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

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

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

Submacular Choroidal Thickness Evaluation After Laser Photocoagulation For Diabetic Retinopathy

Abstract Purpose:To evaluate subfoveal choroidal thickness before and after laser photocoagulation in diabetic retinopathy (DR) visualized by Spectral Domain OCT (SDOCT). Methods:A total of 15 patients affected by DR were involved in this prospective interventional study. Inclusion criteria comprehend DR complicated by significant macular edema or retinal ischemia. Exclusion criteria include media opacities, other vascular or inflammatory retinal pathologies. Seven patients received scatter laser photocoagulation for proliferative DR and eight patients focal or laser grid photocoagulation for diabetic macular edema. By means of a SDOCT (OTI-OPKO, Toronto, Canada) experienced operators measured choroidal thickness in subfoveal area and 3mm away from the fovea in nasal and temporal region, after imaging enhancement procedures. Clinical measurements were performed at baseline, at day 7 and day 14 after laser treatment. Statistical analysis was performed to compare the results. Results:Choroidal and retinal thickness OCT measurements were performed to all subjects on scheduled visits. Mean choroidal thickness at baseline was respectively 250,7 \ub1 60,6\ub5m in subfoveal region, 166,4 \ub1 63\ub5m nasal to fovea and 241,4 \ub1 66\ub5m temporal to fovea; at day 7 was 280,8 \ub1 76\ub5m (p=0.01), 180,8 \ub1 63\ub5m (p>0.05) and 239,2 \ub1 67\ub5m (p>0.05); at day 15, mean choroidal thickness was 246,3 \ub1 62\ub5m (p=0.03), 171,8 \ub1 65\ub5m (p>0.05) and 240 \ub1 68,8\ub5m (p>0.05). Retinal macular thickness measured underwent to an overall variation during follow up from a baseline value of 286,4\ub160,01\ub5m to 323\ub175,9\ub5m at day 7 (p=0.03) and to 310,9\ub162,01\ub5m at day 15 (p>0.05). Conclusions:Our study showed at day 7 a statistically significant increase of choroidal thickness only in subfoveal region, subsequently decreased at day 14. This observation was associated to a significant increase of retinal thickness at day 7. These observations underline and confirm the involvement of choroidal tissue on different traumatic and inflammatory vitreoretinal events, as well as the role of new SDOCT to better evaluate and measure choroidal structure