Macular Edema and Silicone Oil Tamponade

Purpose: To analyze the risk factors for inflammatory macular edema (ME) in a series of patients undergoing vitreoretinal surgery using Silicone Oil (SO) as a long-term tamponade. Materials and methods: We examined 118 consecutive eyes of 115 patients, mean age 57.8 years (range 39-79), suffering from various types of severe retinal detachment. Surgical procedures were carried out on all patients, and SO 1000cs was injected into the eye at the end of surgery to permit stable retinal reattachment. ME was classified as initial, medium and severe. The characteristics of ME were compared with various preoperative, intra-surgical and postoperative parameters. Statistical analyses were carried out using the T test and the Pearson correlation coefficient. Results: Twenty-six eyes were excluded. Twenty out of 92 eyes (22%) presented various types of ME. No significant correlation was found between ME and age or complication and duration of surgery. Significant correlation was found between ME and macular status before surgery and time length of intraocular permanence of SO. Conclusion: SO should be removed as soon as possible, in particular when the preoperative macular status is compromised. Decreased molecular transport in the vitreous space, permanence of inflammatory substances between SO and the macula, mechanical floating of SO and dangerous light exposure might be involved in the pathogenesis of ME

Macular Holes: Main Clinical Presentations, Diagnosis, and Therapies

Macular holes are a spectrum of retinal diseases that comprehends full-thickness macular holes (FTMHs), refractory/recurrent macular holes, lamellar macular holes (LMHs), myopic macular holes (MMHs), traumatic macular holes, and macular holes secondary to other retinal pathologies or injuries. There are various classifications of the subtypes of macular hole, and only in recent times researchers defined a common nomenclature, especially thanks to the evolution in retinal imaging, offered by new instruments like the swept-source OCT. The proposed therapies for macular holes are different and range from a "wait-and-see" approach to the vitrectomy, with different results in each subtype of macular hole. This narrative review has the purpose to investigate the available evidence in literature to give a summary of the knowledge about these retinal pathologies

COVID-19 pandemic and ophthalmological emergencies: a case-control analysis of the impact of lockdowns in a University Hospital in Lombardy region, Italy

Purpose: to evaluate the incidence of ocular pathologies seen at the ophthalmological emergency department (OeD) during the national lockdown in 2020 due to the cOViD-19 pandemic and compare it to the corresponding period in 2019.Methods: electronic records of patients who presented at the OeD of our University hospital in Varese, italy during the cOViD-19 lockdown were compared with that from the corresponding period in 2019. Records from the spring (2020a) and winter (2020B) lockdowns were compared with each other and with the same periods in 2019 (2019a and 2019B). statistical analyses were performed by unpaired student’s t-tests, Poisson’s regression and chi-square test.Results: the number of consultations at the OeD significantly decreased during the cOViD-19 lockdown (p value <.0001). the largest decreases were observed in the youngest (age <15 years: –77.3%) and oldest (age >61 years, –68.5%) age groups. the proportion of men who consulted increased significantly from 61.76% in 2019a to 67.63% in 2020a, and from 54.56% in 2019B to 62.79% in 2020B. a significant reduction in deferrable consultations was also reported (from 943 in 2019 to 335 in 2020; p value <.0001). a statistically significant decrease in the number of consultations involving ocular trauma was also reported despite an increase in its proportion among all consultations for ocular pathologies in 2020.Conclusions: Our evaluation showed a significant reduction in the number of OeD consultations in all deferrable pathologies. although the incidence of conditions that affect visual function was lower, these were more frequent in the lockdown period. the significant reduction in the number of deferrable consultations highlights the misuse of the OeD

Detection of Keratoconus With a New Biomechanical Index

To evaluate the ability of a new combined biomechanical index called the Corvis Biomechanical Index (CBI) based on corneal thickness profile and deformation parameters to separate normal from keratoconic patients

Ten Years of Experience With a Telemedicine Platform Dedicated to Health Care Personnel: Implementation Report

Background: Telemedicine, a term that encompasses several applications and tasks, generally involves the remote management and treatment of patients by physicians. It is known as transversal telemedicine when practiced among health care professionals (HCPs). Objective: We describe the experience of implementing our telemedicine Eumeda platform for HCPs over the last 10 years. Methods: A web-based informatics platform was developed that had continuously updated hypertext created using advanced technology and the following features: security, data insertion, dedicated software for image analysis, and the ability to export data for statistical surveys. Customizable files called "modules" were designed and built for different fields of medicine, mainly in the ophthalmology subspecialty. Each module was used by HCPs with different authorization profiles. Implementation (results): Twelve representative modules for different projects are presented in this manuscript. These modules evolved over time, with varying degrees of interconnectivity, including the participation of a number of centers in 19 cities across Italy. The number of HCP operators involved in each single module ranged from 6 to 114 (average 21.8, SD 28.5). Data related to 2574 participants were inserted across all the modules. The average percentage of completed text/image fields in the 12 modules was 65.7%. All modules were evaluated in terms of access, acceptability, and medical efficacy. In their final evaluation, the participants judged the modules to be useful and efficient for clinical use. Conclusions: Our results demonstrate the usefulness of the telemedicine platform for HCPs in terms of improved knowledge in medicine, patient care, scientific research, teaching, and the choice of therapies. It would be useful to start similar projects across various health care fields, considering that in the near future medicine as we know it will completely change

Clinical course of acute zonal occult outer retinopathy complicated by choroidal neovascularization

Purpose To report the clinical course and multimodal imaging features of acute zonal occult outer retinopathy (AZOOR) complicated by choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) treatment or photodynamic therapy (PDT). Methods Observational case series. Retrospective analysis of patients presenting to different institutions with evidence of AZOOR and neovascular lesions. Diagnosis of AZOOR was made on the basis of clinical presentation and multimodal imaging. All patients underwent a comprehensive ophthalmic evaluation and multimodal retinal imaging, including color fundus photos, fundus autofluorescence, fundus fluorescein angiography and spectral-domain optical coherence tomography. Results Four patients (three males, mean age 53.5 years) were included in the study. Mean follow-up was 5.1 years. Presentation of AZOOR was unilateral in two patients and bilateral in the remainder two patients. One of the patients presenting with unilateral AZOOR developed zonal lesions in the fellow eye during follow-up. All patients presented with unilateral type 2 (subretinal) CNV. Three patients underwent intravitreal anti-VEGF injections and one patient underwent a single PDT. Multimodal retinal imaging showed zonal or multizonal progression during treatment. After treatment, visual acuity and CNV stabilization was observed in all patients. Conclusions The presence of CNV expands the clinical spectrum of AZOOR. CNV complicating AZOOR may be effectively treated with intravitreal injections of anti-VEGF, despite progression of the zonal lesions. Further studies are required to define the role of treatment in the progression of the zonal lesions

Vitreous Substitutes: The Present and the Future

Vitreoretinal surgery has advanced in numerous directions during recent years. The removal of the vitreous body is one of the main characteristics of this surgical procedure. Several molecules have been tested in the past to fill the vitreous cavity and to mimic its functions. We here review the currently available vitreous substitutes, focusing on their molecular properties and functions, together with their adverse effects. Afterwards we describe the characteristics of the ideal vitreous substitute. The challenges facing every ophthalmology researcher are to reach a long-term intraocular permanence of vitreous substitute with total inertness of the molecule injected and the control of inflammatory reactions. We report new polymers with gelification characteristics and smart hydrogels representing the future of vitreoretinal surgery. Finally, we describe the current studies on vitreous regeneration and cell cultures to create new intraocular gels with optimal biocompatibility and rheological properties

Influence of Pachymetry and Intraocular Pressure on Dynamic Corneal Response Parameters in Healthy Patients

To evaluate the influence of pachymetry, age, and intraocular pressure in normal patients and to provide normative values for all dynamic corneal response parameters (DCRs) provided by dynamic Scheimpflug analysis

Influenza vaccination coverage among medical residents: An Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P < 0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future. © 2014 Landes Bioscience