Showing papers by "Vincenzo Scorcia published in 2020"

Dry eye in the COVID-19 era: how the measures for controlling pandemic might harm ocular surface.

Abstract: Dear Editor, The novel coronavirus (COVID-19) has quickly spread all over the world, and the number of cases and deaths is continuously growing. Since there is no currently available vaccine or therapy, unprecedented public health measures of home confinement including smart schooling/working as well as the mass use of face masks have been imposed in order to reduce the size of the outbreak [1]. Although we believe that these measures are essential for controlling pandemic, we would like to discuss about their potential impact on the health of ocular surface. In particular, we have identified two main mechanisms that could be responsible for the onset and/or worsening of dry eye disease (DED) symptoms. On one hand, the increase in smart schooling/working exposes individuals to a higher use of visual display terminal (VDT) that is a well-known risk factor for DED [2]. The excessive evaporation of tear fluid attributable to prolonged blinking intervals while gazing is thought to be the main causative factor. On the other hand, the mass use of face mask could represent an additional piece of the complex puzzle of DED in the COVID-19 era. In fact, the displacement of the mask or its incorrect fitting could disperse air around the eyes, and the air leaking could cause a rapid evaporation of tears. This scenario is similar to that one described in the setting of continuous positive airway pressure (CPAP) users but to a lesser extent. In fact, it is known that CPAP therapy increases ocular irritation, tear evaporation, and squamous metaplasia in the conjunctiva [3]. In order to investigate the prevalence of ocular discomfort symptoms pertaining to DED during COVID-19 pandemic, we administered a survey titled “COVID-19” to 200 randomly selected students attending the Faculty of Medicine of the University Magna Græcia (Catanzaro, Italy). Ethics approval for this study was obtained from the local Institutional Review Board. Of the 200 surveys we attempted to deliver, 107 were returned with success. Respondents had a mean age of 28.5 years and 69 of them (64.5%) were female. Twenty-six (24.3%) used VDT in the last month for > 6 h daily, while 72 (67.3%) wore face mask > 6 h daily (Fig. 1 A-B). Eleven subjects (10.3%) described appearance or worsening of ocular discomfort symptoms, and 21 (19.6%) reported the need for daily use of tear substitutes. The mean score of Ocular Surface Disease Index was 21, and 61 subjects (57%) scored ≥ 15 (pathological values) [4]. It has been shown that ocular symptoms including dry eye are relatively common among COVID-19 patients and can appear before the onset of respiratory symptomatology [5, 6]. There are emerging concerns that also the measures for controlling COVID-19 outbreak could determine detrimental effects on ocular surface. Our survey administered to healthy students exposed to both the risk factors for DED related to anti-pandemic measures (intense VDT use and face mask wearing) showed that a significant proportion experienced the onset of ocular discomfort symptoms that required the use of tear substitutes. Considering the difficulty of predicting the duration of the anti-pandemic measures, a longitudinal examination of DED signs and symptoms in healthy subjects and DED patients is desirable to evaluate the long-term impact of these measures on ocular surface. In the meantime, awareness among ophthalmologists of ocular surface diseases * Giuseppe Giannaccare giuseppe.giannaccare@gmail.com

May home confinement during the COVID-19 outbreak worsen the global burden of myopia?

Abstract: The novel coronavirus (2019-nCoV) that originated inWuhan (China) has quickly spread all over the world. As of April 12, 2020, there have been with more than 1,600,000 confirmed cases and 100,000 deaths globally [1]. To restrict contact among individuals, governments have imposed unprecedented public health measures such as travel bans, workplace distancing, and schools closure. The aim of these measures is to reduce the size of the outbreak as well as its peak in order to decrease the amount of stress on healthcare systems. In a recent correspondence on Lancet, Wang and colleagues pointed out that the measures ordered by the Chinese government to limit the spread of the novel coronavirus, and in particular schools closure, might have negative effects on children’s physical andmental health [2]. In fact, the authors stated that when children are out of school, they are physically less active and have longer screen time, irregular sleep pattern, and less favorable diets resulting in weight gain and loss of cardiorespiratory fitness. In addition, the psychological sphere can also be affected by this forced change of lifestyle. We would like to add another piece to the puzzle of potential impacts of home confinement on children, which is the increased risk of myopia (namely, “quarantine myopia”). The prevalence of myopia has rapidly increased over the past few decades, particularly in countries from East and Southeast Asia. Insufficient time spent outdoors is recognized as an important risk factor for its development [3]. Furthermore, the duration and intensity of near work activities (e.g., reading and writing) are also associated with myopia [4]. The mechanisms of visual feedback regulating the eye growth are complex and not completely understood. Factors that may mediate the relationship between time spent outdoors and myopia include the brightness and chromatic spectrum of light, the energy at high spatial frequencies, the peripheral defocus, and the circadian rhythms [3]. According to UNESCO, more than 160 countries have closed schools in the attempt at containing the spread of COVID-19, and this measure involves over 87% of world’s student population [5]. An important consequence of home confinement on children’s health could be the development and/or the worsening of myopia. Since the exact duration of exposure is currently undetermined, it is difficult to estimate the effect from a refractive standpoint. A recent modeling study on influenza reported that in case of severe pandemics, the reduction of the cumulative disease incidence could be possible only with school dismissal lasting 16 weeks or longer [6]. A prolonged home confinement would very likely have a significant impact on the global incidence of myopia. This represents a serious public health concern for two main reasons. First, uncorrected myopia represents a major cause of visual disability in children, particularly in lowand middleincome countries. Second, high myopia in the current pediatric population is linked to a high risk of potentially sightthreatening complications in the next generations of elderly. A range of new interventions for reducing the progression of myopia in children have now reached high level of evidence [7]. A recent network analysis indicated that the most effective options are muscarinic antagonists such as atropine and pirenzepine, whereas certain specially designed contact lenses including orthokeratology and peripheral defocus modifying contact lenses have moderate effects [7]. Therefore, a post-pandemic ophthalmological surveillance program for children with myopia involving decision-making based on demographical and clinical characteristics, risk factors, and * Giuseppe Giannaccare giuseppe.giannaccare@gmail.com

Clinical Applications of Astaxanthin in the Treatment of Ocular Diseases: Emerging Insights

Abstract: Astaxanthin is a naturally occurring red carotenoid pigment belonging to the family of xanthophylls, and is typically found in marine environments, especially in microalgae and seafood such as salmonids, shrimps and lobsters. Due to its unique molecular structure, astaxanthin features some important biologic properties, mostly represented by strong antioxidant, anti-inflammatory and antiapoptotic activities. A growing body of evidence suggests that astaxanthin is efficacious in the prevention and treatment of several ocular diseases, ranging from the anterior to the posterior pole of the eye. Therefore, the present review aimed at providing a comprehensive evaluation of current clinical applications of astaxanthin in the management of ocular diseases. The efficacy of this carotenoid in the setting of retinal diseases, ocular surface disorders, uveitis, cataract and asthenopia is reported in numerous animal and human studies, which highlight its ability of modulating several metabolic pathways, subsequently restoring the cellular homeostatic balance. To maximize its multitarget therapeutic effects, further long-term clinical trials are warranted in order to define appropriate dosage, route of administration and exact composition of the final product.

The Role of Nutrition and Nutritional Supplements in Ocular Surface Diseases

Abstract: Dry eye disease (DED) is a multifactorial disease of the ocular surface system whose chore mechanisms are tear film instability, inflammation, tear hyperosmolarity and epithelial damage. In recent years, novel therapies specifically targeting inflammation and oxidative stress are being investigated and used in this field. Therefore, an increasing body of evidence supporting the possible role of different micronutrients and nutraceutical products for the treatment of ocular surface diseases is now available. In the present review, we analyzed in detail the effects on ocular surface of omega-3 fatty acids, vitamins A, B12, C, D, selenium, curcumin and flavonoids. Among these, the efficacy of omega-3 fatty acid supplementation in ameliorating DED signs and symptoms is supported by robust scientific evidence. Further long-term clinical trials are warranted to confirm the safety and efficacy of the supplementation of the other micronutrients and nutraceuticals.

MicroRNA-1281 as a Novel Circulating Biomarker in Patients With Diabetic Retinopathy.

Abstract: Objective: Recently, the role of circulating miRNAs as non-invasive biomarkers for the identification and monitoring of diabetes microvascular complications has emerged. Herein, we aimed to: identify circulating miRNAs differentially expressed in patients with and without diabetic retinopathy (DR); examine their predictive value; and understand their pathogenic impact. Methods: Pooled serum samples from randomly selected matched patients with type 2 diabetes, either with or without DR, were used for initial serum miRNA profiling. Validation of the most relevant miRNAs was thereafter conducted by RT-qPCR in an extended sample of patients with DR and matched controls. Results: Following miRNA profiling, 43 miRNAs were significantly up- or down-regulated in patients with DR compared with controls. After individual validation, 5 miRNAs were found significantly overexpressed in patients with DR. One of them, miR-1281, was the most up-regulated and appeared to be specifically related to DR. Furthermore, secreted levels of miR-1281 were increased in high glucose-cultured retinal cells, and there was evidence of a potential link between glucose-induced miR-1281 up-regulation and DR. Conclusion: Our findings suggest miR-1281 as a circulating biomarker of DR. Also, they highlight the pathogenic significance of miR-1281, providing insights for a new potential target in treating DR.

Acute Acquired Concomitant Esotropia From Excessive Application of Near Vision During the COVID-19 Lockdown.

Abstract: The public health measures imposed in many countries to slow the spread of the novel coronavirus (COVID-19) outbreak could have negative effects on children's physical and mental health. The authors describe four cases of acquired concomitant acute esotropia likely caused from excessive application of near vision during the COVID-19 lockdown. [J Pediatr Ophthalmol Strabismus. 2020;57:e88-e91.].

Therapeutic Effects of Lactoferrin in Ocular Diseases: From Dry Eye Disease to Infections

Abstract: Lactoferrin is a naturally occurring iron-binding glycoprotein, produced and secreted by mucosal epithelial cells and neutrophils in various mammalian species, including humans. It is typically found in fluids like saliva, milk and tears, where it reaches the maximum concentration. Thanks to its unique anti-inflammatory, antioxidant and antimicrobial activities, topical application of lactoferrin plays a crucial role in the maintenance of a healthy ocular surface system. The present review aims to provide a comprehensive evaluation of the clinical applications of lactoferrin in ocular diseases. Besides the well-known antibacterial effect, novel interest has been rising towards its potential application in the field of dry eye and viral infections. A growing body of evidence supports the antimicrobial efficacy of lactoferrin, which is not limited to its iron-chelating properties but also depends on its capability to directly interact with pathogen particles while playing immunomodulatory effects. Nowadays, lactoferrin antiviral activity is of special interest, since lactoferrin-based eye drops could be adopted to treat/prevent the new severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, which has conjunctivitis among its possible clinical manifestations. In the future, further data from randomized controlled studies are desirable to confirm the efficacy of lactoferrin in the wide range of ocular conditions where it can be used.

Repeatability and reproducibility of post-mortem central corneal thickness measurements using a portable optical coherence tomography system in humans: a prospective multicenter study.

Abstract: To assess the repeatability and reproducibility of post-mortem central corneal thickness (CCT) measurements made by the portable iVue spectra-domain (SD) optical coherence tomography OCT (Optovue Inc, Fremont, CA) system in humans, and to prospectively establish the time-course of CCT after death. In a prospective multicenter setting, CCT measurements were obtained from 58 human eyes at the following 16 time-points after death: immediately (within 2 h), and at each hour by the next 17 h. The range of CCT values for each subject was determined and longitudinal data were used to illustrate the variation in open and close eye mode. All measurements were made by two independent and well-trained examiners for session. Main outcome measures were intraclass correlation coefficients (ICC), repeatability and reproducibility coefficients, and coefficients of variation of the average central (0-2 mm). Overall, a total of 5,568 OCT measurements were performed by examiners. The repeatability coefficient varied from 0.3 to 1.7% and the reproducibility coefficient varied from 0.3 to 1.6% throughout the entire experimental time frame. Furthermore, the values of the different ICCs were also high during the different postmortem intervals, thus demonstrating the excellent repeatability and reproducibility of the present OCT approach. When CCT measurements were analyzed longitudinally, corneal thickness showed different behavior based on the open or close eye mode. The present study demonstrates that portable OCT imaging can be reliably used for corneal pachymetric measurements in supine subjects and during the post mortem period, i.e. without visual fixation and normal physiology/architecture of examined tissues.

In Vivo and Ex Vivo Comprehensive Evaluation of Corneal Reinnervation in Eyes Neurotized With Contralateral Supratrochlear and Supraorbital Nerves.

Abstract: Purpose To use an automated morphometric analysis system of in vivo confocal microscopy (IVCM) images for evaluating reinnervation occurring at the subbasal nerve plexus (SNP) after direct corneal neurotization (DCN) and to further report neurophysiological and histopathological findings. Methods Prospective interventional case series including 3 eyes with neurotrophic keratitis that underwent DCN. Deep anterior lamellar keratoplasty was performed 18 months after DCN in patient 1. The following evaluations were performed before and at 3, 6, and 12 months after DCN: clinical evolution of keratitis; corneal sensitivity; IVCM images of the SNP analyzed with "ACCMetrics;" neurophysiological study of corneal reflex. Protein gene product 9.5 immunofluorescence staining assay and transmission electron microscopy were conducted on the neurotized button excised during deep anterior lamellar keratoplasty. Results Complete healing was obtained in all patients by 3 months postoperatively. Corneal sensitivity was absent preoperatively in all eyes and improved after surgery, reaching an average value of 30 mm 1 year postoperatively. The corneal SNP was not visible at IVCM in any of the cases preoperatively and became visible by 3 months postoperatively, showing IVCM metrics comparable to normal contralateral eyes at 1 year. In all cases, neurophysiological evaluation showed a partial recovery of the electrical activity of the cornea. In patient 1, protein gene product (PGP) 9.5 staining of neurotized cornea showed nerve fascicles at the SNP, whereas transmission electron microscopy showed amyelinic nerve axons and nerve endings. Conclusions The corneal SNP exhibited IVCM metrics comparable to the normal contralateral eye 1 year after DCN. Ex vivo histopathological assessment of neurotized corneas confirmed the presence of nerves with normal ultrastructure.

Diagnostic Performance of a Novel Noninvasive Workup in the Setting of Dry Eye Disease

Abstract: Purpose. To evaluate the diagnostic performance of a novel noninvasive automated workup employed for the diagnosis of dry eye disease (DED). Methods. One hundred patients with mild to moderate DED and 100 matched control subjects were enrolled in this cross-sectional study. Ocular surface examinations were carried out by means of IDRA Plus (SBM Sistemi, Turin, Italy), which allows the automated evaluation of noninvasive breakup time (NIBUT), lipid layer thickness (LLT), tear meniscus height (TMH), infrared meibography for the measurement of meibomian gland loss (MGL), and blinking analysis. Continuous variables were compared between patients with DED and controls by using the Mann–Whitney U test. The area under the curve (AUC) of receiver operating characteristic curves was calculated. The correlations between ocular surface parameters were evaluated with Pearson correlation analysis. Results. Patients with DED showed significantly lower values of NIBUT, LLT, and TMH compared to controls (6.9 ± 2.5 vs 10.4 ± 2.4 s, = 0.003; 0.231 ± 0.115 vs 0.289 ± 0.164, = 0.012, respectively). Conversely, no significant differences were observed for MGL and blinking analysis (both > 0.05). NIBUT had the highest diagnostic power (AUC = 0.841, sensitivity = 0.89, and specificity = 0.69), followed by LLT (AUC = 0.621, sensitivity = 0.89, and specificity = 0.55), TMH (AUC = 0.606, sensitivity = 0.57, and specificity = 0.63), blink analysis (AUC = 0.533, sensitivity = 0.48, and specificity = 0.59), and MGL (AUC = 0.531, sensitivity = 0.54, and specificity = 0.48). In patients with DED, NIBUT showed a significant correlation with TMH (R = 0.347, = 0.002) and blinking analysis (R = 0.356, = 0.008). Conclusions. The automated noninvasive workup validated in this study may be a useful tool for reaching a noninvasive diagnosis of DED with a good performance, especially for NIBUT.

Umbilical Cord Blood and Serum for the Treatment of Ocular Diseases: A Comprehensive Review

Abstract: Several blood derivatives have been proposed for the treatment of various ocular diseases that affect either the anterior or the posterior segment of the eye. Blood sources may range from the patient's own peripheral blood (autologous) to donor tissues, mainly allogeneic peripheral blood and umbilical cord blood (UCB). The utilization of the latter permits the collection of a large amount of serum all at once, and is characterized by therapeutic feasibility in patients with a poor general condition or anemia and blood dyscrasia. Products derived from UCB have two potential uses. First, serum in the form of eye drops can be applied topically onto the ocular surface to efficiently treat anterior segment disorders such as dry eye syndrome or corneal epithelial defects with different etiologies. The rationale for and efficacy of this application derive from the high concentrations of biologically active components and growth factors in UCB, which can nourish the ocular surface. Second, UCB is a source of stem cells, which are used in the field of regenerative medicine because they differentiate into various mature cells, including corneal and retinal cells. Therefore, UCB-derived stem cells have been proposed as a replacement therapy for the treatment of retinal and optic nerve diseases, given that current standard treatments often fail. The present review explores the clinical results that have been obtained using UCB-derived products in the field of ophthalmology, as well as the current limitations of those products in this field. Furthermore, given the promising development of UCB-based therapies, possible future directions in this area are discussed.

Anti-VEGF Treatment in Corneal Diseases.

Abstract: Background Corneal neovascularization (CN) is a clue feature of different ocular pathological conditions and can lead to corneal edema and opacification with subsequent vision loss. Vascular endothelial growth factor (VEGF), which plays a key role in new vessels formation, proliferation and migration, was found to be up-regulated in these conditions. Nowadays, it is possible to downregulate the angiogenic process by using anti-VEGF agents administered by different routes. Objective To evaluate the efficacy, safety and possible future directions of anti-VEGF agents used for the treatment of CNV owing to different aetiologies. Methods A computerized search of articles dealing with the topic of anti-VEGF therapy in CN was conducted in PubMed, Scopus and Medline electronic databases. The following key phrases were used: anti-VEGF agents, corneal neovascularization, bevacizumab, ranibizumab, vascular endothelial growth factor, angiogenesis. Results The use of anti-VEGF therapy in the treatment of CN reduced pathological vessel density without causing significant side effects. Various administration routes such as topical, subconjunctival and intrastromal ones are available, and the choice depends on patient and disease characteristics. Much more effectiveness is achieved in case of early administration before mature and wellestablished vessels take place. A combined approach between various drugs including anti-VEGF agents should be adopted in those cases at higher risk of neovascularization recurrence such as chronic long-standing diseases where ischemic and inflammatory stimuli are not definitively reversed. Conclusion The efficacy and safety of anti-VEGF agents support their adoption into the daily clinical practice for the management of CN.

Longitudinal Analysis of Infrared Meibography in Patients Undergoing Hematopoietic Stem Cell Transplantation.

Abstract: Purpose To evaluate meibomian gland (MG) changes in patients undergoing hematopoietic stem cell transplantation (HSCT) by infrared meibography and to further investigate possible correlations with hematological characteristics. Methods Thirty-three patients were included: infrared meibography of the lower eyelid, Schirmer test, tear break-up time, ocular surface staining, and Ocular Surface Disease Index questionnaire were conducted before (V0) and 4 months after HSCT (V1). A paired samples t test was used to compare parameters before and after HSCT. A mixed analysis of variance was used to assess the effect of hematological characteristics on changes of MG loss (MGL) after HSCT. Results MGL and corneal staining significantly increased after HSCT (respectively, from 24.3% ± 10.1% to 32.2 ± 15.0 and from 1.2 ± 1.5 to 2.0 ± 1.7; always P 0.05). At V1, MGs' quality reduced in 16 patients (48.5%), remained unchanged in 14 (42.4%), and improved in 3 (9.1%). The increase of MGL after HSCT was higher in patients receiving myeloablative conditioning regimen (P = 0.005). Conclusions MG function, loss, and quality significantly worsened after HSCT. Myeloablative conditioning regimen was associated with higher MGL.

Comparison of corneal densitometry between big-bubble and visco-bubble deep anterior lamellar keratoplasty

Abstract: Aims To evaluate deep corneal densitometry and visual outcomes after big-bubble (BB-DALK) and visco-bubble (VB-DALK) deep anterior lamellar keratoplasty performed in patients with keratoconus. Methods Prospective comparative study of 50 advanced keratoconic patients who underwent DALK surgery; 25 eyes (group I) were completed with BB-DALK and 25 eyes (group II) with VB-DALK after the failure of pneumatic dissection. Best spectacle-corrected visual acuity (BSCVA), corneal tomographic parameters and endothelial cell count were recorded 1, 3, 6, 12 and 24 months after surgery. Densitometric analysis of the deep corneal interface was obtained using Scheimpflug tomography at each visit; values recorded were compared between the two groups and statistically analysed. Results BSCVA was significantly better in the BB-DALK group than the VB-DALK group (0.39±0.29 vs 0.65±0.23 logarithm of the minimum angle of resolution, respectively) for the first 3 months; and in the same time period, densitometry was significantly higher in the VB-DALK group than those recorded in the BB-DALK group (23.97±5.34 vs 17.13±4.44 grayscale units). However, densitometric values and visual acuity did not differ significantly in the two groups at 1 year. No statistically significant difference for the other variables analysed at any time frame was found. Conclusion The use of viscoelastic substance in the VB-DALK technique may induce modification of interface stromal reflectivity resulting in reduced visual acuity up to 3 months postoperatively. However, this initial negative effect on the interface quality does not affect the long-term visual outcome, with densitometric values and visual outcomes similar in the two groups from 6 months postoperatively.

Preliminary Results of a Novel Standardized Technique of Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus.

Abstract: Purpose. To evaluate the feasibility and the initial outcomes of a novel standardized surgical technique of femtosecond laser- (FSL-) assisted big-bubble deep anterior lamellar keratoplasty (BBDALK) for eyes with keratoconus. Methods. This prospective interventional case series included 11 consecutive FSL-assisted BBDALK procedures performed for the eyes with keratoconus from September 2019 to December 2019. The FSL was used to create (i) an intrastromal channel incision (1.7 mm in length, 4.6 mm in width, 80% depth, and cut energy of 1.70 μJ) and (ii) a 9.0 mm diameter circular lamellar side cut 65 μm above the endothelium (cut energy of 0.90 μJ) intersecting the intrastromal incision. In the operating room, a blunt dissector was used to open the intrastromal channel incision, through which a blunt spatula was inserted, tangentially advanced towards the center of the cornea, and replaced with a blunt cannula for pneumatic dissection. The subsequent surgical steps did not differ from the conventional technique. Main outcome measures were the success rate of pneumatic dissection and the percentage of intraoperative complications. Results. Eleven eyes of 11 patients (6 males and 5 females; mean age: 34.54 ± 13.23 years) underwent FSL-assisted DALK. Using the FSL, both corneal incisions (lamellar side cut and intrastromal channel incision) were successfully created in all cases without the need for repeat docking or additional dissection. Pneumatic dissection with type 1 bubble formation succeeded in all 11 eyes (100%). DALK surgery was completed uneventfully in all cases. Descemet membrane perforation did not occur in any case, and no procedure was converted to penetrating keratoplasty. Conclusion. Using standardized FSL parameters for both incision design and cut energy in BBDALK surgery, pneumatic dissection can be achieved in a very high rate of cases with minimal risk of intraoperative complications.

Stromal peeling for deep anterior lamellar keratoplasty in post-penetrating keratoplasty eyes.

Abstract: BACKGROUND/AIMS To evaluate the clinical outcomes of deep anterior lamellar keratoplasty performed by stromal peeling in eyes that have previously undergone penetrating keratoplasty (PK) for keratoconus. METHODS Standardised stromal exchange included (1) 9 mm trephination of the recipient bed outside the old PK wound, (2) creation of a partial anterior corneal flap through lamellar dissection across the PK wound, (3) opening the stromal component of the old PK wound using blunt-tipped Vannas scissors until a plane of separation is reached, (4) severing the attachment of the PK surgical scar from the recipient host, (5) peeling the stroma of the PK graft from the underlying tissue and (6) suturing the donor anterior corneal lamella prepared by microkeratome dissection (450 µm depth, 9 mm diameter). Main outcome measures were success rate, best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss (ECL). RESULTS Of 21 post-PK eyes, stromal exchange succeeded in all but three cases, which were converted to a two-piece mushroom PK. After complete suture removal, mean BSCVA significantly improved from 0.95±0.39 logMAR preoperatively to 0.23±0.17 logMAR (p<0.001). Mean ECL was 5.4±23.2%. Double anterior chamber formation occurred in eight cases (44%), which all resolved after a single re-bubbling. CONCLUSION In post-PK eyes, stromal exchange can be performed by means of simple peeling without deep anterior lamellar dissection of the previous PK graft. Large-diameter (9 mm) repeat keratoplasty through stromal peeling yields excellent visual outcomes and minimal ECL. Double anterior chamber formation may complicate the postoperative course, but prompt intervention allows successful management.

Sterile Corneal Perforation Occurring Several Years After Biliopancreatic Diversion.

Abstract: To report the first two cases of sterile corneal perforation secondary to vitamin A deficiency after biliopancreatic diversion with duodenal switch (BPD/SW). Observational case series. Two patients with a history of BPD/SW presented with corneal perforation associated with conjunctival xerosis and keratopathy. In both cases, serum vitamin A level dosage revealed a marked deficit, and the patients admitted poor compliance with vitamin supplementation. Oral therapy with vitamin A was started immediately, and in one case ocular surgery was performed to preserve the integrity of the globe. Ophthalmologists should carefully examine the ocular surface of patients undergone bariatric surgery in order to promptly recognize the signs of vitamin A deficiency and avoid serious sight-threatening complications.

Keratoconus: advances in anterior lamellar keratoplasty techniques

Abstract: Introduction: Deep anterior lamellar keratoplasty (DALK) is nowadays considered the gold standard for the surgical treatment of keratoconus thanks to the lower rate of complications compare...

False Myths versus Medical Facts: Ten Common Misconceptions Related to Dry Eye Disease.

Abstract: Since the first definition of dry eye, rapid progress has been made in this field over the past decades that has guided profound changes in the definition, classification, diagnosis and management of the disease Although dry eye is one of the most frequently encountered ocular conditions, various “old” misconceptions persist, in particular among comprehensive ophthalmologists not specialized in ocular surface diseases These misconceptions hamper the correct diagnosis and the proper management of dry eye in the routine clinical practice In the present review, we described the 10 most common misconceptions related to dry eye and provided an evidence-based guide for reconsidering them using the format “false myth versus medical fact” These misconceptions concern the dry eye definition and classification (#1, #2, #3), disease physiopathology (#4), diagnosis (#5), symptoms (#6, #7) and treatment (#8, #9, #10) Nowadays, dry eye is still an under-recognized and evolving disease that poses significant clinical challenges to ophthalmologists The two major reasons behind these challenges include the heterogeneity of the conditions that fall under the umbrella term of dry eye and the common discrepancy between signs and symptoms

Donor-to-host transmission of infection: contrasting outcomes of lamellar and penetrating keratoplasty.

Abstract: Donor-to-host transmission of infection is a rare complication of corneal transplantation. Recent evidence reported an increasing trend in the incidence of fungal infection after endothelial keratoplasty compared to penetrating keratoplasty (PK), although neither observation reached statistical significance. The main reason is the creation in lamellar techniques of a donor-host interface that provides a hypoxic sequestered environment for microorganisms to thrive protected from the host immune response. We describe herein the contrasting outcomes of two patients who received tissues from the same donor contaminated with Candida albicans: the first patient underwent Descemet's stripping automated endothelial keratoplasty (DSAEK), while the second one underwent PK.

Ultrasound cyclo plasty for the management of glaucoma secondary to ocular irradiation for choroidal melanoma.

Abstract: Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna 40138, Italy Ophthalmology Unit, Infermi Hospital, Rimini 47838, Italy Ophthalmology Department, Hospital Universitario La Paz, Madrid 28046, Spain Department of Ophthalmology, University of “Magna Graecia”, Catanzaro 88100, Italy Correspondence to: Giuseppe Giannaccare. Department of Ophthalmology, University of “Magna Graecia”, Catanzaro 88100, Italy. giuseppe.giannaccare@gmail.com Received: 2019-04-25 Accepted: 2019-06-13

A Preliminary Comparative Study of Visual Performance Between Two Newly Commercially Available Monofocal Intraocular Lenses Implanted During Cataract Surgery.

Abstract: Purpose To compare visual outcomes of two newly developed monofocal intraocular lenses (IOLs) (I-Stream H and CT Lucia 211P) implanted in patients undergoing surgery for senile cataract. Methods This prospective, comparative, single-center, randomized study included 94 eyes of 94 patients undergoing cataract surgery. Patients were randomized to receive the implantation of I-Stream H IOL (Group 1) or CT Lucia 211P IOL (Group 2). Each patient underwent a complete ocular examination before (V0), 1 month (V1), 3 months (V2) and 6 months (V3) after surgery, including visual acuity testing, objective refraction, slit-lamp biomicroscopy, contrast sensitivity testing and visual function index questionnaire (VF-14). Results After surgery, a significant increase of best-corrected visual acuity (BCVA), CS and VF-14 and a significant decrease of SE were detected in both groups at each time point compared to baseline (always p 0.05). Eyes with an actual refraction within 0.25, 0.50 and 1 D were 53.1%, 85.1% and 100% for Group 1 and 55.3%, 87.2% and 100% for Group 2 (p>0.05). Conclusion I-Stream H and CT Lucia 211P allowed a satisfied recovery of visual function after senile cataract surgery; both IOLs were shown to have similar outcomes of visual performance.

Ex vivo photoactivated chromophore for keratitis-corneal crosslinking on inverted graft: new approach to manage interface infectious keratitis after deep anterior lamellar keratoplasty.

Abstract: A 44-year-old man affected by keratoconus underwent deep anterior lamellar keratoplasty (DALK). Two weeks postoperatively, slitlamp examination showed greyish-white lesions in the donor-host interface. Corneal scraping and donor broth culture tested negative for both bacteria and fungi. In vivo confocal microscopy showed elongated particles resembling Candida pseudofilaments. Despite antimicrobial therapy, the clinical picture worsened and surgical approach was chosen: the graft was peeled off, inverted (epithelium facing down) and ex vivo photoactivated chromophore for infectious keratitis-corneal collagen cross-linking (PACK-CXL) was performed; the recipient bed was washed with antibiotics/antifungals and the graft was resutured. Microbiological and histological evaluations of biopsy specimen tested positive for Candida albicans. Postoperative slitlamp examination revealed a progressive recovery of graft transparency with disappearance of the infiltrates. To the author's knowledge, this is the first report of ex vivo PACK-CXL on inverted DALK graft for the treatment of interface infectious keratitis. This technique allowed the resolution of the infection while sparing the use of new donor tissue.

In-vivo and ex-vivo analysis of an unusual case of huge bullous keratopathy.

Abstract: Cite this article as: Giannaccare G, Lucisano A, Scorcia V. In-vivo and ex-vivo analysis of an unusual case of huge bullous keratopathy. Indian J Ophthalmol 2020;68.2524. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.