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Loa loa is a filarial nematode responsible for loiasis, endemic to West–Central Africa south of the Sahara and transmitted by flies. This study reports a case of L. loa in the vitreous cavity of the eye of a young patient, along with an in-depth literature review. A 22-year-old woman from Cameroon who migrated from Cameroon to Italy was referred to the Emergency Ophthalmology Department at Policlinico di Bari in July 2021 with the presence of a moving parasite in the subconjunctiva of the left eye. A recent onset of a papular lesion on the dorsal surface of the right wrist and a nodular lesion in the scapular region were detected. L. loa filariasis was diagnosed based on anamnestic data, clinical and paraclinical signs, and a parasitological test confirming the presence of microfilariae in two blood samples collected in the morning of two different days. Because of the unavailability of diethylcarbamazine (DEC), albendazole (ALB) 200 mg twice daily was administered for 21 days. A mild exacerbation of pruritus occurred during treatment, but resolved with the use of an antihistamine. A single dose of 12 mg ivermectin was prescribed at the end of the treatment with albendazole. Unlike other endemic parasite infections, L. loa is not included in the Global Program to Eliminate Lymphatic Filariasis, because it is not mentioned in the WHO and CDC list of neglected tropical diseases. This can result in an overall risk of lack of attention and studies on loiasis, with lack of data on global burden of the disease.

Giacomo Boscia,1,&ast; Pasquale Viggiano,1,&ast; Federica Marzulli,1 Maria Oliva Grassi,1 Pasquale Puzo,1 Stefano Dore,2 Antonio Pinna,2 Giovanni Alessio,1 Francesco Boscia1 1Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy; 2Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy&ast;These authors contributed equally to this workCorrespondence: Pasquale Viggiano, Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari, Italy, Tel +390805593728, Email pasquale.viggiano90@gmail.comPurpose: To assess the long-term morpho-functional retinal and choroidal changes in chronic central serous chorioretinopathy (cCSC) pachychoroid eyes in response to continuous oral eplerenone (EPL) treatment.Methods: This pilot study was conducted on patients with unilateral exudative cCSC. We enrolled a total of 17 exudative cCSC and 17 non-exudative fellow eyes of 17 patients. Baseline best-corrected visual acuity (BCVA) and anatomical (structural optical coherence tomography [OCT] and OCT angiography) parameters in both eyes were collected at baseline. Follow-up data were collected at 6, 12, and 48 months after initiation of EPL treatment.Results: (i) Exudative cCSC eyes: Compared with baseline (0.34± 0.13 LogMAR), BCVA significantly improved at follow-up examinations (6 months: 0.28± 0.13 LogMAR, p=0.039; 12 months: 0.22± 0.11 LogMAR, p=0.025; 48 months: 0.21± 0.08 LogMAR, p=0.028). Furthermore, there was a significant reduction from baseline in all structural OCT parameters (subretinal fluid and subfoveal choroidal thickness [SFCT]; p< 0.05). (ii) Non-exudative fellow eyes: There was no significant change in BCVA. There was a significant reduction from baseline in SFCT and choriocapillaris flow deficit percentage (p< 0.05).Conclusion: In this pilot study, continuous oral EPL therapy in cCSC pachychoroid eyes resulted in long-term morpho-functional improvement. The beneficial effect of EPL occurred within the first year and was maintained after four years. Based on these preliminary observations, EPL may be effective in the exudative forms of CSC.Keywords: central serous chorioretinopathy, choriocapillaris reperfusion, OCT and OCTA

Purpose To evaluate and compare the outcomes of live surgery (LS) and no-live surgery (NLS) on cataract surgery with implantation of different types of intraocular lenses (IOLs). Methods Retrospective, contralateral eye, case series of patients that underwent cataract surgery in live or non-live view during two consecutive editions of national meetings. Both eyes of the same patients were implanted with the same IOL, one in LS and the other in NLS. Results 108 eyes of 54 patients, aged between 50 and 82 (72 ± 8.2) and implanted with different types of IOLs, were reviewed. Both eyes in each patient were well matched at baseline in terms of intraocular biometric characteristics, corneal curvature and endothelial cell density (ECD) (p > 0.05). There are no statistically significant differences between the biometric and topographic parameters, aberrometric data and the loss of ECD in the post-operative outcomes (p > 0.05). However, comparing the different types of IOLs, there is a significant loss of ECD in eyes implanted with a toric IOL during LS (p = 0.0014 and p = 0.04, in 2017 and 2018 edition respectively). Conclusions In this series of live cataract surgery, eyes operated in LS or NLS have comparable outcomes, underlying the importance and the benefits of live view in terms of medical education and the low-risk of complications. Nevertheless, we have found a significant increase in ECD loss in patients implanted with toric IOLs during LS.

This paper describes the curious case history of the famous and rare Klippel Feil syndrome type II, identified in the skeleton of a young Slavic soldier who died in 1946. It is a very interesting case given the fusion of the C1 and C2 cervical vertebrae, which prevented the young soldier from rotating his skull while alive. Klippel–Feil syndrome is a rare osteopathology and involves fusion of the vertebrae of the spine and is linked to other pathologies that indicate the presence of this pathological condition. In the present study, several basic investigations were carried out: a macroscopic observation to document the abnormalities throughout the rest of the skeleton, a morphological one to determine the identifying anthropological analysis, a pathological one to determine the pathologies present and a radiographic one to diagnose and confirm the pathology. Studying the pathologies of the past is fundamental in order to know the evolution and behaviour of the disease today, and the investigations carried out in this case study determined what the limitations of the young soldier were, how this disease may have influenced his activities as a soldier during World War II and through which therapies the syndrome may have been treated in such an important historical period.

Samuele Gigliola,1 Giancarlo Sborgia,1 Alfredo Niro,2 Carmela Palmisano,1 Pasquale Puzo,1 Gianluigi Giuliani,1 Luigi Sborgia,1 Valentina Pastore,1 Alessandra Sborgia,2 Giovanni Alessio1 1Eye Clinic, Depatment of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy; 2Eye Clinic, Hospital “S. G. MOSCATI”, ASL TA, Taranto, ItalyCorrespondence: Alfredo NiroEye Clinic, Hospital “S. G. MOSCATI,” ASL TA, Via per Martina Franca, Statte, Taranto, 74010, ItalyEmail alfred.nir@tiscali.itIntroduction: We described a one-handed rotational phacoemulsification technique to decrease phaco time and power, and surgical stress on the cornea in eyes with different types of cataract.Methods: In this technique a single sutureless corneal incision was made without any side-port incision. After hydrodissection and hydrodelamination were performed, a phaco tip was positioned in contact with the nucleus beside the capsulorhexis edge. By using a peristaltic pump, phacoemulsification was started with high levels of vacuum to keep the probe tip on the edge of the lens and to ensure the rotation of the nucleus, and with low ultrasound energy. The torsional mode used required less occlusion time and volume of fluid. The inclination of the tip was modified to 45-degree, directing it toward the lens center. So the nucleus was aspirated from the periphery toward the center by a rotational movement.Results: The eye in the technical video had a NC4-NO4 cataract. The preoperative vision in this eye was 20/100 with no improvement with refraction. On postoperative day 1, visual acuity had improved to 20/20. We recorded low intraoperative parameters including ultrasound time (21.4 sec), phacoemulsification power (73%), balanced salt solution used (31 mL) and cumulative dissipated energy (7.27) at the conclusion of the case. After 1 month, Central Corneal Thickness changed from 504 μm to 516 μm, and Endothelial Cell Loss was 1.15%.Conclusion: This technique uses a single clear corneal incision, high vacuum and low ultrasound power to reduce the exposition to excessive surgical maneuvers, fluid turbulence and ultrasound energy.Keywords: cataract surgery, single corneal incision, one-handed phacoemulsification, phaco-rolling

Background Age-related hearing loss (ARHL) and retinal vessel changes have both been associated to neurodegeneration/dementia, suggesting a possible link between these 2 conditions in older age. We aimed to determine whether superficial and deep vascular density (SVD and DVD) of the capillary plexi of macular vasculature can be associated with peripheral ARHL and age-related central auditory central processing (CAPD). Method We analyzed data on 886 older participants (65 years+, age range: 65–92 years) in the cross-sectional population-based Salus in Apulia Study. Optical coherence tomography angiography was used to measure SVD and DVD of the capillary plexi of the macula at the 3-mm circle area centered on the fovea (whole retina), the parafoveal quadrant, and foveal quadrant. Disabling peripheral ARHL was defined as >40 dB hearing level of pure tone average on the frequencies from 0.5, 1, 2, and 4 KHz in the better ear, and age-related CAPD as Results DVD at the whole retina and at the parafoveal quadrant were inversely associated only with age-related CAPD (odds ratio [OR]: 0.93, 95% confidence interval [CI]: 0.88–0.96 and OR: 0.94, 95 CI: 0.90–0.99, respectively). No further associations with peripheral ARHL were evident. Conclusions Retinal vasculature is associated with central auditory processing pathology, possibly playing an important role in early detection and intervention. The association of retinal vascular density with age-related CAPD may bring us a further step forward in understanding the biological mechanisms underlying the links between neurodegeneration/dementia and ARHL.

To propose a modified ophthalmic triage system based on simple ophthalmic symptoms, signs and anamnestic data and validate its safety and effectiveness. Phase 1 of the study was a retrospective review of chart records of patients admitted at the ophthalmic emergencies room (OER); phase 2 was a prospective study conducted on all consecutive patients presenting in the OER between April 1st, 2018, and May 30th, 2018. We selected the following six factors as predictors of urgency levels: altered vision, ocular behavior, color, distress, eye trauma, floaters and flashes. ATSO final score can be eventually converted into risk groups: low-risk group (scoring 0–3), intermediate-risk group (scoring 4–5) and high-risk group (scoring > 6). A total of 953 consecutive patients who presented to our OER over a two-month period were considered for participation in the study. The male-to-female ratio was 1.24:1. The mean age of the participants was 53 years (range 18–92, SD 19 years). ATSO score significantly correlated with urgency levels (p

The aim of the study was to visualize and evaluate the characteristics and depth of the demarcation line with anterior segment optical coherence tomography (AS-OCT) after epithelium-off iontophoresis corneal collagen cross-linking (epi-off I-CXL). In this prospective, consecutive, single center study 18 eyes of 18 patients with keratoconus were involved. One month after epi-off I-CXL, all the patients underwent an AS-OCT scan to search for a demarcation line and its characteristics. The corneal stromal demarcation line was identified in all the eyes. Mean depth of the corneal stromal demarcation line was 261.8 ± 46.7 μm (range: 184 to 362 μm), at 56.7 ± 12% corneal depth. In conclusion, epi-off I-CXL determines a demarcation line that can be visualized with AS-OCT, which seems clearly distinguishable and similar to that created in standard CXL.

Simple Summary Forensic anthropology deals with human skeletal remains for law and humanitarian purposes, and it is crucial in determining identity, interpreting traumas, and estimating time since death. Although it adopts a wide array of methods from many disciplines, the macroscopic observation of skeleton morphological characteristics is sometimes exhaustive for differential diagnosis between malformations, degenerative diseases, post-traumatic or iatrogenic lesions. In some cases, as described in this study, skeletal remains show signs of specific surgical techniques, so characteristic as to reconstruct almost faithfully the pathological history of the individual to whom they belonged and the therapeutic procedures the subject underwent. It is of even more interest if considering that, based on the time of death, the subject was among the first individuals who underwent an innovative surgical technique that would have revolutionized the surgical approach to a disease until then incurable. In these rare cases, skeletal remains become the historical testimony of surgery evolution, showing the traces of how men have over time perfected the medical treatment of their fellows. Abstract Human skeletal remains are considered as real biological archives of each subject’s life. Generally, traumas, wounds, surgical interventions, and many human pathologies suffered in life leave identifiable marks on the skeleton, and their correct interpretation is possible only through a meticulous anthropological investigation of skeletal remains. The study here presented concerns the analysis of a young Slavic soldier’s skeleton who died, after his imprisonment, in the concentration camp of Torre Tresca (Bari, Italy), during the Second World War (1946). In particular, the skull exhibited signs of surgical activity on the posterior cranial fossa and the parieto-occipital bones. They could be attributed to surgical procedures performed at different times, showing various degrees of bone edge remodeling. Overall, it was possible to correlate the surgical outcomes highlighted on the skull to the Torkildsen’s ventriculocisternostomy (VCS), the first clinically successful shunt for cerebrospinal fluid (CSF) diversion in hydrocephalus, which gained widespread use in the 1940s. For this reason, the skeleton we examined represents a rare, precious, and historical testimony of an emerging and revolutionary neurosurgical technique, which differed from other operations for treating hydrocephalus before the Second World War and was internationally recognized as an efficient procedure before the introduction of extracranial shunts.