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Purpose The aim this study is to determine anterior chamber parameters variations induced by PreserFlo MicroShunt implantation, in the early post-operative days. Methods This is a prospective observational study on 48 eyes undergoing PreserFlo MicroShunt implantation alone (n = 30) or combined with phacoemulsification (n = 18). Anterior chamber depth (ACD) and volume (ACV), central corneal thickness (CCT) and total corneal astigmatism (TCA) were evaluated pre-operatively, post-operatively at day-1 and at 1 week with the Pentacam tomography. Results Intraocular pressure decreased significantly from 20.9 ± 4.0 to 8.0 ± 2.8 mmHg (p p = 0.0001) at day-1 and week-1, respectively. TCA varied significantly from baseline (1.5 ± 1.2 D) to both day 1 follow up (2.7 ± 1.9 D, p = 0.0003) and week 1 follow up (2.2 ± 1.6 D, p = 0.02). Nevertheless, only K1 showed a transient flattening at day 1, while K2 value didn’t show any statistical variation in the early post-operative period. CCT value rose significantly at day 1 (547 ± 49 vs. 529 ± 32 µm at baseline, p = 0.04), but then returned toward pre-operative values at week 1 (537 ± 39 µm, p = 0.57). In contrast, ACD values changed insignificantly from 3.3 ± 0.9 to 3.7 ± 1.0 mm at day 1 (p = 0.21), and then stabilized at 3.4 ± 0.9 mm (p = 0.82) at week 1 follow up. ACV changed from 150.0 ± 36.2 to 159.5 ± 42.1 mm3 at day 1 (p = 0.58), and successively to 153.9 ± 37.9 mm3 at week 1 follow up (p = 0.96). The subgroup analysis in eyes undergoing standalone PreserFlo implantation didn’t show significant changes in both ACD and ACV. Conclusion PreserFlo implantation minimizes the anterior chamber modifications generated by traditional filtering surgery, inducing low and transient corneal and biometric changes only in the very early postoperative period and insignificant changes to ACD and ACV, label of its safety and minimal invasiveness.

To predict improvement of best corrected visual acuity(BCVA) 1 year after pars plana vitrectomy (PPV) for epiretinal membrane(ERM) using artificial intelligence(AI) methods on optical coherence tomography(OCT) B-scan images.Four-hundred 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 PPV with internal limiting membrane(ILM) peeling.Primary outcome was the creation of a deep learning classifier(DLC) based on OCT 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 dataset.For secondary outcome, B-scan acquisitions were analyzed by graders both before and after fibrillary changes(FC) processing-enhancement.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 (EIFL),foveal detachment,ellipsoid zone(EZ) interruption, cotton wool sign, unprocessed FC(OR=2.75(CI 2.49-2.96)) and processed FC(OR=5.42(CI 4.81-6.08)) while preoperative BCVA and central macular thickness(CMT) didn't differ between groups.The DLC showed high performances in predicting 1-year visual outcome in ERM surgery patients. FC should also be considered as relevant predictors.

Background Endothelium damage is a crucial element in the pathogenesis of SARS-Cov-2 infection. Most casualties in critical COVID-19 cases are due to ARDS, diffuse coagulopathy and cytokine storm. ARDS itself is a consequence of pulmonary endothelial cells damage. Damage to retinal capillary microcirculation in post-infective period has been investigated through Optical Coherence Tomography Angiography (OCTA). The aim of the present study is to find a correlation between signs of retinal vascular damage and pulmonary impairment. Methods Patients admitted to hospital and subsequently recovered from COVID-19 infection were summoned 1 month later to undergo coherence tomography (CT) scan and OCTA examination. Results The study population included 87 COVID-19 patients with a mean age of 54.28 ± 14.44 years. Oxygen therapy, non-invasive and invasive mechanical ventilation were necessary in 33, 11 and 4 patients respectively to provide respiratory support during the acute course of the disease. Pulmonary involvement interested 54 patients (62.1%). Peripheral (27.6%) or diffuse (29.9%) involvement and ground glass (GG) opacities (47.1%) represented the prevalent radiological finding. A reduced RCPI FI was independently correlated with the presence of reticulation pattern in CT scan ( p = .019). Also, RNFL and GCC were thinner in patients who displayed reticulation pattern (respectively p = .025 and p = .015). Conclusions A reduction in RPCP-FI and RNFL and GCC thickness were independently correlated to the presence of CT reticulation pattern. This association can reflect cytokine induced remodeling in both organs as a consequence of systemic endothelial damage and inflammation.

Purpose To study the post-operative refractive error (RE) of patients undergoing combined phaco-vitrectomy and to find out which intraocular lens (IOL)-power formula had the best refractive outcomes. Methods In this retrospective multicentric study we compared the preoperative expected target with the postoperative RE of patients undergoing combined phaco-vitrectomy due to vitreomacular traction, macular pucker, full thickness macular hole or lamellar macular hole. A multinomial logistic regression was performed to compare the postoperative REs and the differences between expected and postoperative REs among the SRK-T, Olsen's and Holladay-2 formulas. The correlation between the difference in REs and IOL-power was also studied. Results Sixty-seven eyes with a mean axial length of 23.73 ± 1.21 mm were included. Forty-two (63%), 14 (21%) and 11 (16%) eyes were implanted with an IOL that was calculated respectively with SRK-T, Olsen's and the Holladay-2 formula. The mean preoperative expected- and post-operative REs were −0.16 ± 0.12D and −0.48 ± 0.17, respectively ( p = 0.045). SRK-T and Holladay-2 formulas led to a significant myopic shift whereas Olsen's caused a significant hyperopic error, independently from the IOL power. Conclusion Independently from the IOL power, none of the analyzed formulas is precise at calculating the post-operative RE.

Objectives To investigate the correlation between the AI-measured area of the lacquer cracks (LC) at their first detection and the occurrence of a choroidal neovascularization (CNV) during the follow up in patients affected by pathologic myopia. Secondary outcome was the detection of a correlation between the time to onset of CNV with both baseline LC area and LC area increase during follow up. Methods Optical coherence tomography (OCT) acquisitions of patients diagnosed with LC were retrospectively analyzed. The study population was divided in a CNV group (showing documented onset of a CNV) and a n-CNV group (no CNV development during follow-up). LC area was measured using MatLab software after application of a customized method for LC segmentation on infrared (IR) enface images. Results Fifty-five (55) patients with a mean follow-up of 5.1 ± 1.4 years were included. LC area at baseline was 2.82 ± 0.54 mm2 and 1.57 ± 0.55 mm2 in CNV (20 patients) and n-CNV group (35 patients) group respectively (p

Purpose The aim of this study is to investigate changes in choroidal and optic nerve morphological parameters following MicroShunt PreserFlo implantation. The secondary aim is to investigate how the structural changes relate to the decrease in intraocular pressure (IOP). Methods Prospective observational study on 15 eyes with glaucoma requiring MicroShunt implantation. Optical coherence tomography was used to measure macular choroidal thickness (MCT), peripapillary choroidal thickness (PCT), lamina cribrosa depth (LCD), cup depth and prelaminar tissue thickness (PLT), before and one day after surgery. Results were expressed in median and interquartile range (IQR) and correlated with IOP results. Results The IOP decreased from a median of 25 (IQR = 11) mmHg to 8 (IQR = 2) mmHg the day after surgery. Median MCT increased after MicroShunt implantation from 252.1 (IQR = 156.4) µm to a postoperative value of 318.1 (IQR = 166.6) µm (p p p p = 0.028). On the other side, LCD reduction 24 h after surgery didn’t reach any statistical significance. Conclusion PreserFlo implantation determines retinal structural changes which appear similar to those caused by traditional filtering surgery, confirming the effectiveness of this device, meantime carrying a much smaller complications rate when compared to trabeculectomy.

Even after a successful keratoplasty with a clear graft, a high postoperative refractive error could occur too hard to correct with spectacles or contact lenses. Therefore, refractive surgery could be considered a good tool to correct these high postoperative defects. The authors showed the reasons involved in the refractive errors after successful penetrating (PKP) or lamellar transplantation (DALK), pre-, intra-, and post-operatively. Moreover, they presented different techniques to correct the refractive errors after transplantation for different corneal pathologies, in the plastic phase (managing of transplant sutures) as well as in the static phase (different refractive techniques: incisional (AK, FemtoAK), ablative (PRK, FemtoLASIK), or IOL implantation (Phakic IOL, PHACO + IOL)). Thus, it is necessary to study accurately every single clinical case to choose the best surgery for each patient. Due to the high risk of graft damage or graft rejection, the patient must be adequately informed about the risks and benefits of the surgery proposed and must specifically accept the possibility of a new corneal transplant in the event of surgery failure or graft damage. Certainly, the refractive surgeon must be able in managing all the different refractive surgery techniques to reach the best result in every single case.

To compare acquisitions from single-volume Solix protocol (V1), multi-volume averaged Solix protocol (V4), and AngioVue in patients with diabetic retinopathy (DR) to assess differences in quantitative parameters introduced by high-speed scanning and averaging.Thirty-eight diabetic patients were divided into 4 groups showing either no sign, mild, moderate, or severe DR at fundus examination. For optical coherence tomography angiography (OCTA) acquisitions both AngioVue, Solix V1, and V4 were used on each patient. Outcome measures were macular perfusion density (PD), vessel length density (VLD), and vessel density index (VDI) for both superficial capillary plexus (SCP) and deep capillary plexus (DCP) and flow deficits (FD) in the choriocapillaris (CC).Our study revealed a good agreement in SCP parameters measured with all 3 devices. DCP measurements with Solix V1 showed moderate agreement with V4 and poor agreement with AngioVue measurements. Inter-device agreement in CC-FD assessment was relatively poor considering all 3 devices. The averaging process led to an underestimation of DCP and SCP parameters in all stages of DR (more evident in mild DR). AngioVue measurements compared to Solix V1 led to overestimation of SCP-PD (more pronounced in severe DR patients) and of DCP parameters (more evidently in moderate DR). The regression model derived from Solix V1 parameters was the best for categorization into the different stages.Averaging and high-speed scanning introduce changes in OCTA quantitative parameters in DR. Solix V1 is the most suitable for early diagnosis of DR, while averaged protocol could be the preferred choice in advanced stages of the disease.

High-order aberrations (HOAs) have been demonstrated to profoundly affect both visual acuity and stereoacuity in patients with keratoconus. Corneal collagen cross-linking (CXL) has been proven to significantly lower HOAs in keratoconus. Yet, to the present date, no evaluation of the effect of the procedure on stereopsis has been performed. The purpose of the study was to assess differences in binocular visual performance in patients with keratoconus before and after CXL.Patients with keratoconus undergoing standard Dresden protocol epi-off CXL in the ophthalmology department of Policlinico Universitario Agostino Gemelli Hospital received slitlamp examination, uncorrected distance visual acuity and corrected distance visual acuity assessment, corneal tomography, Lang stereotest, TNO stereoacuity assessment, distance and near cover test, and Irvine test before surgery and 6 months after CXL. Stereopsis tests were performed with spectacle correction.The analysis included 30 patients (mean age 24.63 ± 3.49 years). The Lang test improved after treatment (P 0.027), with 6 of 30 patients (20%) showing a positive Lang test before CXL compared with 16 of 30 patients (53.3%) after treatment. Moreover, TNO stereoacuity increased after treatment (P 0.043), and 14 of 30 patients (46.7%) manifested an improvement of at least 250″ at the TNO test after CXL. In this subgroup of patients, total root mean square values decreased after treatment (P0.001), whereas patients who did not manifest a clinically significant improvement in stereoacuity did not show a reduction in total root mean square values after CXL (P = 0.11). The results of cover test and Irvine test did not vary after CXL.Patients with keratoconus showing a reduction of HOAs after CXL also manifest a significant improvement in stereoacuity after the treatment.

The purpose of this study was to compare the performances of infrared (IR), fundus autofluorescence (FAF), and multicolor (MC) imaging in the characterization of geographic atrophy, with a focus on the possibility to detect incomplete retinal pigmented and outer retinal atrophy (iRORA) on en face imaging.The ground truth was established by two graders evaluating atrophy on spectral-domain optical coherence tomography (SD-OCT) images. A score for visibility of foveal sparing and margins of atrophy was attributed. Measurement of the atrophic area and the fovea-to-margin distance were performed. Accuracy of detection of foveal sparing was evaluated through comparison with B-scan images ground truth, with/without the inclusion of patients with foveal iRORA.Seventy patients were included in this study. Foveal sparing and atrophy's margins subjective visibility were significantly higher rated on MC images compared to IR and FAF (P0.005 and P0.001). Agreement with OCT B-scan assessed foveal sparing revealed a significantly higher area under receiver operating characteristic curves (AUROC) for MC images at the analysis performed both with (0.876) and without (0.853) inclusion of patients with foveal iRORA (P0.001 and P = 0.006). Quantitative measurements revealed lower atrophy extension (P = 0.026) and fovea-to-margin distance (P = 0.019) with MC imaging.MC imaging performed better at foveal sparing assessment, especially in the setting of foveal iRORA. MC also resulted in higher visibility of atrophy's margins, lower atrophy extension measurements, and lower distance from the fovea to atrophy's margins compared to both FAF and IR.MC rated significantly higher in foveal sparing and atrophy detection, higher visibility of atrophy's margins, lower atrophy extension measurements, and lower distance from the fovea to atrophy's margins, compared to FAF and IR.

Lamellar macular holes (LMHs) may show morphological and functional deterioration over time, yet no definite prognostic factor for progression has been identified. Since neurovascular retinal unit impairment may take part in neurodegeneration, we compare progressive LMHs to stable ones in optical coherence tomography (OCT) angiography parameters. Methods: OCT B scans of eyes with LMH were analyzed to detect the presence of tissue loss (TL) over time, allowing us to identify a TL group and a stable (ST) group (14 patients each). The best corrected visual acuity (BCVA) at each considered imaging time point was collected. Lastly, patients underwent macular OCT angiography. Results: BCVA at last follow up was significantly reduced in the TL group compared to both the ST group and TL group baseline assessment. SCP foveal vessel density (VD), SCP and deep capillary plexus (DCP) perfusion density (PD) and parafoveal PD were lower in the TL group. Linear correlations between quantitative TL over time and parafoveal PD in SCP and between the speed of TL and BCVA variation during follow up were also detected. Conclusions: TL in LMHs is associated with both OCT angiography modifications and BCVA deterioration over time. We suggest these findings to be a manifestation of foveal Muller cell impairment in progressive LMHs.

There is no consensus on whether amblyopia affects the retinal vascular plexus and morphology. Previous studies focused on the differences between amblyopic patients and normal controls without evaluating amblyopic eyes after patching. To evaluate differences in the superficial vascular density of amblyopic eyes, normal eyes, and amblyopic eyes reaching normal BCVA after patch therapy, OCTA was used. All patients underwent a comprehensive ophthalmological examination, including visual acuity, refraction, ocular motility tests, and anterior and posterior segment examination. OCTA was performed by an expert physician using the Zeiss Cirrus 5000-HD-OCT Angioplex (Carl Zeiss, Meditec, Inc., Dublin, OH, USA). OCTA scans were performed using a 3 × 3 mm2 and 6 × 6 mm2 fovea-centered image setting. The mean outer macular vessel density in the previously amblyopic group was 19.15 ± 0.51%. This was statistically significantly higher than in both the amblyopic group (18.70 ± 1.14%) and the normal controls (18.18 ± 1.40%) (p = 0.014). The previously amblyopic group also significantly differed from both normal controls and amblyopic eyes with regards to the inner (p = 0.011), outer (p = 0.006), and full (p = 0.003) macular perfusion. Finally, linear regression analysis revealed that BCVA was linearly correlated to outer perfusion in amblyopic (p = 0.003) and ex amblyopic eyes (p &lt, 0.001). Considering the cross-sectional nature of our study, from our results, we can only hypothesize a possible correlation between light stimulation and retinal vasculature development. However, further longitudinal studies are needed to support this hypothesis.

PURPOSE we propose a new releasable 8.0 polypropylene suture for leaking sclerotomies at the end of vitrectomy. Characteristic of this suture is that it can be easily removed the day after surgery at the slit lamp. METHODS Patients undergoing 23 gauge pars plana vitrectomy (PPV) with the need for at least 2 sclerotomy sutures and having preoperative OSDI score

Background In “high-risk” corneal graft recipients, like those with neovascularization of the cornea, the failure rate can exceed 35% at three years, the main cause being graft rejection. The main purpose of the study is to demonstrate the efficacy of pre-transplant Bevacizumab corneal injection in long term lowering of the prevalence of graft failure and rejection in high risk corneal transplantations. Methods This retrospective single-centre case-control study analyzed 37 eyes with significant corneal neovascularization and eligible for corneal transplantation at baseline. One group (BT group) included patients who were treated with a 3 months preoperative cycle of subconjunctival and/or intrastromal 5 mg/0.2 ml Bevacizumab injected at the limbus with a 27 G needle. The control group (NT group) didn’t receive the preoperative treatment. The main outcome was the prevalence of graft failures and rejections during the follow up period. Secondary outcomes included the prevalence of adverse events and the prevalence of patients who avoided corneal transplantation due to the treatment. Results BT group included 24 eyes with a follow up duration of 61.2 ± 24 months. Eight patients (33.3%) avoided transplant surgery after the injection. In the BT group 5 cases of graft failure (20.8%), 1 of which due to graft rejection (4%), occurred during the follow up. The NT group registered 6 cases (46.1%) of immune rejection of the graft and no additional graft failures from other causes. Conclusions Pre-transplant bevacizumab corneal injections are a safe and effective method to prevent graft rejection in neovascularized corneas.

Background Systemic vascular involvement in COVID-19 has been identified in several patients: not only endothelial derangement and increased permeability are reported to be early hallmarks of organ damage in patients with COVID-19 but are also the most important cause of worsening of clinical conditions in severe cases of SARS-CoV-2 infection. There are several reasons to hypothesize that the eye, and the retina in particular, could be a target of organ damage in SARS-CoV-2 infection. Methods This cohort observational study analyzes OCT angiography and structural OCT of 70 post-COVID-19 patients evaluated at 1-month hospital discharge and 22 healthy control subjects. Primary outcomes were macular vessel density (VD) and vessel perfusion (VP); structural OCT features were evaluated as secondary outcomes. In addition, patients and healthy volunteers were evaluated for best corrected visual acuity, slit lamp photograph, and fundus photo image. Results VD and VP in 3 × 3 and 6 × 6 mm scans for SCP and DCP showed no significant differences between the groups. Similarly, CMT and GCL did not reveal significant differences between post-COVID-19 and healthy patients. Nine patients (12.9%) featured retinal cotton wool spots and 10 patients had vitreous fibrillary degeneration. The prevalence of epiretinal membrane and macular hole was similar in the two groups. One case of extra papillary focal retinal hemorrhage was reported in the post-COVID-19 group. Conclusions Macula and perimacular vessel density and perfusion resulted unaltered in mild post-COVID-19 patients at 1-month hospital discharge, suggesting no or minimal retinal vascular involvement by SARS-CoV-2.

This is a cohort study to evaluate the presence of objective signs and subjective symptoms of dry eye disease in postcoronavirus disease 2019 (COVID-19) patients compared with the control.Prospective, observational, single-ctenter, cohort study. Sixty-four post-COVID-19 patients and 50 control were recruited. All participants underwent a complete ophthalmological examination including Ocular Surface Disease Index Questionnaire (OSDI), best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, Schirmer test type 1, tear break-up time test (tBUT), evaluation of conjunctival hyperemia, corneal staining, and tear film osmolarity test.The OSDI score was higher in the post-COVID-19 group in the quantitative and qualitative analysis (P0.001 and P =0.012, respectively). The mean tBUT in post-COVID-19 patients was 6.95 ± 4.07 seconds compared with a mean tBUT of 10.12 ± 3.90 seconds in the control group. The post-COVID-19 group showed a higher number of patients with a simultaneous impairment of the OSDI score and tBUT (P = 0.019). The Schirmer test results were strikingly significant both in the quantitative analysis and qualitative analysis (P0.001 and P = 0.0014, respectively). Both quantitative analysis and qualitative analysis revealed a significant difference in tear osmolarity in the 2 groups.Comparing the ocular surface assessment of post-COVID-19 patients with heathy control, a statistically significant increase of dry eye disease has emerged both in subjective and objective evaluations. Our clinical results support the findings that suggested a susceptibility of the ocular surface to the virus, and it underlines the importance of the ocular surface assessment in post-COVID-19 patients for a correct diagnosis and therapy.

Current evidences suggest that mast cells contribute to the proliferation and differentiation of skin melanocytes. According to these findings, we carried out an observational cross-sectional study to investigate the correlation between the total number of nevi (TN), Breslow thickness (BT), and serum tryptase (ST) levels in a cohort of 35 melanoma (MM) patients. A Mann-Whitney test was performed to compare ST values within each variable. Subsequently, the independent predictive factors were assessed by multiple logistic regression. Pearson's χ-test was chosen to detect statistically significant findings on the TN and the histopatological variables (Breslow, ulceration, and mitotic index). The TN was assessed using a dichotomous scale (≤ 10 or > 10). Patients with TN of 10 or less (3.48 vs. 6.05 ng/ml; P = 0.045), patients with a Breslow thickness of at least 1.01 mm (2.99 vs. 5.67 ng/ml; P = 0.1), and ulcerated MM (2.37 vs. 6.05 ng/ml; P < 0.001) showed lower median ST levels. Similarly, MM with mitotic index of at least 1/mm had median ST levels lower than MM with mitotic index less than 1/mm (P = 0.005). Multiple logistic regression confirmed the statistical significance for the variables ulceration, TN, and mitotic index. Pearson's χ-test showed a statistically significantly (P = 0.003) increased prevalence of MMs with a BT of at least 1.01 mm in patients with a TN of 10 or less. Patients with a TN of 10 or less also showed a higher prevalence of ulceration and mitotic index of at least 1/mm in comparison with the rest of the cohort. Our study highlights lower median ST levels in patients whose MM thickness is at least 1.01 mm; this may encourage new studies on the role of ST in MM also according to the number of nevi.