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Maria Vadalà,1,2 Valentina Sunseri Trapani,1 Giulia Guarrasi,1 Nicasio Ventura,1 Massimo Castellucci,1 Salvatore Cillino1 1Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy; 2IEMEST, Euro-Mediterranean Institute of Science and Technology, Palermo, ItalyCorrespondence: Maria VadalàBiomedicine, Neuroscience and Advanced Diagnostic (BIND) Department, Ophthalmology Institute, University of Palermo, Palermo 90127, ItalyTel +39 091 6553909Email maria.vadala@unipa.itPurpose: There has been an increasing clinical interest in specific retinal parameters as non-invasive biomarkers of retinal inflammation in diabetic macular edema (DME) that have been shown to have prognostic value, such as hyperreflective retinal fields (HRFs) and subfoveal neuroretinal detachment (SND).Methods: We conducted a prospective, non-comparative study of treatment-naïve patients with DME to evaluate the efficacy of a Pro Re Nata (PRN) regimen of intravitreal dexamethasone implant 0.7 mg (DexI, Ozurdex™). After administration, patients underwent subsequent injections according to PRN criteria in case of edema relapse, but not earlier than 4 months after the previous treatment. Patients were evaluated at baseline, within 15 days of injection, and every month thereafter. During all visits, best-corrected visual acuity (BCVA) was recorded; central retinal thickness (CRT), type of edema, presence of SND, and presence and number of HRFs were evaluated using swept-source optical coherence tomography (SS-OCT) 3D. Treatment outcome was defined as changes in BCVA, CRT, SND and HRFs at 12 (T12) and 24 (T24) months compared with baseline (T0).Results: The study enrolled 24 eyes of 18 patients. The mean duration of follow-up was 18± 6.6 months; for all eyes, T12 data were available, while follow-up reached T24 for 12 eyes. BCVA improved significantly and CRT decreased significantly during treatment; the edema was no longer detectable in 13/24 eyes at T12 and 8/12 eyes at T24. No patient presented SND at T12 and T24, and the mean number of HRFs decreased significantly during treatment. Results with CRT and HRFs correlated with BCVA at 12 and 24 months. No significant adverse events were observed.Conclusion: In patients with DME, the intravitreal dexamethasone implant was effective and safe in improving both functional and tomographic parameters. This result is consistent with improvement in biomarkers of inflammation.Keywords: dexamethasone implant, diabetic macular edema, intravitreal implants, Ozurdex, real-world, inflammation

Background and Objectives: The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs’ endothelial dystrophy (FED). Materials and Methods: Retrospective comparative cohort study, including 11 patients with FED who underwent bilateral PK and 13 patients with FED who underwent bilateral UT-DSAEK. All patients were already pseudophakic or had undergone a combined cataract procedure. The main outcomes were corrected distance visual acuity (CDVA) corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and quality of life (QoL). Results: The mean follow-up after the second eye surgery was 32.5 ± 10.2 months in PK and 19.6 ± 8.6 months in UT-DSAEK patients. The CDVA in the UT-DSAEK group was significantly better than in the PK one (0.18 ± 0.07 vs. 0.35 ± 0.16 logMAR, p &lt, 0.0001). The mean anterior corneal total HOAs of the central 5 mm were significantly lower in UT-DSAEK eyes than in PK eyes (0.438 ± 0.078 µ and 1.282 ± 0.330 µ respectively, p &lt, 0.0001), whilst the mean posterior total HOAs did not differ between groups (0.196 ± 0.056 µ and 0.231 ± 0.089 µ, respectively, p = 0.253). The CS was lower at 0.75 and 1.5 cycles/degree in P the K group when compared to the DSAEK one (p = 0.008 and 0.005, respectively). The QoL scores by the NEI RQL-42 test exhibited better values in DSAEK patients in 9 out of 13 scales. Conclusion: Our study confirms that UT-DSAEK provides a better visual function in terms of CDVA and CS, together with lower HOAs, when compared to PK. Hence, the vision-related QoL, binocularly evaluated by the NEI RQL-42 items, indicates a higher satisfaction in UT-DSAEK eyes.

Retinal and choroidal microvascular changes can be related to renal impairment in hypertension and chronic kidney disease (CKD). The study examines the association between retinochoroidal parameters and renal impairment in hypertensive, non-diabetic patients. This is a cross-sectional study on Caucasian patients with systemic arterial hypertension with different levels of renal function. All subjects were studied by blood chemistry, urine examination, microalbuminuria and blood pressure. Complete eye examination was completed with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) scans of macular region. Patients were divided in groups: LowGFR and HighGFR and CKD− and CKD+, according to the value of glomerular filtrate (GFR) and albuminuria. LowGFR and CKD+ groups included patients with clinical kidney impairment. One hundred and twenty eyes of 120 hypertensive patients were evaluated. The mean retinal thickness was thinner in CKD+ versus CKD− group (p

The introduction in the past few years of advanced optical coherence tomography (OCT) techniques has greatly increased our understanding of the choroid, which is the most important vascular layer of the eye. Our study aimed to assess choroidal thickness by using swept-source OCT (SS-OCT) in essential hypertensive patients (EHs) with and without early-stage chronic kidney disease (CKD). We enrolled 100 EHs, of whom 65 were without kidney damage, and 35 had stage 1-3 CKD. In all of the participants, SS-OCT and a routine biochemical workup were performed. Glomerular filtration rate (GFR) was estimated by the CKD Epidemiology Collaboration equation (eGFR). CKD was defined in agreement with the Kidney Disease Outcomes Quality Initiative Kidney Disease: Improving Global Outcomes 2002 guidelines. OCT measurements were performed according to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, which divides the macula into nine subfields. The circular grid consists of three concentric rings. EHs with CKD showed thinner choroidal thicknesses than those without it (all p

The introduction in last years of advanced techniques of optical coherence tomography (OCT) has greatly increased our understanding of the choroid, that is the most important vascular layer of the eye. Our study was aimed to assess choroidal thickness by using Swept-Source OCT (SS-OCT) in essential hypertensive patients (EHs) with and without subclinical renal damage (SRD). We enrolled 100 EHs of which 65 without kidney damage and 35 with SRD. In all the participants SS-OCT and a routine biochemical workup were performed. Glomerular filtration rate (GFR) was estimated by the CKD-EPI equation (eGFR). SRD was defined, by the presence of microalbuminuria or eGFR between 30 and 60 mL/min/1.73 m2. OCT measurements were performed according to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, that divides the macula into 9 subfields. The circular grid consists of 3 concentric rings. EHs with SRD showed thinner choroidal thicknesses than those without kidney damage (all p < 0.05), even after adjustment for age. Overall choroidal thickness correlated significantly and directly with eGFR (r = 0.36) and negatively with urinary albumin excretion (r = – 0.39). The association of choroidal thickness with SRD was confirmed in multiple logistic regression analyses once the effect of age, antihypertensive therapy and triglycerides was accounted for. The odds ratio of having SRD associated with a standard deviation increase of overall choroidal thickness was 0.43 (0.24–0.75, 95% confidence interval; p = 0.007). In conclusion, our study confirms the close relationships between changes in ocular microcirculation and renal dysfunction.