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The Italian Ophthalmological Society (SOI) has developed clinical practice guidelines for the care of ophthalmic patients during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this document is to define guidelines that would help ophthalmologists in their clinical activities through the adoption of recommended procedures to avoid common organization and management of positive asymptomatic contagious patients and healthy people. They are based on data available in scientific literature and real clinical experience. The document underlines the unique nature of ophthalmology and its impact on people’s health and wellbeing, outlines minimal requirements to be able to perform ophthalmology procedures, discusses the use of disposable devices and materials and outlines the criteria to manage potentially contagious patients and healthy people.

Purpose The AT LARA 829MP is a next-generation extended depth of focus (EDOF) intraocular lens (IOL) providing continuous vision over a range of distances. The aim of this prospective multi-centre randomised trial was to compare two EDOF IOLs and one monofocal IOL. Methods Cataract patients between 50 and 80 years were randomised for bilateral implantation with either the AT LARA 829MP (EDOF), the TECNIS Symfony (EDOF) or the CT ASPHINA 409MP (monofocal). Follow-up was at 1 to 2 weeks, 1 month and 4 to 6 months. Results A total of 211 patients were randomised and included in the final analysis. Monocular depth of focus was significantly better for AT LARA 829MP eyes compared with that for TECNIS Symfony at all thresholds (p = 0.024, 0.001 and 0.006, for 0.1, 0.2 and 0.3 logMAR respectively) with no significant difference for binocular depth of focus. LARA eyes had significantly better monocular depth of focus at all levels compared with ASPHINA eyes (all p p p = 0.002). Distance visual acuity was similar for all IOLs at 6 months; intermediate and near visual acuity were significantly better for the EDOF IOLs than for the monofocal (p Conclusion The two EDOF intraocular lenses investigated provided good visual outcomes with comparable visual acuity at all distances. The AT LARA 829MP provided the widest monocular depth of focus at 0.1 and 0.2 logMAR, with a clear superiority compared with the monofocal IOL. TECNIS Symfony was superior to the monofocal control at 0.3 logMAR. Spectacle independence and patient satisfaction were comparable. Trial registration Trial registered on https://clinicaltrials.gov/ under the identification NCT03172351 (date of registration 1 June May 2017).

A multicenter, nonrandomized, prospective, controlled study was conducted to evaluate, as perioperative prophylactic treatment, the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM®) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery. Eye drops containing 0.66% povidone-iodine were applied to the eye undergoing cataract surgery, the untreated contralateral eye was used as control. One hundred and twenty patients set to receive unilateral cataract surgery were enrolled in 5 Italian Ophthalmology Centers and pretreated for three days with 0.66% povidone-iodine eye drops. The contralateral eye, used as control, was left untreated. Conjunctival swabs of both eyes were collected at the baseline visit and after three days of treatment, just before the cataract surgery. A qualitative and quantitative microbiological analysis of bacterial presence was evaluated by means of bacterial culture, followed by identification. Methicillin resistance determination was also performed on staphylococci isolates. Bacterial load before and after treatment of the eye candidate for cataract surgery was evaluated and compared to the untreated eye. A reduction or no regrowth on the culture media of the bacterial load was observed in 100% of the study subjects. A great heterogenicity of bacterial species was found. The 0.66% povidone-iodine eye drops, used for three days prior to cataract surgery, were effective in reducing the conjunctival bacterial load. The 0.66% povidone-iodine eye drops (IODIM®) might represent a valid perioperative prophylactic antiseptic adjuvant treatment to protect the ocular surface from microbial contamination in preparation of the surgical procedure.

Purpose To evaluate the clinical acceptability of monocular implantation of the small-aperture (IC-8) intraocular lens (IOL) in 1 eye and an aspheric monofocal IOL in the fellow eye of bilateral cataract patients over 6 months postoperatively. Setting Twelve clinics in Austria, Belgium, Germany, Italy, Spain, and Norway. Design Prospective case series. Methods The visual acuity, depth of focus, contrast sensitivity, patient satisfaction, visual symptoms, and adverse events were assessed in patients who had bilateral cataract surgery followed by implantation of the small-aperture IOL in 1 eye and an aspheric monofocal IOL in the fellow eye. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were reported in Snellen notation. Results The study comprised 105 patients. At 6 months, the UDVA, UIVA, and UNVA in eyes with the small-aperture IOL were 20/23, 20/24, and 20/30, respectively. Ninety-nine percent, 95%, and 79% of patients achieved 20/32 or better binocular UDVA, UIVA, and UNVA, respectively. Ninety-three patients (95.9%) reported they would have the procedure again versus 4 patients (4.1%) who reported they would not have the procedure again. In eyes with the small-aperture IOL, the target-corrected defocus curve measured with 0.75 diopter (D) of myopia extended the range of functional near vision by an additional diopter without loss of distance vision compared with the distance-corrected defocus curves. The mean UIVA and UNVA remained at 20/25 and 20/32, respectively, for up to 1.5 D of residual astigmatism in eyes with the small-aperture IOL. Conclusion The small-aperture IOL showed excellent visual performance, safety, patient satisfaction, and tolerance to residual astigmatism 6 months after implantation.

Inflammation represents the manifestation of the host's vascular and cellular response to tissue damage, hypersensitivity of the immune system or autoimmunity. As soon as the damage is detected, the mechanisms of localization and removal of foreign substances and damaged tissues are triggered. This response is amplified by the activation of inflammatory cells and by the production of chemical mediators derived from arachidonic acid, vasoactive substances and cytokines.At the ocular level, among the different responses implemented by various inflammation mediators, the action of prostaglandins is mainly expressed in three ways: i) change of intraocular pressure; ii) induction of miosis; iii) increase of protein concentration in the aqueous humor.Ocular inflammation may continue long after the cessation of the initial cause and may also lead to serious consequences, including permanent vision reduction. For this reason, it is essential to establish a correct and effective therapeutic strategy, which allows to control inflammation, the symptoms and the clinical signs associated with it.This article therefore deals with therapeutic strategies to control inflammation, with a particular focus on the role of nonsteroidal anti-inflammatory drugs (NSAIDs) in cataract surgery.

The purpose of this study was to evaluate the efficacy of the OptiVis™ Multifocal Intraocular Lens (IOL) in patients undergoing bilateral crystalline lens replacement following extracapsular extraction by phacoemulsification.This was a prospective 6-month, open-label, nonrandomized clinical trial of subjects undergoing bilateral implantation with the OptiVis Multifocal IOL. Of the 121 eyes enrolled, 88 eyes of 44 subjects completed the entire 6-month trial.After 6 months, the majority of eyes had a distance best-corrected visual acuity of 20/20 or better, with 89.8% achieving that outcome, and 100% with 20/32 or better. At an intermediate distance, most eyes (90.9%) had a distance corrected intermediate visual acuity of 20/40 or better, and 53.4% had an acuity of 20/32 or better. At a near distance, most eyes (95.5%) had a distance corrected near visual acuity of 20/40 or better by month 6. The most commonly reported adverse event was mild-to-moderate halos (n = 30, 36%) and mild-to-moderate glare (n = 15, 18%). In addition, there was one case of cystoid macular edema, one posterior capsular opacification, and one case of severe corneal edema. Postoperative contrast sensitivity was comparable with normal phakic subjects ≥ 60 years of age.The OptiVis Multifocal IOL provided satisfactory visual acuity at distance, near, and intermediate with no apparent reduction in contrast sensitivity. Additional, longer-term follow-up studies are planned.

Purpose To describe a short questionnaire for a rapid assessment of risk factors for AMD, and assess its feasibility and relevance in a large-scale Italian study. Methods Risk factors having shown the most consistent associations with AMD in the literature were included in the STARS (Simplified Théa AMD Risk-assessment Scale) questionnaire, which was designed to be simple, quick and easy to fill in. Its feasibility and relevance were assessed in an Italian nationwide study. Between May and September 2010, all patients of both genders, aged 55 years or more, consulting the participating ophthalmologists during one week of consultations, were invited to take part in the study. Items on demography, medical history, and lifestyle were filled in by the patient. The ophthalmologist then performed the eye examinatio,and filled in the second part of the questionnaire (iris colour, cataract extraction, refraction, AMD classification). Patients affected by soft drusen and/or pigmentary abnormalities were classified as early AMD, whereas patients affected by geographic atrophy and/or neovascular AMD were classified as late AMD. Subjects with early and late AMD were compared to those without AMD using polytomous nominal logistic regression. Results One hundred and seventy-seven ophthalmologists prospectively recruited 12,639 subjects. Overall, 6061 (48.0%) were affected by early AMD, 1483 (11.7%) by late AMD, whereas 5095 (40.3%) were not affected by AMD. In the final multivariate model, age, female gender, North-African origin, family history of AMD, smoking, obesity, history of cardiovascular diseases,cataract surgery, myopia, hyperopia, living in a sunny area and usual solar protection were significantly associated with increased risk for both early and late AMD. High fruit consumption was associated with a significantly decreased risk for early and late AMD, while consumption of green vegetables and fish were not significantly associated with early or late AMD.Consumption of alcohol (beer or wine) and clear iris wereassociated with increased risk for early but not late AMD. Conclusions The STARS questionnaire can easily be implemented in the practice of ophthalmologists. It may prove useful as a screening tool, after improvement and further validation.

Purpose: The purpose of the study is to evaluate the results of the authors' 4-year experience with excimer laser photorefractive keratectomy (PRK) and multiple optical zone corneal ablation in highly myopic eyes. Methods: The authors retrospectively evaluated 56 eyes of 44 patients (mean refraction, −11.3 diopters [D]; range, −5.75 to −24.5 D) who underwent PRK with a Visx Model 20/20 laser (Visx, Santa Clara, CA). Preoperative visual acuity of 20/40 or better was present in 46 eyes. Corneal ablation was divided into concentric optical zones (4, 5, and 6 mm), allowing corrections of up to 18 D, with a refractive goal of within −1 D from emmetropia in 49 eyes. A hand-held fixation system was always used, and a nitrogen-blowing system (NBS) was used in the first 21 eyes only. Results: Before retreatment, the range of final cycloplegic refraction from emmetropia in eyes treated with NBS versus not was within ±1 D in 6 (28.6%) and 15 eyes (44.1%), between −1.25 and −3 D in 5 (23.8%) and 14 eyes (41.1%), and more than −3 D in 10 (47.6%) and 5 eyes (14.7%), respectively. No lines of visual acuity were lost in 37 eyes (80.4%) with 20/40 or better visual acuity before surgery. Three eyes showed vision loss due to worsening of myopic maculopathy and one due to corneal haze. Correction stabilized within 9 months, and at a mean time of 25.6 months, the correction attained was of −8.5 ± 3.6 D, achieving 90.3% of attempted correction. Eyes with preoperative myopia less than −10 D (n = 27) showed regression less than −1 D in 8 eyes (29.6%), between −1.25 and −3.00 D in 5 eyes (18.5%), and greater than −3.00 D in 1 eye (3.7%); eyes with more than −10 D (n = 29) regressed in 3 (10.3%), 6 (20.7%), and 1 eye (3.4%), respectively. Severe haze was observed in 11 eyes (19.6%) 3 months after surgery. Two eyes showed decentration greater than 1.5 mm. At last examination, night driving problems were reported by 12 (41.4%) of 29 patients evaluated who drive. Conclusions: After the NBS was eliminated, the multiple-zone technique achieved a long-term, stable 83.1 % reduction of preoperative myopia. Patients with severe myopia appreciated reduction of most of the refractive defect, although perception of halos was noted by 16 patients.

Relazione e stato dell'arte sulle lenti intraoculari filtranti