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ABSTRACTPurposeElectric weapons have dangers associated with their use, such as burns and trauma related with the impacts of uncontrolled falls, even though they often minimize morbidity and mortality. The exact visual outcome of the damage inflicted is unknown, even though numerous studies have been documented in the literature about the ocular damage induced by the use of these tools.MethodsWe present a narrative review of types of eye damage associated with the use of the Taser. The following search terms were used to identify eligible articles through the PubMed database: “TASER”, “Conducted Electric Weapons”, “CEWs”.ResultsA total of 15 articles were included with information about 38 patients with eye damage associated with the use of taser. The majority of patients were males. In most cases the mechanism of injury was the penetration of the probe inside the eye. Clinical manifestations of ocular damage were present in only 18 out of 38 cases and varied according to the type of damage mechanism. Indeed, the cases in which the probe had penetrated the eye showed more severe clinical manifestations with a poor visual outcome.ConclusionIn conclusion, the introduction of taser use for law enforcement requires serious consideration and adequate training for officers.

BackgroundWe aimed to define the capability of three different publicly available large language models, Chat Generative Pretrained Transformer (ChatGPT-3.5), ChatGPT-4 and Google Gemini in analysing retinal detachment cases and suggesting the best possible surgical planning.MethodsAnalysis of 54 retinal detachments records entered into ChatGPT and Gemini’s interfaces. After asking ‘Specify what kind of surgical planning you would suggest and the eventual intraocular tamponade.’ and collecting the given answers, we assessed the level of agreement with the common opinion of three expert vitreoretinal surgeons. Moreover, ChatGPT and Gemini answers were graded 1–5 (from poor to excellent quality), according to the Global Quality Score (GQS).ResultsAfter excluding 4 controversial cases, 50 cases were included. Overall, ChatGPT-3.5, ChatGPT-4 and Google Gemini surgical choices agreed with those of vitreoretinal surgeons in 40/50 (80%), 42/50 (84%) and 35/50 (70%) of cases. Google Gemini was not able to respond in five cases. Contingency analysis showed significant differences between ChatGPT-4 and Gemini (p=0.03). ChatGPT’s GQS were 3.9±0.8 and 4.2±0.7 for versions 3.5 and 4, while Gemini scored 3.5±1.1. There was no statistical difference between the two ChatGPTs (p=0.22), while both outperformed Gemini scores (p=0.03 and p=0.002, respectively). The main source of error was endotamponade choice (14% for ChatGPT-3.5 and 4, and 12% for Google Gemini). Only ChatGPT-4 was able to suggest a combined phacovitrectomy approach.ConclusionIn conclusion, Google Gemini and ChatGPT evaluated vitreoretinal patients’ records in a coherent manner, showing a good level of agreement with expert surgeons. According to the GQS, ChatGPT’s recommendations were much more accurate and precise.

Background To discuss the efficacy of an inferior implant of XEN 63 gel stent in a patient with refractory glaucoma after trabeculectomy failure and vitreoretinal surgery with silicone oil tamponade.Case Description We report the case of a 73-year-old man with a history of refractory open glaucoma with trabeculectomy failure. He experienced recurrent retinal detachments with silicone oil tamponade, with uncontrolled intra-ocular pressure (IOP) after silicone oil removal. Due to the presence of oil emulsion in the anterior chamber, the chosen location for XEN 63 implantation was the infero-temporal quadrant. Mild hyphema and vitreous hemorrhage were seen post-operatively, but were self-limiting. At week 1, the intraocular pressure was 8 mmHg with a well-formed bleb seen in anterior segment optical coherence tomography (AS-OCT). At 6 month follow up, the patient maintained a IOP of 12 mmHg without topical hypotensive drugs. Slit lamp examination revealed a widespread, developed bleb with no signs of inflammation.Conclusion In this case of refractory glaucoma in a vitrectomized eye with previous oil tamponade, the inferior placement of the XEN 63 gel stent delivered an adequate intraocular pressure even at 6-months follow up, with a diffuse functional infero-nasal bleb seen with AS-OCT.

Objective: To evaluate the safety and efficacy of a new surgical technique for the management of primary rhegmatogenous retinal detachment (RRD), consisting of localized PPV near the retinal break(s), without infusion line, associated with a drainage of subretinal fluid and cryoretinopexy. Methods: Multicentric prospective study conducted at the University Hospital of Cagliari and IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma. Twenty eyes affected by RRD with the causative retinal break(s) in the superior meridians were enrolled between February 2022 and June 2022. Patients with cataract ≥3, aphakia, significant posterior capsule opacification, giant retinal tears, retinal dialysis, history of trauma and PVR ≥C2 were excluded. All eyes underwent a two-port 25-gauge PPV with localized removal of the vitreous surrounding retinal break(s), followed by 20% SF6 injection and cryopexy. The surgical time was recorded for each procedure. Best-corrected visual acuity (BCVA) was measured at baseline and postoperative 6 months. Results: Primary anatomic success at 6 months was achieved by 85% of patients. No complications occurred, except for three (15%) retinal re-detachments. The average surgical time was 8.61 ± 2.16 min. Overall, the difference between pre- and last postoperative mean BCVA was statistically significant (p= 0.02). Conclusions: Two-port dry PPV demonstrated safety and efficacy for the treatment of RRD, reaching an 85% of anatomical success rate. Although further studies are necessary to confirm the efficacy and long-term benefit of this treatment, we believe that this surgical technique could be considered a valid and safe alternative for the management of primary RRD.

Background To describe the efficacy and safety of the adjustable system eyeWatch in vitrectomized glacomatous eyes.Methods Prospective, non-comparative, small case series of 2 patients who underwent glaucoma drainage device implant with the eyeWatch system. Intraocular pressure, number of medications and early and late complications were evaluated.Results None of the operated eyes developed early or late complications. After 1 week post operatively, the IOP raised at 28 mmHg in the first eye and 25 mmHg in the second one. The eyeWatch Pen was used to open and set the device into position 3 (that means implant half opened) After waiting for 30 min, IOP was 15 mmHg and 11 mmHg, respectively. Thirty days after surgery we set the EyeWatch into position 0 (that means implant full opened) even though the IOP was under control. A new IOP measurement was done and we registered that IOP was 14 mmHg and 10 mmHg respectively, and it remained stable after six months of follow up.Conclusion In conclusion, in our case series the use of eyeWatch adjustable system allows a safe and gradual regulation of the flow during post-operative management also in vitrectomized eyes. Considering the percentage of hypotony related complications in vitrectomized eyes this system is an effective and safe technique to handle glaucoma in post vitreoretinal surgery eyes.

Introduction To report a case of a 57-years-old female patient who presented with prominent bilateral proptosis and swollen disks.Case description A 57-year-old obese patient admitted to our ophthalmic department complaining of bilateral sense of eye swelling and mild blurring vision. The anterior segment and pupillary reflex were normal on ophthalmological testing. Likewise, eye movements were preserved and she did not report diplopia in any position of gaze. Dilated fundus examination revealed bilateral hemorrhagic papilledema, pre-retinal hemorrhages in both eyes, dot and blot hemorrhages in the peripheral retina. Visual acuity was 20/20 in both eyes. Routine hematological investigations revealed increased both Von Willebrand factor and ristocetin factor and LAC positivity. The lumbar puncture (LP) showed elevated cerebrospinal fluid (CSF) proteins. Magnetic resonance imaging (MRI) with contrast of brain and spinal cord showed signs of intracranial hypertension and the presence of two lesions in continuity with each other respectively located at T12-L1 and L1-L2. Radiologic features were compatible with the diagnosis of ependymoma. A surgical procedure was conducted and confirmed the diagnosis after anatomical pathology analysis.Conclusion Although rare, bilateral hemorrhagic swollen disks could be an early sign of spinal cord tumors, in particular ependymomas.

Bei mittelschwerem bis schwerem Glaukom ist die Trabekulektomie nach wie vor der «Goldstandard» für die Senkung des Augen­innendrucks (IOP); allerdings erfordert diese Methode eine umfangreiche postoperative Behandlung. Die mikroinvasive Glaukomchirurgie (MIGS) wurde entwickelt, um den intra- und postoperativen Pflegeaufwand zu verringern und gleichzeitig eine akzeptable Senkung des Augeninnendrucks bei Patienten mit leichtem bis mittelschwerem Glaukom zu ermöglichen. Der PreserFlo® MicroShunt (früher InnFocus MicroShunt) ist ein 8,5 mm großes Glaukom-Drainagegerät, das aus Poly(styrol-block-isobutylen-block-styrol) (SIBS), einem äußerst biokompatiblen und bioinerten Material, hergestellt wird. Das Lumen ist eng genug, um eine Hypotonie zu verhindern, aber groß genug, um nicht von Zellschuppen oder Pigmenten verstopft zu werden. Das Gerät wird ab externo, als eigenständiger Eingriff oder in Verbindung mit einer Kataraktoperation, mit intraoperativem Mitomycin C implantiert und ein Sickerkissen unter der Bindehaut und der Tenon-Kapsel erzeugt. Der MicroShunt wurde 2012 mit dem CE-Zeichen versehen und für das primäre Offenwinkelglaukom entwickelt, bei dem der IOP nach maximal verträglicher topischer Behandlung unkontrolliert bleibt. Es wurden mehrere klinische Studien zur Langzeitsicherheit und -wirksamkeit des MicroShunt durchgeführt, die die Wirksamkeit des Geräts über einen längeren Zeitraum und ein erträgliches Sicherheitsprofil belegen. Ziel der vorliegenden Studie ist es, Evidenz für die Wirksamkeit und Sicherheit von PreserFlo fast 10 Jahre nach seiner Einführung zu sammeln und es mit anderen MIGS und der Trabekulektomie, dem Goldstandard in der Glaukomtherapie, zu vergleichen.

Purpose: Previous reports described unfavorable visual outcomes after surgery for uveitic macular pucker. Our goal was to demonstrate that patients with history of uveitis may benefit from vitrectomy for epiretinal membrane if executed under appropriate circumstances.Methods: We performed pars plana vitrectomy with ERM and ILM peeling in patients with post-uveitic macular pucker who did not show signs of ocular inflammation for at least 3 months after the suspension of immunosuppressive therapy. Visual acuity, central macular thickness at OCT, ocular inflammation, and complications were recorded.Results: Twenty-six eyes were operated. Mean duration of follow-up was 67 months. Visual acuity significantly improved from 20/80 to 20/40 after surgery. Vision increased in 20 (77%), remained stable in 4 (15%), and decreased in 2 (8%) eyes. Best-corrected visual acuity ameliorated by at least 2 ETDRS lines in 14 eyes (54%). Contingency analysis did not show any statistical difference among the different types of uveitis (p= 0.46). Mean central foveal thickness improved postoperatively (428 ± 104 vs 328 ± 130 microns; p= 0.017).Conclusion: Patients with uveitic epiretinal membrane benefit from vitrectomy with membranectomy if operated when intraocular inflammation had subsided.

We report a case of synchronous bilateral orbital metastases from primary lobular breast cancer with the radiographic imaging features of a diffuse orbital soft tissue inflammatory process. A 77-year-old lady with a history of lobular breast cancer and bilateral quadrantectomy 15 years earlier was referred to our Ocular Oncology Unit. She complained about double vision and ocular pain. Through an ophthalmological examination, she presented significant bilateral proptosis and complete ophthalmoplegia. Magnetic resonance imaging showed a diffuse soft tissue infiltration of both orbits with mild T2w fat-sat hyperintensity and T1-isointensity relative to extra-ocular muscles and a diffuse involvement of both the intra- and extra-conal compartments. Significant enlargement of the extraocular muscles without sparing the muscle tendons and eyelids soft tissue swelling were also evident. Post-contrast images showed a diffuse and bilateral contrast enhancement of the involved tissues. Due to the inconclusive imaging findings, a bilateral orbital incisional biopsy was planned. The histopathological and immunohistochemical diagnosis was of lobular breast carcinoma and the patient underwent external beam radiotherapy with consistent clinical improvement. In conclusion, post-menopausal women presenting with a history of breast carcinoma and clinical and radiographic findings suggestive of acute bilateral orbital inflammatory disease should be biopsied to rule out metastatic disease even several years from the primary tumour.

Purpose Comparing the effect of standard trabeculectomy with direct sutures versus trabeculectomy with compression and everting sutures.Methods Mono-centric randomized prospective comparative study on 38 glaucomatous eyes undergoing trabeculectomy: 19 with standard fixed sutures (group A) and 19 withremovable regulating sutures (group B). Preoperatively and at day-7, 1-month, 2-months, 3-months and 6-months after surgery, we recorded best-corrected visual acuity (BCVA), intraocular pressure (IOP) and possible complications. Complete, partial success and failure rates were recorded at the end of the study.Results In group B, we pulled everting sutures with the “horse bridle” technique at the 14thday, and successively removed all sutures between the 14th-30thpost-operative day. At month-1, we recorded a significant IOP reduction in both groups (mean reduction of 11.5 mmHg for group A and of 14.4 mmHg for Group B, p = 0.001 and p < 0.0001, respectively). Furthermore, group B showed a significantly lower IOP than group A (−4.2 mmHg, 95% confidence interval [CI] −7.0 to −0.5 mmHg for group B, p = 0.01). At 2, 3 and 6-months, no significant IOP differences were reported between the two groups (all p > 0.05), but failure rate was higher for group A (21%) than for group B (11%). No differences in visual outcomes at any timepoints were noted.Conclusions Trabeculectomy with removable regulating sutures showed a good safety profile, comparable to standard trabeculectomy. Moreover, we reported a lower IOP one month postoperatively, suggesting this technique may optimize early management of trabeculectomy.

To describe a case of cilio-choroidal melanoma presenting as aseptic orbital cellulitis with massive conjunctival chemosis.