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Purpose: To test reliability and reproducibility of ESASO morphologic OCT-based classification of diabetic maculopathy (DM). Methods: This is a multi-center cross-sectional study including a coordination center (CC) and 18 participating centers (PCs). After instruction on the correct use of ESASO Classification, the validation process was carried out in two consecutive stages. In the first retrospective phase, we evaluated the concordance between PCs and CC in the staging of OCT images collected during PCs’ daily activity (608 images). In a second prospective phase, we analyzed the inter-observer agreement of staging assigned by each PCs to OCT images selected by the CC (22 images). Results: The overall concordance achieved in the retrospective phase was 89.8% (Kappa = 0.83 (95% CI: 0.78–0.87); p<0.0001). In 99.5% of cases, concordance did not differ by more than one stage. In the prospective phase, PCs reached an inter-operator agreement of 93.0% (Krippendorff's Alpha = 0.953, 95% CI: 0.929–0.977, p<0.0001). Any discrepancy among the 22 images was within one stage. Conclusion: The results achieved in this study confirm that ESASO OCT-based Classification can be considered as an easy and reproducible method to stage DM during clinical practice. A diffused use of a common and validated method to describe the progression of retinal damage in DM may offer several clinical and scientific advantages.

Purpose:To predict improvement of best-corrected visual acuity (BCVA) 1 year after pars plana vitrectomy for epiretinal membrane (ERM) using artificial intelligence methods on optical coherence tomography B-scan images.Methods:Four hundred and eleven (411) patients with Stage II ERM were divided in a group improvement (IM) (≥15 ETDRS letters of VA recovery) and a group no improvement (N-IM) (<15 letters) according to 1-year VA improvement after 25-G pars plana vitrectomy with internal limiting membrane peeling. Primary outcome was the creation of a deep learning classifier (DLC) based on optical coherence tomography B-scan images for prediction. Secondary outcome was assessment of the influence of various clinical and imaging predictors on BCVA improvement. Inception-ResNet-V2 was trained using standard augmentation techniques. Testing was performed on an external data set. For secondary outcome, B-scan acquisitions were analyzed by graders both before and after fibrillary change processing enhancement.Results:The overall performance of the DLC showed a sensitivity of 87.3% and a specificity of 86.2%. Regression analysis showed a difference in preoperative images prevalence of ectopic inner foveal layer, foveal detachment, ellipsoid zone interruption, cotton wool sign, unprocessed fibrillary changes (odds ratio = 2.75 [confidence interval: 2.49-2.96]), and processed fibrillary changes (odds ratio = 5.42 [confidence interval: 4.81-6.08]), whereas preoperative BCVA and central macular thickness did not differ between groups.Conclusion:The DLC showed high performances in predicting 1-year visual outcome in ERM surgery patients. Fibrillary changes should also be considered as relevant predictors.

The aim of our study was to investigate the clinical features of central serous chorioretinopathy (CSC) with autofluorescence (AF), retromode (RM), and enface imaging. This retrospective study was conducted at Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome (Italy), between September and December 2022. Each patient underwent a complete ophthalmological examination, which included optical coherence tomography (OCT), enface image analysis, AF, and RM imaging. We further evaluated the presence and area of extension of serous retinal detachment and retinal pigment epithelium (RPE) atrophy through AF, RM, and enface imaging. We included 32 eyes from 27 patients (mean age: 52.7 ± 13.3 years). The median AF area was 19.5 mm2 (IQR 6.1–29.3), while the median RM area was 12.3 mm2 (IQR 8.1–30.8), and the median enface area was 9.3 mm2 (IQR 4.8–18.6). RPE atrophy was diagnosed in 26 cases (81.3%) with RM imaging and in 75% of cases with AF. No difference emerged between AF and RM analysis in the detection of central serous detachment in CSC. However, RM imaging showed a high specificity (91.7%) and negative predictive value (84.6%) to detect RPE changes when compared to the AF standard-of-care technique. Thus, RM imaging could be considered an adjunctive imaging method in CSC.

Introduction To explore the early efficacy and safety of treatment with intravitreal injections of brolucizumab in patients presenting neovascular age-related macular degeneration (nAMD) in a real-world setting. Methods This retrospective study included 194 eyes of 180 patients with nAMD treated with standard 6-mg intravitreal injections (IVTs) of brolucizumab in our clinic between 11 March 2021 and 15 June 2022. Both treatment-naive (33 eyes) and switch-therapy patients (161 eyes) were included in the study. Best corrected visual acuity (BCVA), central subfield thickness (CST), retinal fluid distribution (classified as intraretinal, IRF; subretinal, SRF; under the pigmented epithelium, sRPEF), treatment intervals and adverse event rates were collected for analysis. Results Average follow-up time was 37.2±16.6 weeks. Mean baseline BCVA were 38.1±4.5 and 41.9±6.7 letters in the treatment-naive and switch-therapy groups, with a final gain of 16.0±4.9 (p<0.0001) and 10.7±5.9 (p<0.0001) letters in the two groups, respectively. Throughout the study period, CST significantly decreased in both treatment-naïve (from 352.0±129.4 to 284.2±93.8 µm; p=0.0015) and switch-therapy (from 369.9±140.5 to 307.4±123.5 µm; p<0.0001). Significant fluid control rates were achieved at the end of the study period (45% and 27% eyes were completely free-of-fluid in naïve and switch groups, respectively). Five eyes (2.6%) developed adverse events with different grades of intraocular inflammation (IOI) and visual outcomes. Conclusion Brolucizumab IVTs showed a very good anatomical and functional outcomes in both naive and switch patients in this real-world experience. Nevertheless, even showing a favorable risk/benefit profile, clinicians should be aware of the possibility of a small rate of complications.

There are only two Aphaenogaster species from the subterranea group in the western Mediterranean: A. ichnusa Santschi, 1925, from south-western Europe, and A. subterranea (Latreille, 1798), also occurring in central and eastern Europe. Historically, the two species have been widely misunderstood: A. ichnusa was long considered a Sardinian endemic subspecies of A. subterranea, while its continental populations were misidentified as A. subterranea s. str. Recently, A. ichnusa was elevated to species rank and its worker caste was redescribed with that of A. subterranea, allowing for their correct identification. Yet their distribution was documented in detail only for France and Sardinia. Furthermore, no morphological characters were described to distinguish the males and queens of the two species. By investigating private and museum collections, 276 new records of A. ichnusa are provided here and 154 of A. subterranea from the western Mediterranean. Additionally, qualitative and quantitative morphological characters were combined to identify their males and queens. We present the new southernmost, easternmost, and westernmost distribution limits for A. ichnusa. Based on our results, this species is widely distributed in Italy and Catalonia (Spain), also occurring on several Mediterranean islands, avoiding areas with continental climate and high altitudes. Sicily is the only island to host the less thermophilous A. subterranea, which otherwise extends westward to Galicia (Spain). Sympatric occurrence is not rare along the contact zone. Additional natural history observations are reported regarding foraging habits, associated myrmecophiles, habitat preferences, and colony structure in the two species.

Background: A high level of glycosylated haemoglobin (HbA1c), which is a nonenzymatic glycosylation product, is correlated with an increased risk of developing microangiopathic complications in Diabetes Mellitus (DM). Erythrocyte membrane fluidity could provide a complementary index to monitor the development of complications since it is influenced by several hyperglycaemia-induced pathways and other independent risk factors. Materials and methods: 15 healthy controls and 33 patients with long-duration (≥20 years) type 1 Diabetes Mellitus (T1DM) were recruited. Diabetic subjects were classified into two groups: T1DM, constituted by 14 nonretinopathic patients, and T1DM + RD, constituted by 19 patients in any stage of diabetic retinopathy. Red blood cells (RBC) were incubated with the fluorescent Laurdan probe and median values of Generalized Polarization (GP), representative of membrane fluidity, were compared between the two groups. Baseline characteristics among groups have been compared with Student's t test or ANOVA. Values of P <.05 were considered statistically significant. Results: All the participants were comparable for age, Body Mass Index (BMI), creatinine and lipid profile. The duration of diabetes was similar for T1DM (34.4 ± 7.8 years) and T1DM + RD (32.8 ± 7.5 years) subjects as well as values of HbA1c: (55.6 ± 8.1) mmol/mol for T1DM and (61.2 ± 11.0) mmol/mol for T1DM + RD, respectively. Erythrocyte plasmatic membranes of RD patients were found to be more fluid (GP: 0.40 ± 0.04) than non-RD patients (GP: 0.43 ± 0.03) with a statistically significant difference (P =.035). Conclusions: Altered erythrocyte membrane fluidity may therefore represent a marker of retinopathy in T1DM patients as a result of post-translational modifications of multifactorial aetiology (nonenzymatic glycosylation of proteins, generation of reactive oxygen speci

Background: A high level of glycosylated haemoglobin (HbA1c), which is a nonenzymatic glycosylation product, is correlated with an increased risk of developing microangiopathic complications in Diabetes Mellitus (DM). Erythrocyte membrane fluidity could provide a complementary index to monitor the development of complications since it is influenced by several hyperglycaemia-induced pathways and other independent risk factors. Materials and methods: 15 healthy controls and 33 patients with long-duration (≥20 years) type 1 Diabetes Mellitus (T1DM) were recruited. Diabetic subjects were classified into two groups: T1DM, constituted by 14 nonretinopathic patients, and T1DM + RD, constituted by 19 patients in any stage of diabetic retinopathy. Red blood cells (RBC) were incubated with the fluorescent Laurdan probe and median values of Generalized Polarization (GP), representative of membrane fluidity, were compared between the two groups. Baseline characteristics among groups have been compared with Student's t test or ANOVA. Values of P <.05 were considered statistically significant. Results: All the participants were comparable for age, Body Mass Index (BMI), creatinine and lipid profile. The duration of diabetes was similar for T1DM (34.4 ± 7.8 years) and T1DM + RD (32.8 ± 7.5 years) subjects as well as values of HbA1c: (55.6 ± 8.1) mmol/mol for T1DM and (61.2 ± 11.0) mmol/mol for T1DM + RD, respectively. Erythrocyte plasmatic membranes of RD patients were found to be more fluid (GP: 0.40 ± 0.04) than non-RD patients (GP: 0.43 ± 0.03) with a statistically significant difference (P =.035). Conclusions: Altered erythrocyte membrane fluidity may therefore represent a marker of retinopathy in T1DM patients as a result of post-translational modifications of multifactorial aetiology (nonenzymatic glycosylation of proteins, generation of reactive oxygen speci

Purpose: Combined hamartoma of the retina and retinal pigment epithelium is a rare benign tumor characterized by a variable combination of glial, vascular, and pigmented components. The purpose of our study was to analyze the features of combined hamartoma of the retina and retinal pigment epithelium on optical coherence tomography angiography. Methods: Small case series of two cases of combined hamartoma of the retina and retinal pigment epithelium with macular and optic nerve involvement, evaluated with multimodal imaging including optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography. Results: On optical coherence tomography, combined hamartoma of the retina and retinal pigment epithelium is characterized by disruption of the inner neurosensory retina and a variable degree of involvement of the external retina. Optical coherence tomography angiography showed diffuse alterations of the retinal vessels of the superficial and deeper layers, extended to the peripapillary area. Vessel abnormalities included increased tortuosity and caliber of vessels, vascular traction, and vessel stretching within the lesion. Conclusion: Optical coherence tomography angiography allows in-depth multilayer analysis of tumor vascular network, highlighting the fine abnormalities of retinal vasculature characteristic of combined hamartoma of the retina and retinal pigment epithelium.

Purpose: To report the results of a patient’s tailored therapeutic approach using a second course of interventional radiotherapy (brachytherapy) in patients with locally recurrent uveal melanoma. Material and methods: Patients who had already undergone ocular brachytherapy treated at our IOC (Interventional Oncology Center) were considered. Five patients who has received a second course of treatment with a plaque after local recurrences were included in our study. Re-irradiation was performed with Ruthenium-106 (prescribed dose to the apex 100 Gy) or with Iodine-125 plaques (prescribed dose to the apex 85 Gy). Moreover, a systematic literature search was conducted through three electronic databases, including Medline/PubMed, Scopus, and Embase. Results: All patients were initially treated with Ruthenium-106 plaque; the re-irradiation was performed with Ruthenium-106 plaque in three cases and with Iodine in two cases. Mean time between the first and the second plaque was 56.8 months (range, 25-93 months). Local tumor control rate was 100%, no patient underwent secondary enucleation owing to re-treatment failure. Distant metastasis occurred in 1 patient after 6 months from re-treatment. After a median follow-up of 44.2 months (range, 26-65 months) from re-treatment, all patients experienced worsening of the visual acuity (median visual acuity was 0.42 at time of recurrence and decline to 0.24 at the most recent follow-up); cataract occurred in two cases, no patient developed scleral necrosis. We considered 2 papers for a systematic review. Conclusions: In selected cases, especially in presence of marginal local recurrence, a personalized re-treatment strategy with a plaque may offer high probability of tumor control and organ preservation but worsening of visual acuity.

Several pigmented lesions of the ocular fundus can be detected on routine ophthalmic examination. Pigmented tumoral lesions, both benign and malignant, can arise from the retinal pigment epithelium or from choroidal melanocytes. A careful evaluation of the clinical and imaging features can help to differentiate the lesions, avoiding diagnostic errors.

Hypoponera abeillei is the sole member of the otherwise exclusively Afrotropical abeillei group to occur in the West-Palearctic. Since its description about 140 years ago, it has remained little-known. Workers of this species are thought to entirely lack eyes. On the other hand, the male caste was described from 4 Tunisian specimens in 1921, and queens remain undescribed. We present an updated description of the male caste based on 62 specimens and a description of the queen caste. The H. abeillei material we examined comes from Italy, Spain, and Malta and comprises 11 new distribution records, including the first findings in the islands of Mallorca, Malta, and Sardinia. We provide a first phenological overview of the species' nuptial flights. Our data show that H. abeillei sexuals fly during the summer, mostly in August. We demonstrate that they can easily be distinguished from all the other Hypoponera species inhabiting the Mediterranean region based on their morphology. The remarkable diversity of Mediterranean Hypoponera males and queens suggest that sexuals may have a role in future attempts to understand relationships within this genus. Yet, the number of species in which sexual castes are documented is still extremely reduced.

Purpose: To report the case of a 13-year-old girl with torpedo maculopathy, evaluated with multimodal morpho-functional retinal imaging, including fundus photography, infra-red and blue fundus autofluorescence, swept-source optical coherence tomography (OCT), en face OCT, OCT angiography and microperimetry (MP). Observations: On fundus examination, a torpedo-like hypopigmented lesion was observed temporal to the fovea in the left eye. OCT showed disruption of outer retinal layers and the presence of a subretinal cleft. On OCTA, a diffuse attenuation of signal from choriocapillaris was observed along the lesion. Functional analysis with MP revealed a reduction of retinal sensitivity over the lesion. Conclusions: and importance: On OCTA, torpedo maculopathy is characterized by vascular alterations of the choriocapillaris along the lesion.

The ant genus Myrmecina, whose diversity is mostly concentrated in SE-Asia and Oceania, counts four W-Palearctic species. The extremely euryecious and well-studied Myrmecina graminicola occurs from Iberia to the Caucasus and from the Maghreb to Scandinavia, while three little-known species (M. atlantis, M. melonii and M. sicula) coexist with M. graminicola in their narrow Maghrebian, Sardinian and Sicilian ranges, respectively. Myrmecina sicula has been described about 140 years ago from a single site and two specimens only. Their unique morphology suggested the validity of this taxon ever since, but no additional specimens were found in the following century. We present the results of decades of sampling efforts across Sicily, resulting in the collection of M. graminicola from 70 sites and M. sicula from 13 sites. We confirm M. sicula unique morphological identity and report on the marked distributional and ecological differences between the two species. Myrmecina graminicola is widespread and inhabits diverse, mainly forested habitats from lowland to high mountain sites, while M. sicula was found in a very narrow region of old carbonate platform between NW-Sicily and the Egadi Islands, mostly in sparsely vegetated sites at mid to low-altitude. Reviewing their common morphological and biogeographic traits, we propose to consider M. atlantis, M. melonii and M. sicula as a distinct M. sicula complex, whose identity and history deserves further investigation through molecular analyses.

The ant genus Myrmecina, whose diversity is mostly concentrated in SE-Asia and Oceania, counts four W-Palearctic species. The extremely euryecious and well-studied Myrmecina graminicola occurs from Iberia to the Caucasus and from the Maghreb to Scandinavia, while three little-known species (M. atlantis, M. melonii and M. sicula) coexist with M. graminicola in their narrow Maghrebian, Sardinian and Sicilian ranges, respectively. Myrmecina sicula has been described about 140 years ago from a single site and two specimens only. Their unique morphology suggested the validity of this taxon ever since, but no additional specimens were found in the following century. We present the results of decades of sampling efforts across Sicily, resulting in the collection of M. graminicola from 70 sites and M. sicula from 13 sites. We confirm M. sicula unique morphological identity and report on the marked distributional and ecological differences between the two species. Myrmecina graminicola is widespread and inhabits diverse, mainly forested habitats from lowland to high mountain sites, while M. sicula was found in a very narrow region of old carbonate platform between NW-Sicily and the Egadi Islands, mostly in sparsely vegetated sites at mid to low-altitude. Reviewing their common morphological and biogeographic traits, we propose to consider M. atlantis, M. melonii and M. sicula as a distinct M. sicula complex, whose identity and history deserves further investigation through molecular analyses.

The chain of food production, distribution and consumption is undergoing an intense process of innovation, in the face of a generalized crisis that affects the whole world of food. New and varied models of food provisioning are emerging in Western cities, in which food is produced, sold and distributed in the light of three basic principles: the chain is as short as possible; the food has a higher quality and environmental values; and a direct relation between producers and consumers is built and sustained. These models are known as ‘alternative’ or local food networks, and are run and operated by an original alliance of collective and individual stakeholders. They use the Internet and digital technologies as the stepping stones of their organization and, interestingly, exercise their activities (at least partly) outside the mechanisms and infrastructure of the corporate-controlled dominant food distribution sector. In this chapter we will present Cortilia and L’Alveare che dice Sì!, two rapidly consolidating business-oriented alternative food provisioning models from the city of Milan.

The chain of food production, distribution and consumption is undergoing an intense process of innovation, in the face of a generalized crisis that affects the whole world of food. New and varied models of food provisioning are emerging in Western cities, in which food is produced, sold and distributed in the light of three basic principles: the chain is as short as possible; the food has a higher quality and environmental values; and a direct relation between producers and consumers is built and sustained. These models are known as ‘alternative’ or local food networks, and are run and operated by an original alliance of collective and individual stakeholders. They use the Internet and digital technologies as the stepping stones of their organization and, interestingly, exercise their activities (at least partly) outside the mechanisms and infrastructure of the corporate-controlled dominant food distribution sector. In this chapter we will present Cortilia and L’Alveare che dice Sì!, two rapidly consolidating business-oriented alternative food provisioning models from the city of Milan.

Although introduced for the treatment of maculopathies, photodynamic therapy (PDT) is now largely used in some eye cancers treatment. The selective tissue damage with PDT is achieved by sequestration of the photosensitizer in the target tissue and focal activation of the photosensitizer by low energy directed light. In this way, it is possible to achieve the destruction of the tumor tissue by safeguarding the surrounding healthy structures. Our study describes the clinical uses and efficacy of photodynamic therapy in ocular oncology.

PURPOSE: To analyze the relationship between swelling of the arcuate nerve fiber layer (SANFL) and long-term decrease of retinal nerve fiber layer thickness after internal limiting membrane peeling for idiopathic epiretinal membrane, and to investigate if SANFL is related to a mechanical surgical damage. METHODS: Prospective, interventional consecutive case series of 46 eyes that underwent combined epiretinal membrane/internal limiting membrane peeling for idiopathic epiretinal membrane. Infrared, blue autofluorescence, color fundus imaging and measurement of retinal nerve fiber layer thickness in six peripapillary sectors by spectral-domain optical coherence tomography were performed preoperatively and at 2 weeks, 1, 3, 6, and 12 months after surgery. The presence of SANFL was checked postoperatively on infrared and blue autofluorescence fundus imaging, and the extent of each SANFL was measured on infrared fundus images. RESULTS: Areas of SANFL were identified in 39 eyes (84.8%) at 2-week follow-up. Retinal nerve fiber layer thickness significantly decreased in the temporal sectors at 1, 6, and 12 months (P < 0.0001). The linear extent of SANFL was significantly correlated with the percentage of reduction in retinal nerve fiber layer thickness in the temporal (R = 0.45; P < 0.0001) and infero-temporal (R = 0.23; P = 0.0008) sectors at 12 months of follow-up. Correspondence between sites of surgical grasping and the points of origin of SANFL was demonstrated on blue autofluorescence fundus images superimposed on intraoperative surgical frames. CONCLUSION: Early postoperative SANFL is correlated with late focal retinal nerve fiber layer thinning in the temporal sectors. Intraoperative surgical grasping seems to be a leading factor for the onset of SANFL.

BACKGROUND Schizofrenic and bipolar disorder are complex and disabling psychiatric diseases, whose recent neurobiological, neuropsychological, genetic and brain imaging findings are in contrast with the traditional categorical approach of psychiatric nosography. Schizophrenia has been for many years at the center of the interest of research in the psychiatric field, but, only recently, studies have compared the schizophrenic disorder with bipolar disorder and have considered these diseases in a spectrum and continuum perspective. In particular, the neurocognitive aspects of diseases are more numerous than the positive symptomatology, patient’s outcome, and because they are possible endophenotypic markers of vulnerability to the pathology. However, rather than a single cognitive profile corresponding to each diagnostic categories, recent studies have identified significant intra- and cross-diagnostic variability in patterns of cognitive impairment. Purpose of the research In a sample of schizophrenia spectrum patients, of psychopathologically stable affective-bipolar spectrum, and in a sample of healthy controls and unaffected relatives of first-degree, it was performed a neuropsychological assessment, using a battery of neuropsychological tests. The goal of this study was to contribute to the literature on cognitive heterogeneity in mood disorders by identifying cognitive subprofiles in a population of patients with schizophrenic and bipolar disorder, and healthy controls. Because of these reasons, the aim of this study is: 1. to Determine affinities and differences in neuropsychological performance in patients belonging to the schizophrenic and bipolar spectrum, in clinical stability phase, compared to healthy control and first-degree relatives of patients without psychiatric pathology; 2. to Investigate possible correlations of cognitive performance with some clinical variables such as age, age of onset and duration of disease; 3. to Investigate the presence of co

Purpose: To develop a predictive model and nomogram for maculopathy occurrence at 3 years after106Ru/106Rh plaque brachytherapy in uveal melanoma. Material and methods: Clinical records of patients affected by choroidal melanoma and treated with106Ru/106Rh plaque from December 2006 to December 2014 were retrospectively reviewed. Inclusion criteria were: dome-shaped melanoma, distance to the fovea > 1.5 mm, tumor thickness > 2 mm, and follow-up > 4 months. The delivered dose to the tumor apex was 100 Gy. Primary endpoint of this investigation was the occurrence of radiation maculopathy at 3 years. Analyzed factors were as follows: gender, age, diabetes, tumor size (volume, area, largest basal diameter and apical height), type of plaque, distance to the fovea, presence of exudative detachment, drusen, orange pigment, radiation dose to the fovea and sclera. Univariate and multivariate Cox proportional hazards analyses were used to define the impact of baseline patient factors on the occurrence of maculopathy. Kaplan-Meier curves were used to estimate freedom from the occurrence of the maculopathy. The model performance was evaluated through internal validation using area under the ROC curve (AUC), and calibration with Gronnesby and Borgan tests. Results: One hundred ninety-seven patients were considered for the final analysis. Radiation-related maculopathy at 3 years was observed in 41 patients. The proposed nomogram can predict maculopathy at 3 years with an AUC of 0.75. Distance to fovea appeared to be the main prognostic factor of the predictive model (hazard ratio of 0.83 [0.76-0.90], p < 0.01). Diabetes (hazard radio of 2.92 [1.38-6.20], p < 0.01), and tumor volume (hazard radio of 21.6 [1.66-281.14], p = 0.02) were significantly predictive for maculopathy occurrence. The calibration showed no statistical difference between actual and predicted maculopathy (p = 1). Conclusions: Our predictive model, together with its nomogram, could be a useful tool

Purpose: To develop a predictive model and nomogram for maculopathy occurrence at 3 years after106Ru/106Rh plaque brachytherapy in uveal melanoma. Material and methods: Clinical records of patients affected by choroidal melanoma and treated with106Ru/106Rh plaque from December 2006 to December 2014 were retrospectively reviewed. Inclusion criteria were: dome-shaped melanoma, distance to the fovea > 1.5 mm, tumor thickness > 2 mm, and follow-up > 4 months. The delivered dose to the tumor apex was 100 Gy. Primary endpoint of this investigation was the occurrence of radiation maculopathy at 3 years. Analyzed factors were as follows: gender, age, diabetes, tumor size (volume, area, largest basal diameter and apical height), type of plaque, distance to the fovea, presence of exudative detachment, drusen, orange pigment, radiation dose to the fovea and sclera. Univariate and multivariate Cox proportional hazards analyses were used to define the impact of baseline patient factors on the occurrence of maculopathy. Kaplan-Meier curves were used to estimate freedom from the occurrence of the maculopathy. The model performance was evaluated through internal validation using area under the ROC curve (AUC), and calibration with Gronnesby and Borgan tests. Results: One hundred ninety-seven patients were considered for the final analysis. Radiation-related maculopathy at 3 years was observed in 41 patients. The proposed nomogram can predict maculopathy at 3 years with an AUC of 0.75. Distance to fovea appeared to be the main prognostic factor of the predictive model (hazard ratio of 0.83 [0.76-0.90], p < 0.01). Diabetes (hazard radio of 2.92 [1.38-6.20], p < 0.01), and tumor volume (hazard radio of 21.6 [1.66-281.14], p = 0.02) were significantly predictive for maculopathy occurrence. The calibration showed no statistical difference between actual and predicted maculopathy (p = 1). Conclusions: Our predictive model, together with its nomogram, could be a useful tool

PURPOSE: To report our experience with photodynamic therapy (PDT) with verteporfin for patients with vasoproliferative retinal tumors (VPRTs). METHODS: Three patients with VPRTs who presented with macular exudative changes were treated with one session of PDT with 6 mg/m body surface area of verteporfin and a light dose of 100 J/cm at 689 nm delivered in 166 seconds. Biomicroscopy, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and ultrasonography were performed before treatment and 1 month, 3 months, 6 months, and 1 year after treatment; visual acuity was measured using Early Treatment Diabetic Retinopathy Study criteria. RESULTS: At the 1-year follow-up, all tumors responded with a reduction in size (mean height: pretreatment, 2.96 mm; posttreatment, 1.32 mm), and optical coherence tomography showed complete resolution of macular exudates. For all patients, fluorescein angiography evidenced reduction of leakage from the lesion, and indocyanine green angiography verified nonperfusion of the vascular channels. An improvement in visual acuity (average, 4.7 Early Treatment Diabetic Retinopathy Study letters) was observed. No retreatment was needed. CONCLUSION: PDT may represent an effective and safe modality of treatment for VPRTs because of its selectivity. Our study supports the application of a light dose of 100 J/cm, although further studies with larger numbers of cases and longer follow-ups are required. Copyright © by Ophthalmic Communications Society, Inc.

Purpose: To compare visual outcomes and local tumor control between two groups of patients with amelanotic choroidal melanoma treated with brachytherapy alone, or neoadjuvant photodynamic therapy before brachytherapy. Methods: Patients diagnosed with amelanotic choroidal melanoma were recruited for the study and divided into two groups: brachytherapy alone (Group A) and photodynamic therapy preceding brachytherapy (Group B). Patients of both groups were selected to be comparable. Results: Twenty-six patients with amelanotic choroidal melanoma were enrolled in the study. Within Group B, 1 month after photodynamic therapy, ultrasonography showed reduction of tumor height in 11 patients (73.4%). The mean doses of irradiation to macula and optic nerve, at baseline were 74.37 and 52.07 Gy, whereas after photodynamic therapy there was a decrease of 17.26% (P 0.008) and 21.22% (P 0.025), respectively. In terms of visual acuity, a mean decrease of 14 ETDRS letters and 5 ETDRS letters was observed at 24 months follow-up, in Groups A and B, respectively (P 0.001). Conclusion: Photodynamic therapy as neoadjuvant therapy before brachytherapy reduces tumor thickness in 73.4% of cases. As a result, a decrease of radiation toxic effects on visual function could be obtained, without compromising disease control.

To verify the efficacy of 25-gauge pars plana vitrectomy (PPV) for the management of posteriorly dislocated lens material after complicated cataract extraction and to determine in what patients this approach offers the optimal benefit in terms of efficacy and safety, considering the amount of retained nuclear material and the duration of surgery.

Purpose. To report the risk of methicillin-resistant Staphylococcus aureus (MRSA) ocular infection after UVA-riboflavin corneal collagen cross-linking in a patient with atopic dermatitis. Methods. A 22-year-old man, with bilateral evolutive keratoconus and atopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and cyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum antimicrobic therapy. Results. The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic therapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures was unavoidable. Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in halting keratoconus' progression. However, this procedure is not devoid of infectious complications, due to known risk factors and/or poor patients' hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with keratoconus and Staphylococcus aureus colonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity with atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days after surgery and the imposition of strict personal hygiene rules are strongly recommended.

Acute exudative polymorphous vitelliform maculopathy is a rare retinal disease characterized by bilateral serous macular detachment and subretinal accumulation of yellowish deposits resembling Best dystrophy lesions. Corticosteroid systemic therapy has been used empirically in the attempt to treat this retinal disorder with mixed results. Thus, the benefit of corticosteroid remains undetermined. To our knowledge, we report the first case of acute exudative polymorphous vitelliform maculopathy (AEPVM) treated in one eye with intravitreal dexamethasone implant (Ozurdex; Allergan, Inc., Irvine, California, USA).

Services are increasingly becoming a crucial driver of the economies of developed countries. At the same time, innovation is not only recommended, but also required, to ensure survival and growth of organisations, within the manufacturing as well as the service sectors. Given globalisation and the development of information and communication technologies, more and more heterogeneous parties are and might be involved in innovation processes; meaning that both manufacturers and service providers shall take into consideration a more diverse set of needs and expectations when developing new offerings. Within the service context, specifically, empirical evidence and existing research suggest that interactions between stakeholders are an important element of innovation processes. Therefore, when managing and studying innovation in the service context, interactions between stakeholders should be taken into consideration. So far, the literature on innovation in services has addressed some of the aspects of interactions between stakeholders, such as customer involvement and open innovation practices. Nevertheless, when looking at innovation processes in services, scholars have typically adopted a firm-centric approach and taken into consideration only the perspective of the service-providing organisation. The perspective of the beneficiary of the service, however, as well as that of other stakeholders, is a crucial element for the understanding of innovation in services and related interactions. In fact, given the recognition that services are characterised by interactivity between stakeholders, the perspective of the service beneficiary determines the way an outcome is co-produced. This dissertation investigates how interactions between stakeholders unfold throughout innovation processes in services, and how service organisations and their stakeholders navigate and manage such unfolding to reach successful outcomes. Grounded in the literature and theories on innovation in s

I traumi oculari durante la pratica dell’attività sportiva non sono un’evenienza rara e le loro conseguenze a volte molto invalidanti, fino ad arrivare alla perdita della capacità visiva nell’occhio traumatizzato. Una valutazione oculistica, quindi, dovrebbe essere parte integrante della visita medica preventiva (specie per il rilascio del certificato d’idoneità agonistica), soprattutto per le discipline sportive a maggior rischio di trauma oculare. La valutazione, comunque, dovrebbe essere sempre di tipo complessivo considerando i fattori di rischio, la tipologia dello sport praticato, la motivazione allo sport e, non ultimo, il livello competitivo.

Government ‘e-service’ as a subfield of the e-government domain has been gaining attention to practitioners and academicians alike due to the growing use of information and communication technologies at the individual, organizational and societal levels. This paper conducts a thorough literature review to examine the e-service research trends during the period between 2005 and 2009 mostly in terms of, research methods, theoretical models and frameworks employed as well as type of research questions. The results show that there has been a good amount of papers focusing on ‘e-Service’ within the field of e-government with a good combination of research methods and theories. In particular the findings show that technology acceptance, evaluation and system architecture are the most common themes, that circa half of the studies surveyed focus on the organizational perspective and that the most employed research methods are case studies and surveys, often with a mix of both types of methodologies.

Purpose: The purpose of this study was to evaluate 1-year functional and structural effects of intravitreal bevacizumab for subfoveal choroidal neovascularization secondary to pathologic myopia (myopic choroidal neovascularization). Methods: Fifteen eyes with myopic choroidal neovascularization participated in this prospective interventional, noncomparative case series. All patients were treated with one intravitreal injection of 1.25 mg bevacizumab. Retreatments were performed in case of persistent or recurrent leakage on fluorescein angiography and/or intraretinal fluid on optical coherence tomography. Evaluation of best-corrected visual acuity using Early Treatment of Diabetic Retinopathy Study criteria, MP-1 microperimetry, optical coherence tomography, and fluorescein angiography were performed before treatment and 1 month, 3 months, 6 months, and 1 year after treatment. Results: After a follow-up of 12 months, best-corrected visual acuity improved on average of 0.23 logarithm of the minimum angle of resolution. Mean macular sensitivity within the central 8[degrees] increased on average of 2.62 dB at 12-month postinjection. The mean number of measurement points within the central absolute scotoma reduced significantly from 12.47 before treatment to 6.27 at 1-year follow-up. An improvement of fixation stability from baseline was observed in 9 patients (60%). No treatment adverse events were evidenced. Conclusion: Improvement of macular sensitivity and fixation stability 1 year after intravitreal bevacizumab for myopic choroidal neovascularization suggest a stable and progressive macular function recovery. The mean treatment session was 1.53, with 53.3% of patients needing only a single intravitreal bevacizumab injection, supporting a potential long-lasting efficacy of intravitreal bevacizumab treatment.

To evaluate the long-term efficacy of verteporfin photodynamic therapy (PDT) as the primary treatment for symptomatic circumscribed choroidal hemangioma (CCH).

PURPOSE: To evaluate the efficacy and safety of intravitreal bevacizumab in proliferative diabetic retinopathy (PDR) patients. METHODS: This interventional case series study included 15 eyes of 10 patients with bilateral PDR: 13 eyes with severe PDR and active new vessels (NV) and two eyes with recurrent vitreous haemorrhages. Study eyes received a single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab. All eyes were followed up for 3 months, and eight of them for 9 months. Reinjection was performed in three eyes 4-6 months after the first injection. Study eyes were evaluated by fluorescein angiography at baseline, 1, 3 and 9 months. Quantitative planimetric analysis (QPA) of NV area was measured before and after treatment. All eyes received or completed panretinal photocoagulation (PRP) 1 month after the first injection. RESULTS: As early as at 1 month, all study eyes had a regression (paired t-test, P = 0.01) of QPA-estimated NV area. The eyes with recurrent vitreous haemorrhages had clearing of bleeding. These early effects were maintained at 3 months for all eyes and tended to be stable at 9 months. The fast and measurable efficacy of bevacizumab allowed a subsequent complete and safe PRP. CONCLUSION: Intravitreal bevacizumab did not reveal any side-effects and was effective in the regression of NV areas and the resolution of vitreous haemorrhages. This approach is potentially useful in allowing (within a planned temporal window) a safe and efficient PRP to be performed while minimizing the risk of its complications.

In this paper we apply Davis' Technology Acceptance Model (TAM) in a qualitative fashion to analyze and interpret the chronological sequence of events leading to the acceptance of the Groupware technology, BSCW, in a virtual learning team. The research question investigated is: What are the factors influencing the integration process of Groupware technology in virtual learning teams in part-time adult education? The data were gathered through an in-depth qualitative action research study of one virtual learning team doing problem-oriented project work within a master education program. We find that one important factor influencing the integration process of Groupware is: How the technology provides support for social perspective awareness. In the case investigated the technology BSCW supported social awareness, which influenced both the ease-of-use and the perceived-usefulness of the Groupware technology, thus being an important condition that influenced the positive outcome of the integration process.

In this paper we apply Davis' Technology Acceptance Model (TAM) in a qualitative fashion to analyze and interpret the chronological sequence of events leading to the acceptance of the Groupware technology, BSCW, in a virtual learning team. The research question investigated is: What are the factors influencing the integration process of Groupware technology in virtual learning teams in part-time adult education? The data were gathered through an in-depth qualitative action research study of one virtual learning team doing problem-oriented project work within a master education program. We find that one important factor influencing the integration process of Groupware is: How the technology provides support for social perspective awareness. In the case investigated the technology BSCW supported social awareness, which influenced both the ease-of-use and the perceived-usefulness of the Groupware technology, thus being an important condition that influenced the positive outcome of the integration process.

In this chapter we look into earlier empirical research on the barriers to electronic commerce (EC) adoption and diffusion for small and medium sized enterprises (SMEs). We explore research conducted in the context of information and communications technologies (ICT) in general, as well as EDI and Internet based EC. What we are interested in is whether these barriers are something new created by the new wave of Internet based technologies. We divide the barriers, inhibitors or factors slowing down the diffusion of new technologies found in previous literature into those internal to an organization, and those imposed by external forces. The basic premise of this chapter is, that technologies advance or change, but the barriers for SMEs to adopt them do not. The authors hope that understanding this will help researchers, small companies and policy makers to move on and do something active to reduce such barriers.

In this paper we look into earlier empirical research on the barriers to electronic commerce (EC) for small and medium sized enterprises (SMEs). We look into research conducted in the context of information and communications technologies (ICT) in general, as well as EDI and Internet based EC. We divide the barriers, inhibitors or factors slowing down the diffusion of new technologies found in literature into those internal to an organization, and those imposed by external forces. The basic premise of this paper is, that technologies advance or change, but the barriers for SMEs to adopt them do not.

Based on a longitudinal case study of ICT adoption and e-services development in a Danish library, we examine how governance modes affect technical and organizational change in the public sector. We contribute to extant literature on the links between governance and innovation by highlighting three important aspects that characterize such links. First, our case study shows that the transition from what could be considered as a spurious New Public Management approach towards a “networked model” implies important organizational innovations and more emphasis on bottom-up decision making. Second, we provide evidence of increasing involvement of end users in innovation and co-creation activities. Third, the increasing involvement of users has created important innovation opportunities that are more and more characterized by their frugal/bricolage nature, hence more localized but not necessarily trivial and relatively easy to diffuse to different contexts.

In this paper we discuss how users may be involved in the ideation phase of innovation. The study compares the use of a blog and three future workshops (students, employees and a mix of the two) in a library. Our study shows that the blog is efficient in giving the users voice whereas the mixed workshop method (involving users and employees) is especially good at qualifying and further developing ideas. The findings suggest that methods for involving users in ideation should be carefully selected and combined to achieve optimum benefits and avoid potential disadvantages.