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Purpose: To study the amount of steroids that is found in the aqueous humor after topical administration of dexamethasone solution eye-drops and dexamethasone suspension eye-drops. Materials and methods: One hundred seventeen consecutive patients of both genders 18 years or older, candidates for cataract surgery were randomly assigned to one of three groups. Fifty-one patients (group A) received a single instillation of a suspension containing tobramicin 0.3% mg/ml + dexamethasone 0.1% mg/ml; 56 patients (group B) received a single instillation of a solution containing tobramicin 0.3% mg/ml + dexamethasone 0.1% mg/ml; 10 patients (group C), control group, did not receive any drops. Samples were taken immediately before surgery from the anterior chamber and dexamethasone levels were measured using gas chromatography/mass spectrometry. Results: The mean dexamethasone concentrations were 0.56 μM (min 0.00, max 3.25) in group A and 0.15 μM (min 0.00, max 2.93) in group B. Dexamethasone was not detected in samples from group C. Conclusions: Dexamethasone suspension gives concentrations of steroids in the aqueous humor approximately three times higher than with dexamethasone solution drops. [ABSTRACT FROM PUBLISHER]

Purpose: To assess the anesthetic efficacy and safety of topical ropivacaine versus topical lidocaine in cataract surgery.Setting: Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy.Methods: This prospective controlled randomized double-blind study comprised 64 patients scheduled for planned routine cataract extraction. Patients were randomized into 2 groups; 1 received topical ropivacaine 1% and the other, topical lidocaine 4%. The duration of surgery, intraoperative and early postoperative complications, and the need for supplemental intracameral anesthesia were recorded. Intraoperative and postoperative subjective pain was quantified by patients using a scale from 1 to 10. An endothelial cell count was performed preoperatively and 2 months after surgery.Results: The mean endothelial cell density decreased from 2334 cells/mm2 ± 496 (SD) to 2016 ± 674 cells/mm2 in the ropivacaine group and from 2519 ± 404 cells/mm2 to 1847 ± 607 cells/mm2 in the lidocaine group. The difference in cell density between groups was not significant before (P = .154) or after surgery (P = .329); however, the difference in mean cell loss between groups was statistically significant (P = .031). The duration of surgery and intraoperative complications were the same in both groups. Four patients in the ropivacaine group and 5 in the lidocaine group required supplemental anesthesia (P > .05). The mean subjective analog pain score was slightly higher in the lidocaine group (P > .05). The day after surgery, 12 eyes in the ropivacaine group and 6 in the lidocaine group had transient corneal edema (P = .150).Conclusions: Topical ropivacaine performed at least as well as topical lidocaine in efficacy and safety in cataract surgery. It provided sufficient and long-lasting analgesia without the need for supplemental intracameral anesthesia in most cases. [Copyright &y& Elsevier]

A 39-year-old woman presented to our hospital with a history of photorefractive keratectomy (PRK), performed two weeks prior; slit-lamp examination revealed diffuse conjunctival congestion, corneal ulcer and stromal infiltration. After 5 days of antifungal and antibacteric treatment, the infiltrate progressively increased so that a therapeutic penetrating keratoplasty was necessary. The microbiological analyses revealed the presence of fungal filaments. Twenty days after surgery the patient had recurrent fungal infiltrate in the donor cornea with wound dehiscence. We performed a second penetrating keratoplasty. With the matrix-assisted-laser-desorption-ionization-time-of-flight analysis (MALDI-TOF) we identified a Fusarium solani. Intravenous amphothericine B, a combination of intracameral and intrastromal voriconazole and intracameral amphotericine B were administered. After 6 months from the last surgery the infection was eradicated. The management of fungal keratitis after PRK depends on many factors: In our experience, a prompt keratoplasty and the use of intracameral antifungal medication proved to be very effective. [ABSTRACT FROM AUTHOR]

Melanocortin peptides induce neuroprotection in acute and chronic experimental neurodegenerative conditions. Melanocortins likewise counteract systemic responses to brain injuries. Furthermore, they promote neurogenesis by activating critical signaling pathways. Melanocortin-induced long-lasting improvement in synaptic activity and neurological performance, including learning and memory, sensory-motor orientation and coordinated limb use, has been consistently observed in experimental models of acute and chronic neurodegeneration. Evidence indicates that the neuroprotective and neurogenic effects of melanocortins, as well as the protection against systemic responses to a brain injury, are mediated by brain melanocortin 4 (MC 4 ) receptors, through an involvement of the vagus nerve. Here we discuss the targets and mechanisms underlying the multiple beneficial effects recently observed in animal models of neurodegeneration. We comment on the potential clinical usefulness of melanocortin MC 4 receptor agonists as neuroprotective and neuroregenerative agents in ischemic stroke, subarachnoid hemorrhage, traumatic brain injury, spinal cord injury, and Alzheimer’s disease. [ABSTRACT FROM AUTHOR]

To assess the clinical utility of targeted Next-Generation Sequencing (NGS) for the diagnosis of Inherited Retinal Dystrophies (IRDs), a total of 109 subjects were enrolled in the study, including 88 IRD affected probands and 21 healthy relatives. Clinical diagnoses included Retinitis Pigmentosa (RP), Leber Congenital Amaurosis (LCA), Stargardt Disease (STGD), Best Macular Dystrophy (BMD), Usher Syndrome (USH), and other IRDs with undefined clinical diagnosis. Participants underwent a complete ophthalmologic examination followed by genetic counseling. A custom AmpliSeq™ panel of 72 IRD-related genes was designed for the analysis and tested using Ion semiconductor Next-Generation Sequencing (NGS). Potential disease-causing mutations were identified in 59.1% of probands, comprising mutations in 16 genes. The highest diagnostic yields were achieved for BMD, LCA, USH, and STGD patients, whereas RP confirmed its high genetic heterogeneity. Causative mutations were identified in 17.6% of probands with undefined diagnosis. Revision of the initial diagnosis was performed for 9.6% of genetically diagnosed patients. This study demonstrates that NGS represents a comprehensive cost-effective approach for IRDs molecular diagnosis. The identification of the genetic alterations underlying the phenotype enabled the clinicians to achieve a more accurate diagnosis. The results emphasize the importance of molecular diagnosis coupled with clinic information to unravel the extensive phenotypic heterogeneity of these diseases. [ABSTRACT FROM AUTHOR]

Abstract: Besides specific triggering causes, Alzheimer's disease (AD) involves pathophysiological pathways that are common to acute and chronic neurodegenerative disorders. Melanocortins induce neuroprotection in experimental acute neurodegenerative conditions, and low melanocortin levels have been found in occasional studies performed in AD-type dementia patients. Here we investigated the possible neuroprotective role of melanocortins in a chronic neurodegenerative disorder, AD, by using 12-week-old (at the start of the study) triple-transgenic (3xTg-AD) mice harboring human transgenes APPSwe, PS1M146V, and tauP301L. Treatment of 3xTg-AD mice, once daily until the end of the study (30 weeks of age), with the melanocortin analog [Nle4,D-Phe7]-α-melanocyte-stimulating hormone (NDP-α-MSH) reduced cerebral cortex/hippocampus phosphorylation/level of all AD-related biomarkers investigated (mediators of amyloid/tau cascade, oxidative/nitrosative stress, inflammation, apoptosis), decreased neuronal loss, induced over-expression of the synaptic activity–dependent gene Zif268, and improved cognitive functions, relative to saline-treated 3xTg-AD mice. Pharmacological blockade of melanocortin MC4 receptors prevented all neuroprotective effects of NDP-α-MSH. Our study identifies, for the first time, a class of drugs, MC4 receptor-stimulating melanocortins, that are able to counteract the progression of experimental AD by targeting pathophysiological mechanisms up- and down-stream of β-amyloid and tau. These data could have important clinical implications. [Copyright &y& Elsevier]

Age-related macular degeneration (AMD) is a progressive and degenerative disorder of the macula. In advanced stages, it is characterized by the formation of areas of geographic atrophy or fibrous scars in the central macula, which determines irreversible loss of central vision. These patients can benefit from visual rehabilitation programmes with acoustic "biofeedback" mechanisms that can instruct the patient to move fixation from the central degenerated macular area to an adjacent healthy area, with a reorganization of the primary visual cortex. In this prospective, comparative, non-randomized study we evaluated the efficacy of visual rehabilitation with an innovative acoustic biofeedback training system based on visual evoked potentials (VEP) real-time examination (Retimax Vision Trainer, CSO, Florence), in a series of patients with advanced AMD compared to a control group. Patients undergoing training were subjected to ten consecutive visual training sessions of 10 min each, performed twice a week. Patients in the control group did not receive any training. VEP biofeedback rehabilitation seems to improve visual acuity, reading performances, contrast sensitivity, retinal fixation and sensitivity and quality of life in AMD patients. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy and the safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic postoperative cystoid macular edema (PCME), which is refractory to standard therapies. Methods: A retrospective chart review of ten eyes of ten patients affected by refractory PCME who underwent SMYL was performed. Five PCME cases were subsequent to uncomplicated cataract surgery (CS), two cases to complicated CS (CCS) with posterior capsule rupture and three cases occurred after retinal detachment surgery (RD). All conditions were refractory to conventional treatments prior to SMYL interventions for at least 4 months, including nonsteroidal anti-inflammatory eyedrops, topical steroids, oral indomethacin, sub-Tenon's triamcinolone injections and Dexamethasone intravitreal implants. All patients underwent one or more treatments with 577 nm SMYL photo-stimulation, with 7 × 7 grids with confluent spots and a 5% duty cycle covering the whole edematous retina, including the foveal center. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were obtained using OCT, and evaluated before and after the treatment at 1, 2, 3 and 6-month follow-ups. Results: A complete subfoveal macular edema resolution was observed in all of the eyes, with statistically significant improvements in terms of BCVA and CMT in all of the follow-up timelines (at 6 months, p = 0.002 and p = 0.005, respectively). The mean number of laser treatments was 1.3. At the final follow-up, a complete subfoveal edema reabsorption was observed in all patients with visual acuity improvement. No complications were observed in any case. Conclusions: SMYL seems to be a safe and effective treatment for the long-term resolution of refractory PCME and may be a useful alternative to expensive and invasive therapeutic options. [ABSTRACT FROM AUTHOR]

Hypovolemic shock is a circulatory failure, due to a loss in the effective circulating blood volume, that causes tissue hypoperfusion and hypoxia. This condition stimulates reactive oxygen species (ROS) and pro-inflammatory cytokine production in different organs and also in the central nervous system (CNS). Levosimendan, a cardioprotective inodilator, and dobutamine, a β1-adrenergic agonist, are commonly used for the treatment of hypovolemic shock, thanks to their anti-inflammatory and antioxidant effects. For this reason, we aimed at investigating levosimendan and dobutamine's neuroprotective effects in an "in vitro" model of lipopolysaccharide (LPS)-induced neuroinflammation. Human microglial cells (HMC3) were challenged with LPS (0.1 µg/mL) to induce an inflammatory phenotype and then treated with levosimendan (10 µM) or dobutamine (50 µM) for 24 h. Levosimendan and dobutamine significantly reduced the ROS levels and markedly increased Nrf2 and HO-1 protein expression in LPS-challenged cells. Levosimendan and dobutamine also decreased p-NF-κB expression and turned off the NLRP3 inflammasome together with its downstream signals, caspase-1 and IL-1β. Moreover, a reduction in TNF-α and IL-6 expression and an increase in IL-10 levels in LPS-stimulated HMC3 cells was observed following treatment. In conclusion, levosimendan and dobutamine attenuated LPS-induced neuroinflammation through NF-κB pathway inhibition and NLRP3 inflammasome activation via Nrf2/HO-1 signalling, suggesting that these drugs could represent a promising therapeutic approach for the treatment of neuroinflammation consequent to hypovolemic shock.

Aim: To report a paediatric case of retinopathy-positive cerebral malaria, emphasizing the clinical significance of long-term neurological and ophthalmological follow-up (5,5 years)., Case Report: After a recent journey in Ghana, a 17-month-old African female child was admitted at the Paediatric Emergency Room with fever and vomiting. Blood smear confirmed a Plasmodium Falciparum parasitaemia. Iv quinine was promptly administered, but after a few hours, the child developed generalized seizures, requiring benzodiazepine therapy and assisted ventilation for severe desaturation. Brain imaging (CT and MRI), lumbar puncture and several electroencephalograms showed data compatible with cerebral involvement of malaria. Schepens ophthalmoscopy and Ret-Cam pictures acquisition revealed macular haemorrhages in the left eye with central whitening and bilateral capillary abnormalities, typical signs of malarial retinopathy. Antimalarial therapy and iv Levetiracetam allowed neurological improvement. Eleven days after the admission, the child was discharged, showing no neurological symptoms and with an improved EEG signal, a normalized fundus oculi and brain imaging. Neurological and ophthalmological long-term follow-up were conducted: EEG controls didn't reveal abnormalities and the complete ophthalmological assessment showed a regular visual acuity and fundus oculi, as well as a normal SD-OCT and electrophysiologic testing., Conclusion: Cerebral malaria is a severe complication, characterized by a high fatality rate and challenging diagnosis. A helpful instrument for diagnostic and prognostic evaluation is the ophthalmological detection of malarial retinopathy and its monitoring over time. In our patient the long term visual follow-up didn't reveal any adverse outcome., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim : To investigate the efficacy and safety of micropulse laser trabeculoplasty (MLT) using a 577 nm yellow wavelength laser randomly assigned to either 1500 or 1000 mW in patients with primary open-angle glaucoma (POAG). Methods : A prospective, double-blinded study of POAG patients was performed in a single center. MLT treatment included a 577 nm micropulse laser (IRIDEX IQ 577 TM , IRIDEX, Mountain View, CA, USA) to 360° of the trabecular meshwork at randomly assigned varying powers: 1500 mW in one eye (MLT 1500 group) and 1000 mW in the other (MLT 1000 group). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal central thickness (CCT), and endothelial cell count (ECC) were evaluated at baseline (T0), post-operative 1 h (T1), 24 h (T2), 1 month (T3), 3 months (T4), and 6 months (T5) after laser treatment. Topical medications were assessed pre-treatment and at T4. Results : Among the 18 eyes included, we achieved a success rate (IOP reduced > 20%) in 77% of sampled eyes. In particular, IOP reduced at T2 and T3 with both MLT 1500 and 1000 without any significant differences (IOP reduction 22.9% vs. 17.3%, respectively, MLT1500 vs. MLT1000 at T2). The IOP returned to baseline values at T4 and T5 in both groups, with a reduction in topical medications administered from 2.5 ± 1.1 to 2.0 ± 1.2 to the 1500 mW group and from 2.4 ± 1.0 to 1.9 ± 1.0 to the 1000 mW group. At 1 h post-laser treatment, a transient IOP spike was registered among the MLT1500 group. There were no differences in CCT and ECC at any timepoint according to the laser powers. Conclusions : Over a 6-month follow-up period, 577 nm MLT at either 1500 or 1000 mW reduces IOP, enabling a stable reduction in the number of topical medications required for patients treated for POAG without any significant difference in terms of effectiveness and safety.

Background and Objectives: A cross-sectional single-center study was conducted to investigate the etiology in hypertensive anterior uveitis whose clinical features are not fully distinctive from cytomegalovirus or from rubella virus and to demonstrate the possible coexistence of both these viruses in causing anterior uveitis. Materials and Methods: The clinical charts of a cohort of patients with hypertensive viral anterior uveitis of uncertain origin consecutively seen in a single center from 2019 to 2022 were retrospectively reviewed; data on the clinical features, aqueous polymerase chain reaction, and antibody response to cytomegalovirus and rubella virus were collected. Results: Forty-three eyes of as many subjects with viral anterior uveitis of uncertain origin were included. Thirty-two patients had an aqueous polymerase chain reaction or antibody index positive to cytomegalovirus only, while 11 cases had an aqueous antibody response to both cytomegalovirus and rubella virus. This latter overlapping group had a statistically significant higher rate of hypochromia and anterior vitritis (p-value: 0.02 and < 0.001, respectively). Conclusions: The simultaneous presence of intraocular antibodies against cytomegalovirus and rubella virus could redefine the differential diagnosis of hypertensive viral anterior uveitis, demonstrating a possible “converged” immune pathway consisting in a variety of stimuli.

Fuchs endothelial corneal dystrophy (FECD) is a bilateral, hereditary syndrome characterized by progressive irreversible injury in the corneal endothelium; it is the most frequent cause for corneal transplantation worldwide. Oxidative stress induces the apoptosis of corneal endothelial cells (CECs), and has a crucial function in FECD pathogenesis. The stimulation of the adenosine A 2A receptor (A 2Ar ) inhibits oxidative stress, reduces inflammation and modulates apoptosis. Polydeoxyribonucleotide (PDRN) is a registered drug that acts through adenosine A 2Ar . Thus, the goal of this study was to assess the effect of PDRN in an in vitro FECD model. Human Corneal Endothelial Cells (IHCE) were challenged with H 2 O 2 (200 μM) alone or in combination with PDRN (100 μg/mL), PDRN plus ZM241385 (1 μM) as an A 2Ar antagonist, and CGS21680 (1 μM) as a well-known A 2Ar agonist. H 2 O 2 reduced the cells' viability and increased the expression of the pro-inflammatory markers NF-κB, IL-6, IL-1β, and TNF-α; by contrast, it decreased the expression of the anti-inflammatory IL-10. Moreover, the pro-apoptotic genes Bax, Caspase-3 and Caspase-8 were concurrently upregulated with a decrease of Bcl-2 expression. PDRN and CGS21680 reverted the negative effects of H 2 O 2 . Co-incubation with ZM241385 abolished the effects of PDRN, indicating that A 2Ar is involved in the mode of action of PDRN. These data suggest that PDRN defends IHCE cells against H 2 O 2 -induced damage, potentially as a result of its antioxidant, anti-inflammatory and antiapoptotic properties, suggesting that PDRN could be used as an FECD therapy.

Aim: To evaluate the impact of cataract surgery on cognitive function in very elderly patients (≥ 85 years)., Methods: A prospective, nonrandomized, comparative study of very elderly patients (≥ 85 years), and elderly patients (≥ 65 < 85 years) scheduled for first time cataract surgery. Cognitive function, quality of life (QoL), best corrected visual acuity (BCVA), endothelial cell count (ECC), and central corneal thickness (CCT) were assessed at 90 days before surgery (T0), at surgery (T1), and at 30 (T2) and 90 days (T3) after surgery. Macular thickness (MT) was evaluated at T2. Six-item cognitive impairment test (6CIT) was used to evaluate cognitive function while the Catquest-9SF test was used to assess QoL. The confusion assessment method (CAM) was used to evaluate the presence of delirium episodes at within 48 h from T1., Results: A total of 78 patients (very elderly n = 24, elderly n = 54) were enrolled; average age 80.3 ± 6.2 years old. Significant improvements for cognitive function, BCVA, QoL (p < 0.01) during the observational period were observed among the cohort. A greater improvement in cognitive function was observed in the very elderly patients between T1 and T2 (p = 0.02), while there was no difference in BCVA and QoL between the groups. There were no significant differences in ECC and CCT changes between the groups. No delirium episodes or significant macular abnormalities were registered., Conclusions: Cataract surgery in very elderly patients seems to offer a greater improvement in cognitive function as compared to elderly patients, and it is associated with a significant improvement in QoL, without any incidence of postoperative delirium., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: To report the safety and efficacy of subthreshold micropulse yellow laser of 577 nm for a complex case of refractory pseudophakic cystoid macular edema., Methods: A retrospective chart review of an interventional case report of three subthreshold micropulse yellow laser interventions for refractory pseudophakic cystoid macular edema., Patient: A 77-year-old healthy female underwent pseudoexfoliative cataract surgery complicated by posterior capsule rupture and sulcus intraocular lens implantation. After 3 months, she required a scleral fixation of the same lens, due to a lack of capsular support and decentration of the intraocular lens. One month later, she experienced a severe pseudophakic cystoid macular edema (foveal thickness of 399 µm and best-corrected visual acuity of 20/80 Snellen). The condition was refractory to conventional treatments prior to subthreshold micropulse yellow laser interventions, including non-steroidal anti-inflammatory eye drops, topical steroids, oral indomethacin and three sub-Tenon's triamcinolone injections, attempted over a 14-month period., Results: Subthreshold micropulse yellow laser treatment was performed and immediate resolution was achieved and maintained for 2 months. Two cases of edema relapse were observed at 3 months from initial laser treatment and again at 4 months from the second laser treatment. Final patient's follow-up at 6 months from the third laser treatment evidenced the absence of edema, improved visual acuity (foveal thickness of 265 µm/best-corrected visual acuity of 20/30 Snellen) and the absence of complications., Conclusions: Subthreshold micropulse yellow laser seems to be a safe and effective treatment for short-term resolution of refractory pseudophakic cystoid macular edema after complicated cataract surgery and represents a useful alternative to expensive and invasive therapies. A trend towards a longer duration of edema resolution with every subthreshold micropulse yellow laser repetition was observed.

Background: Delirium is a severe condition that can arise in many contexts during hospitalization. The aim of this research was to measure the incidence of postoperative delirium in patients aged 75 years or older, with the exclusion of those with preexisting neurocognitive disorders (NCD), who underwent fast-track, moderate surgery., Methods: We conducted a prospective cohort study with patients ≥ 75 years of age who were eligible for fast-track, moderate surgery, without severe dementia, with a planned hospitalization of 24 h and with a physical status varying from very fit to vulnerable. The 4-item confusion assessment method (CAM4) was used to measure delirium., Results: Of the 209 eligible patients, 195 subjects were enrolled in the study. The percentage of the population with a CAM4 score above 0 before surgery was 2.56%; after surgery, the percentage was 10.25%; and on the following day, the percentage was 4.61%. There was a statistically significant difference in the CAM4 scores between immediately after surgery and at 24 h after surgery (p = 0.0172)., Conclusion: The data from this study support an enhanced recovery approach for elderly patients, in which after a minor surgical procedure with anaesthesia, a recovery period of one night in the hospital can contribute to normalizing the CAM4 score and reducing the incidence of delirium.

Purpose: To describe clinical and genetic features in a series of Italian patients with sector retinitis pigmentosa (sector RP)., Methods: Fifteen patients with sector RP were selected from the database of Hereditary Retinal Degenerations Referring Center of Careggi Hospital (Florence, Italy). Eleven patients from five independent pedigrees underwent genetic analysis with next-generation sequencing (NGS) confirmed with Sanger sequencing. The diagnosis of sector RP was based on the detection of topographically limited retinal abnormalities consistent with corresponding sectorial visual field defects. Best-corrected visual acuity (BCVA), fundus color pictures as well as fundus autofluorescence (FAF), spectral domain-optical coherence tomography (SD-OCT), full-field electroretinography (ERG), and 30-2 Humphrey visual field (VF) data were retrospectively collected and analyzed., Results: For the 30 eyes, the mean BCVA was 0.05 ± 0.13 logMAR, and the mean refractive error was -0.52 ± 1.89 D. The inferior retina was the most affected sector (86.7%), and the VF defect corresponded to the affected sector. FAF showed a demarcation line of increased autofluorescence between the healthy and affected retina, corresponding on SD-OCT to an interruption of the ellipsoid zone (EZ) band in the diseased retina. Dark-adapted ERG amplitudes were decreased in comparison to normative values. In five unrelated families, the sector RP phenotype was associated with sequence variants in the RHO gene. The same mutation c.568G>A p.(Asp190Asn) was found in nine patients of four families., Conclusions: Typical sector RP is a mild form of RP characterized by preserved visual acuity with limited retinal involvement and, generally, a more favorable prognosis than other forms of RP., (Copyright © 2021 Molecular Vision.)

Aim: This study aims to evaluate the morphology of ganglion cell complex (GCC) along with functional outcomes in patients undergoing vitrectomy with ILM peeling and macular abrasion with Tano diamond dusted membrane scrapers (DDMS) for three different stages of the idiopathic macular hole (IMH)., Methods: This retrospective study was conducted between April 2019 and December 2019. 33 patients with IMH were included and divided into three groups: stage I, stage II, and stage IV. All patients were subjected to vitrectomy with ILM peeling. Gentle and vigorous macular abrasion was additionally performed for stage II and stage IV patients, respectively. The best-corrected visual acuity (BCVA), GCC thickness (measured by spectral domain-optical coherence tomography (SD-OCT)), and photopic contrast sensitivity (Rodenstock CV 900 Chart Panel) were determined before surgery and at 1- and 3-month follow-ups., Results: Closure of MH was achieved in all the patients. The difference between the preoperative and one- and three-month postoperative values of BCVA was statistically significant in the three groups ( P < 0.01). Contrast sensitivity progressively improved in all patients and was statistically significant ( P < 0.01). The reduction in GCC thickness during follow-up was 34%-42% of the preoperative measurements. On comparing the mean GCC thickness of the operated and healthy eyes, it was not statistically significant in stage I patients. However, the same when done in stage II and IV was statistically significant with P value < 0.05 and P < 0.01, respectively., Conclusion: Combining ILM peeling with macular abrasion in advanced stages of MH may facilitate its closure without significantly affecting the functional outcome., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Aurelio Imburgia et al.)

Purpose: To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications., Methods: In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups., Results: We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p =0.49). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group ( p =0.22). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences ( p =0.18). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group ( p < 0.001)., Conclusion: A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Matteo Forlini et al.)

Purpose: To evaluate capsulotomy shape and posterior capsule opacification (PCO) during an 18-month follow-up for bimanual femtosecond laser-assisted cataract surgery (FLACS)., Methods: 74 eyes operated by a well-trained surgeon with bimanual FLACS technique using low-energy LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) were included in the study. The follow-up period was 18 ± 2 months. Another 91 eyes, which underwent standard bimanual microincision cataract surgery (B-MICS), served as a control group. In all cases, a BunnyLens AF (Hanita Lenses, Israel) intraocular lens was implanted in the bag. A digital image of the capsule with slit-lamp retroillumination was performed in all patients at 18 months of follow-up. Image analysis software (ImageJ) was used to evaluate the shape of the capsulotomy in terms of diameter, area, and circularity. PCO score was evaluated using EPCO 2000 software. Best corrected visual acuity (BCVA) and endothelial cell count (ECC) were evaluated before and after surgery at 1 and 18 ± 2 months., Results: At 18 months, mean capsulotomy diameter was 5.34 ± 0.21 mm while capsulorhexis was 5.87 ± 0.37 mm ( p < 0.001) and the deviation area from baseline was 1.13 ± 1.76 mm 2 in FLACS and 2.67 ± 1.69 mm 2 in B-MICS ( p < 0.001). Capsulotomy circularity was 0.94 ± 0.04 while capsulorhexis was 0.83 ± 0.07 ( p < 0.001). EPCO score was 0.050 ± 0.081 in the FLACS group and 0.122 ± 0.239 in the B-MICS group ( p =0.03). The mean BCVA improvement was significant in both groups, without a significant difference at 18 months. We noticed a statistically significant difference in endothelial cell loss at 18 months (FLACS 12.4% and B-MICS 18.1%; p =0.017)., Conclusions: Bimanual FLACS is a safe and effective technique, as determined in a long-term follow-up. Capsulotomy shape presented higher stability and circularity in the FLACS group over the 18-month observation period. FLACS resulted in lower PCO scores and endothelial cell loss at 18 months in comparison to B-MICS standard technique., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Tommaso Verdina et al.)

Purpose: To evaluate the effectiveness of Visual Evoked Potential (VEP) biofeedback rehabilitation in selected low vision patients with advanced age-related macular degeneration (AMD)., Design: Retrospective observational cohort study., Methods: Patients affected by advanced AMD, central macular atrophy with unstable fixation and best corrected visual acuity (BCVA) between 20/100 and 20/320 were considered. Selected patients underwent fundus photography and microperimetry with fixation analysis for the selected eye (highest BCVA). Ten consecutive training sessions of 10 min each were performed twice a week in the selected eye with Retimax Vision Trainer (CSO, Florence). BCVA, reading acuity and reading speed, contrast sensitivity, fixation, retinal sensitivity and quality of life questionnaire (VFQ-25) were evaluated at baseline and 7 days following the final session., Results: Significant improvements in terms of BCVA [ p = .011], reading speed [ p = .007], VFQ-25 score [ p = .007], retinal sensitivity [ p = .021] and fixation stability in the central 2° and 4° [ p = .048; p = .037] post-treatment were observed for the 9 patients enrolled, with insignificant improvements observed in reading acuity and contrast sensitivity [ p = .335; p = .291]., Conclusions: Preliminary results support VEP biofeedback rehabilitation improvements for visual function and quality of life in advanced AMD patients with low vision.

Headings: Multifocal electroretinography (mfERG) may be useful in the management of sector retinitis pigmentosa (SRP)., Aim: To compare multifocal electroretinographic responses in SRP, generalised retinitis pigmentosa (GRP), and healthy controls., Methods: Eighteen patients with SRP, twelve with GRP, and fifteen controls were included in the study. All participants underwent: complete ophthalmological examination, Humphrey visual field testing, full-field ERG, and mfERG. The mean P1 amplitude, the implicit time (IT), and the mapping of the local responses were evaluated., Results: The mean P1 amplitude was higher in the SRPs than in GRPs (p < 0.001), while it did not differ between SRPs and controls (p = 0.913). In the SRPs, the P1 amplitude in pathologic areas was higher than in the GRPs (p < 0.001). In normal areas, this parameter did not differ from the controls (p = 0.499). Moreover, in the SRPs, no differences in the P1 amplitude and the IT between pigmented and non-pigmented areas were found., Conclusion: In the present study, the mfERG examination displayed significant differences between sector and generalised RP, showing normal values in sector RP even in pigmented areas. Considering the patients included in this study, SRP seems to represent a favourable variant of the disease, characterised by a limited retinal involvement and apparently mild functional damage. It is still unclear how these results can be extended to other forms of SRP.

Purpose: To evaluate the efficacy and safety of bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions compared to standard bimanual phacoemulsification (bimanual microincision cataract surgery)., Design: Prospective, non-randomized comparative case series., Methods: Bimanual femtosecond laser-assisted cataract surgery with microincisions was performed on 80 eyes (Group A) with the low-energy Ziemer LDV Z8; a matched case-control series of 80 eyes performed with standard bimanual microincision cataract surgery technique was selected for comparison (Group B). All interventions were performed by the same experienced surgeon. Intraoperative parameters were recorded as well as intra- and postoperative complications. Best corrected visual acuity, surgically induced astigmatism, central corneal thickness and endothelial cell count were evaluated before surgery and at 1 and 3 months post intervention., Results: The mean effective phaco times were 3.79 ± 2.19 s (Group A) and 4.49 ± 1.84 s (Group B) (p = 0.041). No major intra- or postoperative complications occurred. An overall significant mean best corrected visual acuity improvement was noted at 3 months, but was not statistically different between the groups. No significant changes were observed for surgically induced astigmatism or corneal pachymetry. A significant loss of endothelial cell count in both groups was detected at 3 months, with Group A reporting a significantly lower endothelial cell count loss compared to Group B (p = 0.009)., Conclusion: Bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions by an expert surgeon was proven to be safe and effective in this study. This technique has advantages compared with standard bimanual microincision cataract surgery in terms of endothelial preservation.

Background: To evaluate macular pigment optical density (MPOD) after bimanual femtosecond laser-assisted cataract surgery (FLACS) compared to standard bimanual phacoemulsification (B-MICS). Methods: A prospective, case matched, comparative cohort study conducted at the Institute of Ophthalmology, University of Modena and Reggio Emilia (Italy); 30 eyes underwent bimanual FLACS with low-energy Ziemer LDV Z8 (FLACS) and 30 underwent B-MICS standard technique (B-MICS). All interventions were conducted by the same expert surgeon. MPOD using the Macular Pigment Screener II (MPS II) was evaluated at baseline, 7 and 30 days after surgery. As secondary outcomes, we considered best corrected visual acuity (BCVA) and central macular thickness (CMT) obtained using optical coherence tomography. Results: In all cases, a BunnyLens AF IOL was safely implanted in the capsular bag through a 1.4 mm incision. We found a significant reduction in MPOD in both groups at 7 and 30 days; 0.16±0.14 and 0.10±0.12 (FLACS) and 0.18±0.13 and 0.15±0.14 (B-MICS), respectively ( P <0.05). However, there was no significant difference between the two groups at either 7 ( P =0.52) or 30 days ( P =0.18). BCVA improved significantly in both groups and CMT increased in both groups ( P <0.001, P <0.001, respectively). BCVA and CMT were similar between the groups with a significant difference in CMT in favor of the FLACS group at 30 days ( P =0.017). Conclusions: MPOD was reduced in both groups without any significant difference between the FLACS and B-MICS cataract interventions. FLACS is associated with a significantly higher increase of macular thickness at 30 days compared to B-MICS., Competing Interests: The authors report no conflicts of interest in this work.