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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]

Aim: To analyze the visual outcomes and the posterior capsule opacification (PCO) with the new Incise ® MJ14 intraocular lens (IOL) implanted through a 1.4 mm clear corneal incision (CCI) in patients who underwent bimanual microincision cataract surgery (B-MICS)., Methods: Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study: 40 eyes were implanted with an Incise ® MJ14 IOL through a 1.4 mm CCI (group A) without enlargement of the main CCI, while 40 eyes were implanted with an Akreos ® MI60 IOL with enlargement of the main CCI to 1.8 mm (group B). Best corrected visual acuity (BCVA), astigmatism and endothelial cell loss were evaluated before and after surgery at 7, 30d and 6mo. Anterior segment-optical coherence tomography (AS-OCT) of CCI was performed at 1, 3, 7, 30d, 6 and 18mo. PCO incidence was evaluated at 18mo using EPCO 2000 Software., Results: Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups; no statistically significant difference in surgically induced astigmatism (SIA) was noticed in the two groups. At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet's membrane at 1 and 7d after surgery; no statistically significant alterations were found at 1, 6 and 18mo. PCO score at 18mo was 0.03±0.07 for group A and 0.08±0.18 for group B ( P =0.11) with no sign of central optic plate invasion in both groups., Conclusion: The implant of the new Incise ® MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery. PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

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., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: A database study to test a new model of surgical safety checklist for eye surgery in the outpatient operating room, especially for cataract surgery and intravitreal anti-VEGF injections., Methods: WHO Surgical Safety Checklist analysis, and changes to obtain a customized surgical safety checklist for eye surgery. Testing of the new checklist in the outpatient operating room of the Institute of Ophthalmology, University of Modena during a period of 4 months (January-April 2011). All cataract surgery and intravitreal anti-VEGF operations were included in the study, and controlled by the new surgical safety checklist. The percentage of answers to each safety check was calculated to obtain an estimate of adherence to our new checklist., Result: Eight hundred and forty nine procedures (390 cataract, 452 anti-VEGF injections, seven combined surgery) were analyzed. The study showed a high level of adherence to the majority of the safety checks in the checklist. Important differences were identified in consent confirmation (correct confirmation in 99.76 %, no confirmation in 0.24 %), surgical site marking (correct marking in 99.29 %, no marking in 0.71 %), patient cooperation during operation (95.17 % of patients were cooperative, 4.83 % of patients were uncooperative), adherence to antibiotic prophylaxis (correct prophylaxis in 93.17 %, no prophylaxis in 6.83 %), critical situation during surgical procedures (no critical situation in 91.76 %, critical situation in 8.24 %), Conclusion: The study showed a high level of adherence to the checklist. A surgical safety checklist could improve the management of an eye surgery operating room.

Background: Combined post-traumatic aniridia and aphakia demand extensive and complex reconstructive surgery. We present our approach for simultaneous correction of this surgical situation with the use of the ArtificialIris (Dr. Schmidt Intraocularlinsen GmbH, Germany) with a foldable acrylic IOL Lentis L-313 (Oculentis, GmbH, Germany) sutured to its surface. The novelty (our first operation was on June 2010) of this surgical technique is based on the combined use of foldable (with closed haptics) IOL and Artificialiris to correct post-traumatic aniridia and aphakia., Methods: Four consecutive cases of combined post-traumatic lesions of iris and lens, corrected with complex device ArtificialIris and foldable IOL. In two cases, the compound implant was sutured to the sclera in sulcus during the penetrating keratoplasty; in another case, it was positioned through a corneal incision of about 5.0 mm with transscleral fixation, and in one patient with preserved capsular support and possibility of IOL in-the-bag implantation the ArtificialIris was placed in sulcus sutureless through a clear corneal tunnel., Results: Maximal follow-up was 6 months. The complex device was placed firmly fixed within the sulcus, including in the eye implanted without sutures, and showed a stable and centered position without any tilt or torque., Conclusion: Management of post-traumatic aniridia combined with aphakia by haptic fixation of a foldable acrylic IOL on a foldable iris prosthesis appears to be a promising approach which gives the surgeon the possibility to correct a complex lesion with one procedure, which is less traumatic and faster. Existence of foldable materials, both iris and IOL, permits relatively small corneal incisions (4.0-5.0 mm). Moreover, the custom-tailored iris prosthesis gives a perfect aesthetic result.

Purpose: To evaluate bimanual microincision cataract surgery (MICS) clear corneal incision (CCI) architectural features over the long-term using anterior segment optical coherence tomography (AS-OCT)., Design: Case series., Setting: Institute of Ophthalmology, University of Modena, Modena, Italy., Methods: Patients who had uneventful bimanual MICS in the previous 2 to 16 months were examined using AS-OCT. Images were used to measure corneal thickness, incision length, incision angle, incidence of epithelial or endothelial gaping, misalignment, Descemet membrane detachment, and posterior wound retraction., Results: Fifty-two eyes (33 patients) were enrolled. Mean incision length and incision angle were, respectively, 1427.91 μm and 31.19 degrees for the right hand, 1440.63 μm and 31.54 degrees for the left hand, 1474.13 μm and 31.27 degrees for temporal incisions, and 1394.41 μm and 31.46 degrees for nasal CCIs. Posterior wound retraction was the only architectural feature found. Its prevalence was 7.10% at 2 to 3 months, 31.8% at 4 to 11 months, and 33.3% at 12 months. Fifty-three percent of posterior wound retractions were in 1.8 mm CCIs and 47% in 1.4 mm CCIs., Conclusions: Bimanual MICS was not related to particular morphologic features of CCIs. The enlargement of 1 incision or construction of the incision with the dominant or the nondominant hand did not affect long-term wound architecture. Posterior wound retraction was the only architectural feature; however, its prevalence seems substantially lower than with other surgical techniques., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Aim: To describe our series of bottle cork and cap injuries to the eye in order to report the visual impairment and clinical outcomes observed in 34 cases over an 8-year period., Methods: Retrospective review of the database of the Ophthalmology Institute of Modena from January 1999 to September 2007. All patients presented with closed-globe injury according to Kuhn et al.'s classification. All the cases were caused by sparkling wine: white in 24 cases and red in ten cases., Results: The incidence varied between six and two cases a year (average 3.89). Bottle cork and cap injuries represent 11% of all injuries admitted to our department in the period considered in our series. In details: nine patients recovered totally, 22 patients recovered partially, three patients had a severe visual outcome (

Purpose: To assess the efficacy and safety of bimanual microphacoemulsification combined with vitrectomy in eyes with clinically evident cataract and vitreoretinal pathology., Setting: Institute of Ophthalmology of the University of Modena and Reggio Emilia, Modena, Italy., Methods: This prospective case series comprised 19 consecutive patients with clinically significant cataract who were scheduled for vitrectomy. Bimanual microphacoemulsification was performed, and an Acri. Smart 46 S hydrophobic acrylic intraocular lens (IOL) with a 6.0 mm optic (Acri.Tec, Inc.) was implanted in the capsular bag. Immediately after, standard 3-port vitrectomy was performed., Results: The prevailing vitreoretinal pathology was retinal detachment, with 1 case of macular pucker and 1 case of macular hole. In all cases, the IOL was implanted in the capsular bag. There were no intraoperative complications during the cataract surgery or vitrectomy. Follow-up 1, 15, 30, 90, and 180 days after surgery showed significant visual recovery in all cases. The mean endothelial loss was 10.05%+/-2.01% (SD). In 3 cases that had tamponade with heavy silicone oil, progressive posterior capsule opacification occurred 6 months after surgery., Conclusions: Bimanual microphacoemulsification combined with vitrectomy was effective and safe. The microincisions and 19-gauge instruments provided excellent chamber resistance that simplified surgical maneuvers in eyes that might have a distorted fundus reflection and increased zonular laxity. The Acri. Smart 46 S IOL, which can be injected through a 2.0 mm incision, provided good fundus visibility during vitrectomy and good maneuverability up to the extreme periphery without resulting in glare or distracting reflections for the surgeon.

Purpose: To compare the outcomes of bimanual microphacoemulsification and coaxial miniphacoemulsification and assess the potential advantages of the former over the latter., Setting: Institute of Ophthalmology, University of Modena, Modena, Italy., Methods: In a controlled prospective clinical trial, 100 eyes of 50 patients with nuclear or corticonuclear cataract of grade 2 to 4 on the Lens Opacities Classification System III had phacoemulsification. Fifty eyes were randomized to have surgery by the bimanual technique and 50, by the coaxial technique. All surgeries were performed by the same surgeon using the same machine (Sovereign WhiteStar, American Medical Optics). In all cases, the incision was made superiorly in clear cornea and a hydrophobic acrylic flexible intraocular lens (Acri. Smart 48 S, Acri.Tec) was implanted. Intraoperative parameters were mean phacoemulsification time, total phacoemulsification percentage, effective phacoemulsification time (EPT), total volume of balanced salt solution (BSS) used, total surgical time, and final size of the corneal incision. Postoperative parameters were visual acuity, astigmatism changes by vector analysis, corneal thickness, endothelial cell count, and presence of flare and cells in the anterior chamber., Results: The only statistically significant difference between the 2 groups was the total volume of the BSS used (P = .004) and total surgical time (P = .045)., Conclusions: Both techniques were safe and effective for cataract surgery. With bimanual microphacoemulsification, significantly less BSS was used and the total surgical time was significantly shorter than with the coaxial method.