significant ME (no CSME) (45 eyes: 20.8%); 3) clinically significant macular edema (CSME) (106 eyes: 49.1%). Three-month follow-up tomograms were taken to evaluate eyes laser-treated only for ME. The control group consisted of 50 eyes of 50 non-diabetic, age- and sex-matched subjects.

RESULTS

MT was 369.3 +/- 163.2 microm in diabetics and 161.9 +/- 12.9 microm in controls (p < 0.001). In the four DR groups it was: 1) 211.0 +/- 37.6 microm; 2) 370.8 +/- 159.6 microm; 3) 419.1 +/- 138.2 microm; 4) 456.1 +/- 162.0 microm (p<0.001). In the three ME groups, MT was: 1)227.8 +/- 53.4 microm; 2) 321.8 +/- 124.2 microm; 3) 476.2 +/-146.6 microm (p < 0.001). In the 52 eyes treated with laser photocoagulation of the posterior pole only and with a follow-up > 3 months, MT before and after treatment was 468.2 +/- 83. 17 microm and 372.1 +/- 120.63 microm.

CONCLUSIONS

MT was greater in diabetics than controls and tended to increase with DR and ME severity. OCT is a sensitive technique for detecting early diabetic macular abnormalities and quantifying their reduction after laser treatment.

Axial length and refraction in retinal vein occlusions

To assess whether axial length and refraction are risk factors for retinal vein occlusion, we measured these parameters in 88 consecutive patients with unilateral branch retinal vein occlusion (BRVO), in 58 consecutive patients with unilateral central retinal vein occlusion (CRVO) and in 50 patients selected as a control group. Patients and controls were free or affected by systemic or local predisposing factors. We compared eyes with CRVO with control eyes, eyes with BRVO with control eyes, and eyes with CRVO with eyes with BRVO. Comparing CRVO eyes and controls, none of the investigated variables was shown to be significant. From the analysis of BRVO eyes versus controls, it resulted that refraction was the only variable which played the role of an independent prognostic factor. When comparing BRVO eyes with CRVO eyes, we found that age was slightly related to the development of BRVO. In conclusion, faulty refraction appeared to be a risk factor for the development of BRVO. We did not find any influence of axial length on the occlusion of retinal veins.

Choroidal calcifications in patients with Gitelman's syndrome

Gitelman's syndrome is a renal tubular disorder characterized by a sodium and chloride reabsorption defect in distal tubular cells that determines hypokalemia, metabolic alkalosis, hypomagnesemia, and low calcium excretion. The presence of choroidal calcifications was sought in five patients with Gitelman's syndrome by ophthalmic examination, fluorescein angiography, indocyanine green angiography, and ocular ultrasonography. Calcifications observed in the choroid of two patients were shown by ultrasonography in both patients. Ophthalmic and fluorangiographic examinations detected this alteration in one of the two subjects. Chondrocalcinosis was found in one patient with choroidal calcifications. These findings suggest that precipitation of calcium salts can occur in the choroidal tissue of patients with Gitelman's syndrome. Deposits appeared to be well seen by ultrasonography because of their depth in ocular tissues. Sclerochoroidal calcifications may be favored by the low calcium excretion, which is associated with normal intestinal calcium absorption in patients with Gitelman's syndrome.

High-frequency ultrasound biomicroscopy versus ultrasound and optical pachymetry for the measurement of corneal thickness

The aim of this study was to correlate central corneal thickness measurements obtained using optical as well as ultrasound pachymeters and high-frequency ultrasound biomicroscopy (UBM), assuming UBM as reference. Each measurement was performed on 32 patients (60 eyes) by three observers unaware of the other's results, on 3 different days. Pearson correlation was used. A strong correlation was found between UBM and ultrasound pachymetry measurements (r=0.858), a weaker one between UBM and optical pachymetry (r=0.506). Optical versus ultrasound measurements were poorly correlated (r=0.540). Each correlation was statistically significant (p<0.001). UBM can be used as an accurate and reproducible method for determining corneal thickness.

Bilateral occlusion of the central retinal artery in a homocystinuric patient: the role of echography

The authors describe a case presented by a homocystinuric 26-year-old male patient with bilateral occlusion of the central retinal artery. Echography carried out the same day of the occlusion and the following days identified and monitored a mass located in the orbit of the OD. Characteristics and dimension of the mass were confirmed and measured by a CT scan and NMR examination. The orbital mass of the OD appeared to be a swelling of the central retinal artery with echo-refracting opacities, which, in light of recent studies, can be interpreted as multiple arterial thrombi, composed predominantly most likely by platelets. Therapeutic possibilities are discussed.

Extraocular muscle size comparison between normal and myopic eyes using standardized A scan echography

The aim of this study was to establish the range of diameters of extraocular muscles in myopic patients and to obtain the baseline data to follow progression or regression of pathologies involving them. Standardized A scan and B scan ultrasound was used to measure the thickness of straight extraocular muscles at the muscle belly. No statistical differences were seen between right and left eyes. We found no consistent correlation with age or with axial length in the control or in the myopic patients (p>0.05). Diameters in myopic and control eyes were similar. This lack of difference between myopic and control muscle sizes means that we can obtain accurate measurements also from myopic patients.

Unilateral macular retinoschisis with stellate foveal appearance in two females with myopia

Stellate foveal retinoschisis is considered the hallmark of X-linked retinoschisis. We describe the finding of unilateral retinoschisis with stellate foveal appearance in 2 females with myopia who had no evidence of familial disease. Optical coherence tomography (OCT) and fluorescein angiography were obtained in both cases. Neither patient had a family history of low vision, night blindness, or retinal detachment. Visual acuity in the affected eyes was 20/50 and 20/25, respectively. Both fellow eyes had normal fundi, except for mild myopic changes. With OCT, widespread retinal splitting was detected at the posterior pole in the affected eyes, whereas the fellow eyes were normal. In one case, OCT showed that foveal retinoschisis represented the macular involvement of a flat inferior retinoschisis, although this was not clinically apparent. Macular retinoschisis with stellate foveal appearance may rarely be associated with pathologic myopia. OCT was useful to establish the true extension of these macular changes.

Axial length in patients with diabetes

PURPOSE

To investigate the relationship between axial length and retinal involvement in patients with diabetes.

METHODS

A total of 157 consecutive patients with diabetes underwent biometry. The patients were divided into three groups, according to retinopathy: 44 without retinopathy, 37 with background retinopathy, and 76 with proliferative retinopathy. To compare axial length in diabetic versus nondiabetic subjects, a control group of 157 healthy subjects with age and sex distribution similar to the diabetic group was selected from an orthopedic clinic. We investigated in the diabetic group whether the axial length was related to specific type of diabetes (non-insulin-dependent or insulin-dependent), duration of disease, presence of retinopathy, or laser treatment. To eliminate the confounding effect of myopia, we excluded all patients with axial length greater than 24 mm from the two groups. Comparison of diabetic patients without retinopathy versus nondiabetic subjects was also performed.

RESULTS

Diabetic patients presented shorter axial lengths compared with the controls (mean +/- standard deviation, 22.4+/-1.3 mm versus 23.4+/-1.3 mm; P<0.001). Significantly shorter axial lengths were found in the background and proliferative retinopathy groups compared with the group without retinopathy (22.0+/-1.2 mm and 22.1+/-1.1 mm versus 23.2+/-1.4 mm, respectively; P<0.05). No difference in axial length was found between the diabetic patients without retinopathy and the nondiabetic subjects (P = 0.3). Multivariate analyses showed that retinopathy was negatively correlated with axial length (P<0.01). Including only the patients with axial length under 24 mm, we obtained similar results.

CONCLUSION

Axial length is shorter in diabetic patients than in nondiabetic subjects. Within the diabetic group, patients with retinopathy had shorter axial lengths than did patients without retinopathy.

Ultrasound biomicroscopic evaluation of ciliochoroidal effusion after laser treatment

We evaluated ciliochoroidal effusion (CE) by ultrasound biomicroscopy (UBM) following diode endophotocoagulation at the end of the vitreoretinal surgery. The aim of our study was to assess any differences in the CE morphology following diode endophotocoagulation or transpupillary krypton photocoagulation, and to demonstrate the influence of diabetes and intravitreal surgery on CE formation. Sixty-six consecutive patients were divided in to four groups. Twenty-nine patients with proliferative retinopathy underwent transpupillary krypton photocoagulation; 11 diabetic patients underwent vitreoretinal surgery and diode endophotocoagulation; 18 nondiabetics underwent vitreoretinal surgery and diode endophotocoagulation; 8 consecutive nondiabetic patients were the control group and underwent vitreoretinal surgery, without laser treatment. UBM was performed in the four groups before and after laser treatment, if performed. We determined, by UBM, not only the presence, but also the thickness of CE. CE was present in all the patients treated by laser, diabetics and nondiabetics, and its thickness was not correlated with the number of laser spots (p = 0.28). CE was seen ultrasonically in all the patients undergoing transpupillary photocoagulation or endophotocoagulation, regardless of diabetes and surgical trauma.

Optical coherence tomography in idiopathic epiretinal macular membrane surgery

PURPOSE

To evaluate the usefulness of Optical Coherence Tomography (OCT) images for surgical indication, intraoperative management and postoperative outcome of patients with idiopathic epiretinal macular membrane (IEMM).

METHODS

28 selected eyes underwent surgery for removal of IEMM. The patients' mean age was 57.3 years. The macular region and the IEMMs were studied before and after surgery using OCT, slit-lamp biomicroscopy and fundus photography. The mean postoperative follow-up was 6.2 months (range 1.3-14).

RESULTS

Preoperatively, in 12 of the 28 eyes (42.9%) only the OCT images revealed IEMM partially separated from the macula, with tractional focal point(s) of attachment to the macular region. In the other 16 eyes (57.1%) in which IEMMs were totally adherent to the macular region, the membranes were barely visible by OCT in 13 eyes and not visible in three. Intraoperatively, the surgeon was guided in the peeling procedures. A significant correlation (p < 0.001) was found between visual acuity and macular thickness before surgery and at the end of the postoperative follow-up.

CONCLUSIONS

OCT images provide very useful information for the surgical indication, intraoperative management and postoperative outcome of patients with IEMM.

Clinical and ultrasound study of peripheral vitreoretinal adhesions

PURPOSE

To evaluate the frequency of peripheral vitreoretinal adhesions in the region of the vitreous base by ultrasound examination in relation to axial length of the eye and the age of the patient. Patient gender and the presence of visual symptoms also were considered.

METHODS

A total of 228 consecutive patients (445 eyes) underwent biometry, ultrasound examination, and biomicroscopic fundus examination. Their medical history also was taken. The patients were divided into three groups according to axial length of the eye (< 24 mm, 24-26.5 mm, and > 26.5 mm) and into three age groups (20-40 years, 41-60 years, and > 60 years).

RESULTS

No correlations was found between peripheral vitreoretinal adhesions and gender or between peripheral vitreoretinal adhesions and axial length of the eye. A significant correlation was found between peripheral vitreoretinal adhesions and age (P < 0.001). The proportion of adhesions increased with age (P < 0.001). The association between adhesions and presence of symptoms also was significant (P < 0.001). Multivariate analysis showed that only the presence of symptoms independently correlated with adhesions (relative risk, 1.71, 95%; confidence interval, 1.19, 2.46).

CONCLUSION

Our study shows that peripheral vitreoretinal adhesions, detected by ultrasound, were always associated with the presence of symptoms.

Correlation of lens thickness with blood glucose control in diabetes mellitus

The aim of this study was to verify if lens thickness in insulin-dependent diabetic patients is greater than in non-diabetics, and to establish which parameters affect the thickness of the lens age, diabetes duration, glycaemic control, insulin dose. Ultrasound biometry and blood glucose measurements were taken in 87 patients three times a day: fasting 2 and 4 h after lunch. The patient sample was divided into three groups: 30 with no retinopathy, 30 presented background retinopathy and 27 with proliferative retinopathy; 30 normal subjects with a similar age to the diabetic group, comprised the control group. No correlation was found between biometric values and blood glucose in the three groups (p < 0.05). A significant difference in lens thickness was found in the four groups, even after adjusting for age (p < 0.05). Significant differences in lens thickness were seen between proliferative retinopathy and the other groups, after adjusting for age and duration of diabetes (p < 0.05); lens thickness was shown to correlate with diabetes duration (p < 0.05).

Ultrasound biomicroscopy following the intraocular use of silicone oil

We evaluated the ultrasound biomicroscopy findings and the amount and location of silicone oil residue in anterior structures of the eye before and after silicone oil removal. We examined the anterior structures in 40 silicone oil 1000 cs-filled eyes at the end of silicone oil tamponade time (mean silicone oil tamponade duration 5.1 months), and in the same eyes after silicone oil removal. High resolution ultrasound biomicroscopy, 50 MHz transducer, 50 microns of resolution, was used. Silicone oil droplets--often not ophthalmoscopically visible--appeared as highly reflective images with after ringing effect. They were present in the anterior structures of the eye in up to 95% of eyes with silicone oil in the vitreous cavity, and in up to 87.5% after careful silicone oil removal. With ultrasound biomicroscopy it was possible to identify small silicone oil droplets with a typical morphological appearance. Once silicone oil is used in vitreoretinal surgery, its complete removal from the anterior structures of the eye is very difficult to achieve later on.

[Ocular color Doppler echography: the examination technic, identification and flowmetry of the orbital vessels]

We studied the main ocular and retrobulbar vessels with color-Doppler US and report on examination technique, detectability of the vessels and their flow characteristics to define the normal ranges of Doppler spectra for each artery and vein. We comparatively examined both eyes of 20 healthy subjects. Of each eye we studied the ophthalmic artery, the central retinal artery, the ciliary artery, the central retinal vein and the superior ophthalmic vein. The following flow parameters were considered: peak systolic velocity, end-diastolic velocity and resistive index for arteries; maximum and minimum velocity for veins. The examination lasted about 10 minutes per eye--20 minutes for each subject. In all subjects the five investigated vessels were identified in both eyes, and adequate Doppler spectra were obtained. The average peak systolic velocities of ophthalmic, central retinal and ciliary arteries were respectively about 35, 12 and 10 cm/s, with low resistance patterns (resistive index: 0.75, 0.72 and 0.68, respectively). The venous flow, which is usually continuous, may be sometimes influenced by cardiac and respiratory activities: the maximum velocities of superior ophthalmic and central retinal veins were about 6 and 5 cm/s, respectively. Color-Doppler US noninvasively visualizes both ocular and retrobulbar vessels, providing major hemodynamic information from different flow parameters; the knowledge of these parameters in normal conditions can be the basis of hemodynamic studies in many abnormal orbital conditions.

Echographic diagnosis of Drusen of the optic nerve head in patients with angioid streaks

A total of 58 patients (116 eyes) with angioid streaks, referred to this department over 2 years (1990-1992), underwent a thorough ophthalmic examination, retinal fluorescein angiography, dermatological visit with skin biopsy, and a series of other examinations (blood and biochemistry, skull X-ray, vascular echo Doppler, abdominal ultrasound) and eye ultrasonography. Fifty patients (100 eyes, 86.2%) had pseudoxanthoma elasticum (PXE). In the whole caselist, 21.6% had drusen compared with 21.0% in the group with PXE. Both these findings are higher than those published elsewhere. Drusen of the optic nerve head were also found in 25% of the 16 eyes (8 patients) with angioid streaks but no PXE. We believe we found a higher prevalence of drusen of the optic nerve head in these patients with angioid streaks because we systematically employed ultrasound.

Correlation of corneal thickness with blood glucose control in diabetes mellitus

The aim of this study was to prove the existence of a correlation between corneal thickness and glycaemic control in insulin-dependent patients. Ultrasound pachometry and blood glucose measurements were taken in 87 patients three times a day: fasting, two, and four hours after lunch. The sample was divided into three groups of patients: 30 of them did not have retinopathy, 30 presented background retinopathy and 27 proliferative retinopathy. Thirty normal age-matched subjects were the control group. No correlation was found between pachometry values, blood glucose and duration of diabetes in the three groups (p > 0.05). A significant increase in corneal thickness was found in patients with background and proliferative retinopathy compared to the others (p < 0.01). No corneal thickness differences resulted between background and proliferative retinopathy (p = 0.74).

Prenatal detection and early diagnosis of hereditary retinoblastoma in a family

A couple asked for prenatal testing, the husband being a retinoblastoma survivor. Family history suggested that the tumor predisposing mutation came from his paternal side. DNA analysis indicated that the foetus had not inherited that mutation. Detection of a regressed retinoblastoma in the husband's mother changed the interpretation of the haplotypes obtained, and it was concluded that the foetus had inherited the mutation. Ultrasonography on the 3rd day of extra-uterine life showed a retinal mass in the newborn's left eye. Two years later, the couple asked for a new prenatal diagnosis. DNA analysis showed that the foetus had inherited the mutant retinoblastoma haplotype from the father. Fundus examination on the 2nd day of extra-uterine life showed a retinal lesion in the newborn's left eye at the posterior pole. This case indicates the necessity of a thorough check on history and an ophthalmological examination of family members.

Ocular involvement in acute lymphoblastic leukemia: an echographic study

We report a case of acute lymphoblastic leukemia (ALL) with ocular involvement in which bilateral swelling of the optic disk head was noticed. Massive direct infiltration of the optic nerve head by leukemic cells can give rise to a clinical picture identical to that of a true papilledema. Ocular echography allowed a better and more complete interpretation of the optic disk involvement. No echographic description of a leukemic infiltration of the optic nerve head has been reported previously.

Peripheral retinal changes and axial myopia

The relationship between the presence of peripheral chorioretinal changes and axial myopia in 513 eyes (513 patients) 24 mm or more in length, or beyond the upper range of normal axial length, is studied. Axial length was measured with A-scan ultrasonography (immersion technique) and retinal periphery was studied by biomicroscopic examination and scleral indentation. The presence of lattice degeneration, pavingstone degeneration, pigmentary degeneration, white with or without pressure (WWP), retinal holes, tears, or both (RHT), retinal detachment, and posterior vitreous detachment was reported. The correlation between presence of a lesion and a longer axial length was always significant, except with retinal detachment, pigmentary degeneration, and RHT. Pavingstone degeneration was significantly related to older age and WWP and RHT to younger age. Posterior vitreous detachment was frequent in almost all axial length groups and age classes. No significant relationship was found between any kind of lesion and gender of the patient, or between axial length and patient age.

Chronic bilateral dacryo-adenitis in identical twins: a possible incomplete form of Sjögren syndrome

We report an unusual case of chronic bilateral dacryo-adenitis in 10-year-old identical twin sisters. Both girls presented with bilateral lacrimal gland enlargement and developed moderate xerophthalmia and keratitis. Both the lacrimal and minor salivary gland biopsies showed a non-granulomatous inflammatory infiltration of mono-nuclear cells. All granulomatous diseases and neoplasms could therefore be ruled out and only Sjögren syndrome and very few other forms of chronic dacryo-adenitis remained as possible diagnoses. Both patients and their parents were evaluated for auto-antibodies. Very low titres of smooth muscle antibodies were found in one, antinuclear antibodies in two and anti-dsDNA antibodies in all four members of the family. Even though the titres of antinuclear and anti-dsDNA antibodies increased in one of the sisters, both patients did not develop any sign or symptom of a systemic connective tissue disease. During the 6 years' follow up, both patients showed persistent tarsal gland enlargement but no other symptoms apart from a moderate xerophthalmia and occasional mild keratitis.

Microphthalmos with colobomatous orbital cyst in trisomy 13

The authors describe a case of trisomy 13 with microphthalmos and colobomatous cyst of the optic nerve and of the chorioretina with orbital extension, in a six-month-old female patient. The colobomatous cyst has been studied by means of computerized axial tomography and ultrasonography in order to follow its evolution. The orbital cyst has not increased in size.

Early ultrasonographic diagnosis of hereditary retinoblastoma

A hereditary retinoblastoma (RTB) was identified by ocular echography in a newborn, whose predisposition to RTB had been assessed based on the family history and DNA testing of the chorionic villi at the eighth week of pregnancy. Ultrasonography was performed during pregnancies without an abnormality being demonstrated. On the third day of life a B-scan examination showed a small membranous lesion in the nasal parapapillary area, whilst on A-scan, the lesion appeared as a hyperreflective peak. Thanks to its early identification, the tumor was successfully treated by photocoagulation.

Hypertensive choroidopathy: a case report

The authors report a case of exudative retinal detachment of the posterior pole and peripheral choroidal detachment in a patient with renovascular accelerated hypertension. The peculiar clinical situation of this patient was comparable with experimental models of hypertension recently reported in the literature. Both the retinal and the choroidal detachment regressed after blood pressure stabilization with systemic antihypertensive therapy, supporting a choroidal pathogenesis for the chorioretinal lesions.

Clinical variability in keratometry, ultrasound biometry measurements, and emmetropic intraocular lens power calculation

We calculated inter-examiner and intra-examiner variability in keratometry and ultrasound biometry when performed by two different examiners. The potential effect on intraocular lens power calculation was also considered. Intra-examiner variability was statistically and clinically significant for axial measurements, particularly in eyes with axial length greater than 24 mm. Thus, variability in biometric examination affected the emmetropic intraocular lens power, especially in myopic eyes.