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Purpose To explore the risk factors for central retinal vein occlusion (CRVO) by comparing a large sample of patients with healthy controls. Materials and Methods Multi-center case-control study. The study group includes patients affected by central retinal vein occlusion, confirmed angiographically, aged 50 years old or above (Group A). The control group includes healthy subjects without an history of retinal vein occlusion (Group B). Outcome measures: age, gender, active smoking, presence of uncontrolled arterial hypertension (uHTN), presence of the following comorbidities: diabetes mellitus type II (DMII), chronic liver disease (CLD), chronic kidney disease (CKD), thyroid disease (TD), systemic lupus erythematosus (SLE), hyperhomocystenemia (HHcy), dyslipidemia (DLip), carotid artery disease (CAD), glaucoma, atrial fibrillation (AF), migraine headache (MH), chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), history of myocardial infarction (MI). Odds-ratios were calculated with logistic regression analysis. Results A total of 203 patients (Group A) and 339 controls (Group B). Statistically-significant differences were found for the following variables: age (OR: 1.109 [1.081–1.138], p Conclusions Older age, active smoking, as well as presence of DMII, HHcy, DLip, CAD, glaucoma, OSAS, and uHTN, all increase the risk for CRVO. A comprehensive assessment of patients with CRVO is paramount. Adequate control of all the aforementioned risk factors is likely of great significance in reducing the incidence of CRVO among the general population, and it likely plays an important role in improving the prognosis following the occlusive event.

Elena Pacella,1 Lorenzo Loffredo,2 Mariaelena Malvasi,1 Edoardo Trovato Battagliola,1 Daniela Messineo,3 Fernanda Pacella,1 Loredana Arrico1 1Department of Sense Organs, University of Rome La Sapienza, Rome, Italy; 2Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy; 3Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Rome, ItalyCorrespondence: Fernanda PacellaDepartment of Sense Organs, University of Rome La Sapienza, Policlinico Umberto I, Viale del Policlinico 155 – 00161, Rome, ItalyTel +39 3333534396Email fernanda.pacella@gmail.comPurpose: Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants.Materials and Methods: A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards.Results: Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and − 0.41 mmHg (T3) (p < 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and − 0.66 mmHg (T3) (p < 0.05).Conclusion: Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30– 90 days following the implantation procedure and responds well to topical pressure-lowering medications.Keywords: intravitreal dexamethasone implant, Ozurdex injection, hypertension, side effect, complications, retinal vein occlusion

Dyslexia is a language-based learning disability. Although this condition is characterized by anatomical malformation of the brain, it seems that the typical reading pattern of dyslexic may be also related to more complex sensory deficits. Among them, visual-perceptive deficits have been described in a subtype of dyslexia, called visual-perceptive dyslexia. The distinctive feature of a patient suffering from visual-perceptive dyslexia form is marked by effortlessly recognize the characteristics of each individual stimulus. The Tetra protocol is a visual-perceptual evaluation protocol that was introduced for the diagnostic phase and the rehabilitation of visual-perceptive dyslexia. The diagnostic tests include: the eidomorphometry test, designed to evaluate the perception of spatial relationships; the contrast sensitivity threshold test, especially at low spatial frequencies; and the REPORT TEST words, to assess the speed and the reading efficiency. In addition, the rehabilitation phase is carried out with the visual neuro-enhancement program TRIGRAM, a visual training proposal designed to reduce the lateral masking phenomenon in visual-perceptive dyslexic. Thus, in this study we used the diagnostic tests of TETRA® Protocol to determine presence of visual-perceptual abnormalities in children with dyslexia. Proven time the presence of these visual-perceptual alterations, the patients were also subjected to the rehabilitation sessions of TRIGRAM, in order to investigate whether this visual training may improve the pattern of reading. At the end of the program (t1) and after three months (t2), the same subjects underwent the same diagnostic tests of TETRA® Protocol to evaluate and confirm the results obtained during rehabilitation program. The results showed a significant increase in contrast sensitivity at low and high spatial frequencies. Moreover, the same improvements in the visual system's ability to discriminate the contours of an object within the field of view, have been maintained three months after the end of treatment. We also observed a significant improvement in the perception of spatial relationships, with reduction of SRA value. In conclusion, this study demonstrates that the visual rehabilitation training (TRIGRAM) is able to improve the perception of spatial relationships, and increase contrast sensitivity in young patients affected by "visual dyslexia". Nonetheless, these data need to be confirmed in larger cohort of subjects in order to establish whether these effects can also increase lexical ability (increased reading speed and reduce errors during the lexical task).

Purpose: To evaluate the efficacy and the safety of the enzymatic vitreolysis with a single intravitreal injection of ocriplasmin 125 μg across a group of patients with symptomatic vitreomacular adhesion (sVMA) during 6 months follow up. Design: A randomized, placebo-controlled, double-masked, 6-month follow up study. Participants: A total of 28 patients (12 M / 16F) (19 receiving ocriplasmin; 9 receiving placebo), mean aged 71 years old, diagnosed with sVMA, VMT, FTMH e ERM by optical coherence tomography. Methods: A single intravitreal injection of ocriplasmin 125 μg or placebo. Primary endpoint was sVMA resolution or FTMH closure. Secondary endpoint included the integrity of the external membrane and the inner and outer segments of the photoreceptor interface using OCT. The evaluation was carried out at baseline and during 6 months after intravitreal injection of ocriplasmin or placebo. Results: After a 6 months follow-up period, the rate of VMA resolution was 42.1% in the Ocriplasmin group vs the 22% in the placebo group. FTMH closure rate was 50% in the Ocriplasmin group vs 0% in the placebo group. The best results were optained within 28 days from the treatment. No case of uveitis, endophthalmitis, retinal tears, retinal detachment or bleeding during follow-up were reported. One patient reported floaters and transitional photopsias. Conclusions: The study confirmed the efficacy and safety of Ocriplasmin injection for patients with VMT, including when associated with full-thickness macular holes during six months follow up. Long term studies are certainly needed to confirm these results.

Background: Retinal arterial macroaneurysms (RAM) is a pathological dilatation of retinal arterial vessel. Argon laser photocoagulation has been for a long time the gold standard of many vascular diseases of the retina such as macroaneurysm. From this work emerges how the introduction of intravitreal anti-VEGF therapies have enhanced the 'effectiveness of the combination of argon laser photocoagulation in cases of persistent retinal edema, we present the case of a retinal macroaneurysm with macular hemorrhage focus and oedema in a patient with a history of systemic arterial hypertension. Methods: A 77 year-old woman patient reported sudden decline in visual acuity in the left eye; the best corrected visual acuity (BCVA)was 1/10 in left eye. Fluorescein angiography (FAG) resulted in diagnosis of Macroaneurysm at the posterior pole with macular hemorrhage focus and oedema. The patient was treated with laser treatment in the left eye; after 30 days, the visual acuity was 1/50 and at optical coherence tomography (OCT) the retinal profile was significantly altered. After 30 days, a single intravitreal ranibizumab injection was performed and, after 7 days, visual acuity was 1/10. After 24 months from ranibizumab-based therapy the final visual acuity was 10/10 and OCT examination revealed a normal retinal profile. Conclusion: In this case report the association of argon laser photocoagulation with intravitreal anti-VEGF injection has been proven to be effective and safe in case of persistent retinal oedema.

Objective: The study compares the effectiveness of an intravitreal slow-release dexamethasone implant respect to an intravitreal injection of a anti-VEGF, ranibizumab, in the treatment of diabetic macular edema (DME). Design: we used a non randomized retrospective study to compare the effectiveness of two treatment approaches to DME Subjects: 50 patients were investigated, 30 of whom underwent injections of ranibizumab and 20 of whom underwent dexamethasone implantation. Methods: When patients were injected with the anti-VEGF ranibizumab, they were monitored every three months. Dexamethasone implant was administered only once in 6 months, different to ranibizumab which was administered monthly . Main Outcome Measures: these were carried out by measuring the improvements in ETDRS (visual acuity scores) and CMT (central macular thickness) after one month, three months, and six months (T1, T3, T6). intraocular pressure were performed. Results: Data evidenced that the slow-release dexamethasone implant is more efficacious than the intravitreal injection of the anti-VEGF, ranibizumab, in terms of improvement of visual acuity and central macular thickness. Dexamethasone implant at T3 produced an improvement of visual acuity which was significantly better respect to injections of ranibizumab, with a mean ETDRS gain of nearly 8,5 letters, compared to only 4 letters gained in the case of ranibizumab injected patients. This significance, however, is lost by T6, (p=0.516), where those treated with dexamethasone had lost 6 of the eight letters gained, while those with ranibizumab had lost 4 letters. As such, the overall gain at the T6 checkpoint was only 2.5 letters for dexamethasone implant and 2 for ranibizumab. Conclusion: The study highlighted a better initial efficacy of the dexamethasone implant due to its superior performance at 3 and 6 month evaluation points.

Purpose: to evaluate the efficacy and safety of combined therapy with Photodynamic Therapy with Verteporfin (PDT-V) and intravitreal ranibizumab same-day compared with monotherapy with ranibizumab (three monthly injections ) for the treatment of the choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Type of study : open-label, randomized controlled trial (RCT). Materials and Methods: 17 eyes of 17 patients were consecutively enrolled and randomly assigned to ranibizumab intravitreal injection + PDT compared with a control group of 30 eyes of 30 patients treated with only ranibizumab 0.5mg in three monthly injections. Best corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography were examined before and after treatment. Patients were followed-up for twelve months. Results: in the combined therapy group, the mean baseline BCVA is 32.6 letters, at 24-months after treatment it’s 31.4 letters with a loss of 1.2 letters. The mean central thickness at baseline is 314.6 µm. After twenty four months the mean CMT is 222.5 µm, with mean CMT reduction of 92.1µm. In the ranibizumab-alone group, the mean baseline BCVA is 29.1 letters at 24-months it’s 28.6 letters with a little loss of 0.5 letters. The mean baseline CMT is 297.6 µm, at 24-months it is 235.9 µm, with mean CMT reduction of 61,7µm. Conclusions: the two treatments showed the same efficacy from a functional and anatomic point of view with a less number of retreatments in the combined therapy group. There were no serious ocular adverse events such as retinal detachment, endophthalmitis or ocular hypertone.

Background: The aim of this study is systematically review the scientific literature on the relationship between tobacco smoking exposure and UM. Methods: The search was performed on Medline and Scopus databases. For each database, we used the following query: “smok* AND (eye OR uveal) melanoma”. Results: 3 observational studies were considered suitable, two case-control studies and one cohort study. There is no significant evidence in the scientific literature about the association between smoking and UM. Conclusions: More complete and multi-center studies are desirable, giving the importance of smoking as a risk factor in the development of cancers.

Introduction: Accomodative esotropia is secondary to inappropriate convergence during accomodative effort in an uncorrected hyperope and is often familial. Case presentation: we report the case of 20 year old Caucasian patient with congenital esotropia alternating, of 30 prism diopters distance (5 m) and 40 prism diopters of esotropia at near, in both eyes. Measures: Was performed strabismus, in peribulbar anesthesia, the right medial rectus was cashed 3.0mm, the left medial rectus was collected 3.5 mm. Results: Immediately after surgery, the patient complained of intermittent diplopia, resolved with orthotic exercise which stimulated binocular vision, Conclusion: This case report suggests that the surgical correction strabismus, should be considered with due caution in the treatment of congenital esotropia alternating and branches, and in some clinical scenarios selected to avoid the complication of postoperative diplopia, that in the case report resolved so benign. After three months surgical treatmen, remains a small angle strabismus aesthetically acceptable, has not given double vision and remains abnormal retinal correspondence with orthotic exercise.

Identify if glycorrhachia and cerebrospinal fluid protein could influence the time of sensory block to T10, the duration and the metameric block's level, after a standard dose of Ropivacaine.80 patients, ASA I - III undergoing to transurethral prostate resection with spinal anesthesia in a prospected open study were recruited. A 0.2 ml liquor's sample was taken; glycorrhachia, by glycemic stix and CSF protein, by urinary stix, were got, before Ropivacaine 0.5% 15 mg injection (0.10 - 0.15 mlsec). After anti-trendelemburg, with 30 ° tilting for 15 min, the onset of sensory block to T10, the maximum metameric level to 15' and the time of sensory block were reported. The data collection were analyzed using the software language R.A significant correlation liquor specific weigh preoperative glycemia (0.749), liquoral specific weigh glycorrhachia (rho = 0.751; R2 = 0.564; P 0.05) and specific weigh CSF protein (rho = 0.684; R2 = 0.468; P 0.05) were reported. Inverse relation CSF weightsensory block level (rho -0.789, P 0.05, R2 0.621) was evidenced. Inverse relation onset time to T10 glycorrhachia (84%) and cephalic block glycorrhachia (76%) were found. Inverse correlation onset time to T 10 CSF protein and cephalic block proteinorrachia was respectively 84% and 67%. A rho of 0.712 with R2 of 51% BMI onset to T10 and rho of 0.681 with R2 of 51% BMI maximum cephalic block with P 0.05 were reported.The predictability of a iso-hypobaric local anesthetic could reduce the risk of procedure failure and adverse events by further cephalic spread.

The Authors report three cases of ophthalmic neurosyphilis in patients who complained a visual decrease monocular. The diagnosis was performed with physical and fundus examination, electrophysiological, hemato-chemical and microbiological tests, fluorangiografy and RMN. The physical examination provided standard results about eyes interested while the fundus examination, as well as the electrofunctional and fuorangiografy examinations, showed some alterations. The sockets and encephalon RMN were normal. Moreover; the patients were submitted to specific haematic and microbiological laboratory tests which showed positivity for syphilis. To sum up all patients received an incidental diagnosis of syphilis. This trend could be attributable to an extensive use of antibiotics that changing the natural course of disease, mask clinical evidences and make them harder to diagnose.

Purpose To evaluate the visual, motor, and sensory outcomes of photorefractive keratectomy (PRK) in the treatment of purely refractive accommodative esotropia in young adult patients. Setting Policlinico Umberto I, Department of Ophthalmology, Rome, Italy. Methods This prospective study comprised patients with hyperopia and purely accommodative hyperopic esotropia. A complete ophthalmologic examination was performed preoperatively and 1, 3, and 12 months postoperatively. The examination included uncorrected (UDVA) and corrected (CDVA) distance visual acuities and orthoptic and sensory tests. All patients also had keratometry, pachymetry, and corneal topography assessment before and after treatment. Treatment was performed using a Technolas 217 excimer laser. Results Thirty eyes of 15 patients (mean age 30.8 years) were treated. Preoperatively, the CDVA was 20/30 or better in all eyes and the mean cycloplegic spherical equivalent (SE) was +3.50 diopters (D). One year postoperatively, the UDVA was 20/30 or better in all eyes and the mean SE was −0.01 D. The mean esotropic deviation for distance vision without correction preoperatively was 8.7 prism diopters. At 1 year of follow-up, 12 patients achieved orthophoria and 3 patients had a reduction in the angle of deviation. There were no intraoperative or postoperative complications. Stereopsis was unaffected by treatment in all patients. Conclusions Photorefractive keratectomy was effective in the treatment of purely accommodative esotropia in young adult patients at a follow-up of 1 year. There were no cases of visual acuity loss or complications from the laser treatment.