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Purpose: As a progressive condition, glaucoma may impair health-related quality of life (HRQoL), due to vision loss and other factors. This study evaluated HRQoL in a cohort of patients treated for primary open-angle glaucoma (POAG) and assessed its association with clinical features., Methods: This was an Italian, multicentre, cross-sectional, observational study with the subgroup of newly diagnosed patients with POAG prospectively followed up for one year. Patients with previous or new diagnosis (or strong clinical suspicion) of POAG aged >18 years were considered eligible. Information was collected on demographic characteristics, medical history, clinical presentation and POAG treatments. HRQoL was measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and Glaucoma Symptom Scale (GSS). Subscale and total scores were obtained and a Pearson correlation coefficient between instruments' scores calculated., Results: A total of 3227 patients were enrolled from 2012 to 2013 and 3169 were analysed. Mean age was 66.9 years. A total of 93.8% had a previous diagnosis (median duration: 8.0 years). Median values for mean deviation and pattern standard deviation were 3.9 and 3.6 dB, respectively. Mean scores on most subscales of the NEI-VFQ-25 exceeded 75.0 and mean GSS subscale scores ranged between 70.8 and 79.7 (with a total mean score of 74.8). HRQoL scores on both scales were significantly inversely associated with POAG severity., Conclusion: In this large sample of Italians treated for POAG, disease severity was limited and HRQoL scores were high. QoL decreased with advancing disease severity. These findings confirm the role of vision loss in impairing QoL in POAG, underlying the importance of timely detection and appropriate treatment., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

PurposeEye alignment is a serious concern when performing corneal surface ablation. Although several excimer lasers monitor horizontal and vertical movements, little is known about the potential impact of cyclotorsional movements. Dynamic cyclotorsions have been measured on 10 emmetropic subjects during a simulated PRK treatment.MethodsCyclotorsional eye movements were measured using a 3D videoculographic system (SMI) in 10 emmetropic subjects in upright and supine position. The subjects were wearing an eyelid speculum and were asked to fixate on a 1° red spot. The fixation target was either in focus or optically degraded by electronic filters. Data were collected at the University Eye Clinic, Torino, Italy, and the different setting measurements were compared using Student's t-test for paired data.ResultsCyclotorsions were significantly higher when subjects were fixating an optically degraded stimulus (upright: P=0.04; supine: P=0.0002). The cyclotorsional movements ranged from −13 to 17°. A significant difference in eye orientation was present when changing from the upright to the supine position (P=0.03). Even when correcting for this positional error, significantly higher cyclotorsional movements were detected in the supine position (in focus: P=0.0043; optically degraded: P=0.0008). The torsional range was from −14.85 to 14.55°.ConclusionsThe high range of cyclotorsional eye movements during a simulated PRK procedure suggests that 3D tracking could improve surface ablation results when treating high astigmatism or when wavefront guided.Eye (2006) 20, 764–768. doi:10.1038/sj.eye.6701994; published online 1 July 2005 [ABSTRACT FROM AUTHOR]

Aim: To review indications and corneal tissue use for penetrating and lamellar surgery between 2002 and 2011., Methods: The surgical reports of corneal grafts performed during 2002-2011, using tissues supplied by the Eye Bank of Piedmont (Italy), were reviewed retrospectively. Patient demographic data, date of intervention, indication for surgery, and surgical technique used were recorded. Surgical techniques included penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK). The χ (2) test was used to compare the distribution of indications and types of surgical technique used, for corneal grafts done during 2002-2006 versus those done during 2007-2011., Results: The number of corneal grafts increased by 30.7% from 2002-2006 to 2007-2011 (from 1567 to 2048). Comparing the two periods, both main indications and surgical techniques changed significantly. In 2007-2011, the proportion of interventions for aphakic/pseudophakic bullous keratopathy (from 16.8% to 21.3%), graft failure (from 16.4% to 19.1%) and Fuchs endothelial dystrophy (from 12.8% to 16.7%) all increased significantly (P<0.05), while those for keratoconus decreased significantly (from 35.6% to 27.3%; P<0.001). In 2007-2011, the proportion of PK decreased significantly (from 92.4% to 57.2%; P<0.001) while that of EK and DALK went from 0.4% to 30.2% (P<0.001) and from 7.2% to 12.6% (P<0.001) respectively., Conclusion: During 2002-2011 the number of interventions increased significantly for corneal endothelial diseases and graft failure. The growing demand for interventions for these diseases corresponded to the widespread adoption of EK techniques. The use of DALK also increased, but more moderately than EK procedures.

Introduction: A coronal seal is fundamental for a positive outcome to endodontic therapy. In this in vitro study, we evaluated the adaptation of composite resins in postendodontic restorations using optical coherence tomographic (OCT) imaging. Our null hypothesis was that there would be no difference in marginal adaptation to the pulp chamber floor between resin composites of different viscosities., Methods: Thirty intact upper molars extracted for periodontal reasons were selected, endodontically treated, and filled with gutta-percha. The excess gutta-percha was entirely removed from the pulp chamber floor, and teeth were randomly divided into 3 groups (n = 10) according to the material used for the restoration: group 1: 0.5-mm horizontal layer of flowable composite followed by nanohybrid composite, group 2: bulk layering of bulk fill flowable composite; and group 3: oblique layering of nanohybrid composite. The degree of adaptation to the cavity floor was assessed using OCT imaging, and images were analyzed with the software program ImageJ (National Institutes of Health, Bethesda, MD) to assess the marginal gap between the composite and the pulp chamber floor. Collected data were statistically analyzed using analysis of variance testing, and statistical significance was set at P < .05., Results: Flowable composites showed significantly better adaptation than traditional packable nanohybrid composites (P < .05). All significant differences were found between groups 1 and 2., Conclusions: Within the limitations of this OCT imaging-based in vitro study, it was concluded that the flowable composite (flow + nanofilled; flow bulk fill composite) adapted better to the pulp chamber floor than the packable nanohybrid composite resin. Further studies are necessary to confirm these results., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Visual electrophysiology is a valuable tool for evaluating the visual system in various systemic syndromes. This review highlights its clinical application in a selection of syndromes associated with hearing loss, mitochondrial dysfunction, obesity, and other multisystem disorders. Techniques such as full-field electroretinography (ffERG), multifocal electroretinography (mfERG), pattern electroretinography (PERG), visual evoked potentials (VEP), and electrooculography (EOG) offer insights into retinal and optic nerve function, often detecting abnormalities before clinical symptoms manifest. In hearing loss syndromes like Refsum disease, Usher syndrome (USH), and Wolfram syndrome (WS), electrophysiology facilitates the detection of early retinal changes that precede the onset of visual symptoms. For mitochondrial disorders such as maternally-inherited diabetes and deafness (MIDD), Kearns–Sayre syndrome (KSS), and neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome, these tests can be useful in characterizing retinal degeneration and optic neuropathy. In obesity syndromes, including Bardet-Biedl syndrome (BBS), Alström syndrome, and Cohen syndrome, progressive retinal degeneration is a hallmark feature. Electrophysiological techniques aid in pinpointing retinal dysfunction and tracking disease progression. Other syndromes, such as Alagille syndrome (AGS), abetalipoproteinemia (ABL), Cockayne syndrome (CS), Joubert syndrome (JS), mucopolysaccharidosis (MPS), Neuronal ceroid lipofuscinoses (NCLs), and Senior–Løken syndrome (SLS), exhibit significant ocular involvement that can be evaluated using these methods. This review underscores the role of visual electrophysiology in diagnosing and monitoring visual system abnormalities across a range of syndromes, potentially offering valuable insights for early diagnosis, monitoring of progression, and management. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet's membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 ± 4.5 D to 43.5 ± 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 ± 0.4 to 0.3 ± 0.2 LogMAR; the central corneal thickness was reduced from 629 ± 39 μm to 532 ± 45 µm; and the endothelial cell density was 1926 ± 199 cells/mm2. None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the distribution of corneal spherical aberration in patients with cataract using the Pentacam HR., Methods: Consecutive cataract patients were examined using the Pentacam HR high-resolution rotating Scheimpflug camera (Oculus, Wetzlar, Germany). In one eye of each patient, the root-mean-square (RMS) of anterior, posterior, and total corneal spherical aberration Z4(0) was calculated by ray-tracing on an area of 6 mm diameter. The Pearson correlation coefficient (r) was used to assess correlations between Z4(0) RMS values and age/total corneal refractive power. The χ2 test was used to compare the proportion of eyes qualifying for spherically neutral or negatively aspheric (-0.17 and -0.27 μm) intraocular lenses (IOLs) by targeted level of residual spherical aberration., Results: Fifty-seven men and 92 women were included (mean [±SD] age, 71.73 [±9.12] years). The RMS mean (±SD) values of Z4(0) were +0.353 (±0.132) μm, -0.121 (±0.034) μm, and +0.328 (±0.132) μm, respectively, for the anterior, posterior, and total cornea. The anterior, posterior, and total Z4(0) were on average significantly higher (p < 0.001) in women than in men. In both sexes, statistically significant (p < 0.05) age-related changes were found for the anterior and total Z4(0) but not for the posterior Z4(0) (p > 0.05). The total Z4(0) and total corneal refractive power were significantly correlated in men (p = 0.01) but not in women (p = 0.14). For postoperative targets of 0 ± 0.05/+0.10 ± 0.05 μm residual Z4(0), the proportion of eyes that would have qualified for implantation of negatively aspheric IOLs with -0.17 and with -0.27 μm was similar (61.1 and 56.3%, respectively; p = 0.09); significantly fewer eyes (6.7%) would have qualified for implantation of neutrally aspheric IOLs (p > 0.05)., Conclusions: Total corneal Z4(0) measured by Pentacam HR might be higher than that reported in previous studies. In most patients, the implantation of commercially available negatively aspheric IOLs would partially compensate for the positive total corneal Z4(0).

Blepharoptosis of the upper eyelid is a common condition among patients presenting for oculoplastic surgery. Although there are many types of ptosis, the two most frequent clinical cases are simple congenital ptosis in young patients and senile ptosis in adults. Patient examination is important to distinguish these from other more infrequent types of ptosis, such as those neurogenic, myogenic and posttraumatic. These latter cases may require specific therapeutic strategies. Ptosis can usually be corrected surgically. The article discusses guidelines for the choice of intervention. Various different surgical techniques are also presented, together with results and complications.