Atrial septal aneurysm: echopolycardiographic study

Atrial septal aneurysm (ASA) with diagnosis during life is a rarely reported anomaly, especially when not associated with other congenital or acquired valvular cardiopathies. Among 4,000 routine echocardiograms, 23 cases of ASA were found (8 men and 14 women, aged 19 to 79 years). Three patients had coronary artery disease, 2 had dilated cardiomyopathy, 2 had systemic hypertension, 11 had mitral valve prolapse and 5 had no other identifiable cardiovascular diseases. Echocardiography revealed various motion patterns of ASA. No phonomechanocardiographic findings were related to the presence of ASA, and no correlation between echographic and phonocardiographic findings was found.     

Perception of, and anxiety levels induced by, laser treatment in patients with sight-threatening diabetic retinopathy. A multicentre study.

AIMS: To investigate how laser treatment is perceived, in terms of anxiety and awareness, by diabetic patients attending four centres in Northern Italy with specific interest and expertise in diabetic retinopathy, where work settings and flow are organized differently. METHODS: The Hospital Anxiety and Depression Scale (HADS), Family Apgar-List of Threatening Experiences (FA-LTE), State-Trait Anxiety Inventories 1 and 2 (STAI-1 and STAI-2) questionnaires were completed by 259 patients, 131 waiting for laser treatment and 128 control subejcts awaiting non-intervention visits. Open questions were also asked on whether patients had ever heard the word 'laser' and whether they could describe laser treatment. RESULTS: High scores were detected by HADS, STAI-1 and STAI-2 among patients waiting for photocoagulation. Anxiety was greater in women and people with poor schooling. After controlling for centres, gender, previous laser treatment and schooling, HADS and STAI-1 remained significantly lower among persons waiting for non-intervention visits. Having received photocoagulation previously did not modify anxiety. Anxiety was lower in those centres where facilities and resources were more patient-oriented. Most patients could neither describe photocoagulation nor explain why they were about to receive it, but had a negative perception and some described it with words evoking cruelty and pain. CONCLUSIONS: These data suggest that laser treatment is experienced as an event that causes anxiety. Preoperative education and counselling may help to reduce fear and patients' avoidance of treatment.     

Optical coherence tomography angiography in dry age-related macular degeneration

Optical coherence tomography angiography is a new imaging modality that provides noninvasive characterization and quantification of the microvasculature in different retinal conditions. The purpose of this study was to give an updated review of the features of dry age-related macular degeneration investigated by means of new-generation optical coherence tomography angiography. We searched PubMed and Medline using the terms “optical coherence tomography angiography” associated with “age-related macular degeneration,” “drusen,” “reticular pseudodrusen,” and “geographic atrophy” and reviewed publications up to January 2017.     

Serous Retinal Detachments Complicating Interferon-α and Ribavirin Treatment in Patients with Hepatitis C

Purpose

To report the cases of two patients with chronic hepatitis C infection showing serous retinal detachments similar to Vogt-Koyanagi-Harada (VKH) disease.

Methods

We reviewed the clinical records of two patients who were diagnosed with VKH-like disease during combined interferon-α (IFNα) and ribavirin treatment.

Results

Interruption of IFNα and ribavirin treatment in association with oral corticosteroids resulted in a favorable visual outcome in the case of diffuse retinal detachment (case 1). On the contrary, visual acuity did not improve when late cicatricial stage disease was already present (case 2).

Conclusions

There is increasing evidence of a link between hepatitis C virus infection treated with pegylated IFNα-2b and the development of VKH-like disease. Knowing the potential side effects of IFNα and ribavirin administration is fundamentally important, as is the need to closely follow up those patients that need to undergo this treatment.Key Words: Serous retinal detachment, Vogt-Koyanagi-Harada, Hepatitis C, Interferon, Uveitis     

Experience with the Pascal® photocoagulator: an analysis of over 1,200 laser procedures with regard to parameter refinement

Aim:

To systematically refine and recommend parameter settings of spot size, power, and treatment duration using the Pascal^® photocoagulator, a multi-spot, semi-automated, short-duration laser system.

Materials and Methods:

A retrospective consecutive series with 752 Caucasian eyes and 1242 laser procedures over two years were grouped into, (1) 374 macular focal / grid photocoagulation (FP), (2), 666 panretinal photocoagulation (PRP), and (3) 202 barrage photocoagulation (BP). Parameters for power, duration, spot number, and spot size were recorded for every group.

Results:

Power parameters for all groups showed a non-gaussian distribution; FP group, median 190 mW, range 100 – 950 mW, and PRP group, median 800 mW, range 100 – 2000 mW. On subgroup comparison, for similar spot size, as treatment duration decreased, the power required increased, albeit in a much lesser proportion than that given by energy = power × time. Most frequently used patterns were single spot (89% of cases) in FP, 5 × 5 box (72%) in PRP, and 2 × 2 box (78%) in BP. Spot diameters as high as ≈ 700 μm on retina were given in the PRP group. Single session PRP was attempted in six eyes with a median spot count of 3500.

Conclusion:

Overall, due to the small duration of its pulse, the Pascal^® photocoagulator tends to use higher powers, although much lower cumulative energies, than those used in a conventional laser. The consequent lesser heat dissipation, especially lateral, can allow one to use relatively larger spot sizes and give more closely spaced burns, without incurring significant side effects.