LONG-TERM INTRAOCULAR PRESSURE AFTER UNCOMPLICATED PARS PLANA VITRECTOMY FOR IDIOPATHIC EPIRETINAL MEMBRANE

\u2019Purrpose: To investigate long-term intraocular pressure trends after uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane. Methods: Three hundred and sixty-eight eyes of 368 consecutive patients were enrolled. Changes in intraocular pressure 1, 3, 6, and 12 months after surgery and during the fi nal follow-up visit were evaluated in vitrectomized eyes and nonvitrectomized fellow eyes. Results: The median follow-up period was 36 months (range 12 \u2013 92 months). Longitudinal data analysis evidenced a 2.5-mmHg (2.2 mmHg; 2.7 mmHg, 95% con fi dence interval) statis- tically signi fi cant difference in intraocular pressure 30 days after surgery between treated and fellow untreated eyes, gradually recovering to a not signi fi cant 0.2-mmHg ( 2 0.1 mmHg; 0.4 mmHg, 95% con fi dence interval) difference within 26 months. The incidence of late-onset ocular hypertension was 5.7% (21 over 347, 2%; 12%, 95% con fi dence interval) without difference between the treated eyes and the group control. No signi fi cant difference in the incidence of late-onset ocular hypertension and sex, lens status, or gauge of vitrectomy instru- ments was detected. Only patient \u2019 sagewassigni fi cantly higher (mean difference 4.2 years; 0.1 \u2013 8.0 years, Monte Carlo, 95% con fi dence interval) in those who de veloped late-onset ocular hypertension in the vitrectomized eye. Conclusion: Uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane seems not to increase the risk of late-onset ocular hypertension or open-angle glaucoma development.

Long-Term Macular Vascular Changes after Primary Rhegmatogenous Retinal Detachment Surgery Resolved with Different Tamponade or Different Surgical Techniques

Simple Summary Primary rhegmatogenous retinal detachment is an acute threat to visual impairment due to a retinal break that allows the passage of vitreous fluid into the subretinal space. Although it is clear that functional results are influenced by retinal detachment extension and surgical timing, we do not have definitive indications on post-operative changes in macular microcirculation and how they might affect visual performance. The study aims to evaluate the long-term macular vascular changes and their correlation with functional recovery in patients successfully treated for rhegmatogenous retinal detachment. We found a reduction of the vascular density in the operated eyes, not influenced by surgical techniques, independently from the pre-operative detachment extension. However, we found that functional recovery is influenced by different intraoperative choices. In conclusion, such visual acuity and microvascular changes can be considered biomarkers that highlight the relevance of careful management of this sight-threatening disease. Background: The aim of this study was to assess long-term macular vascular changes and their correlation with functional recovery in patients successfully treated for Macula-ON and Macula-OFF rhegmatogenous retinal detachment (RRD). Methods: This retrospective observational study included 82 eyes of 82 patients who received primary successful retinal detachment surgery, 33 Macula-ON and 49 Macula-OFF. Superficial and deep capillary plexuses (SCP and DCP) were evaluated by optical coherence tomography angiography (OCTA), and were correlated with visual acuity (VA), surgical technique and tamponade at 12 months after surgery. The fellow eyes were used as controls. Results: At 12-month follow-up, there was a significant decrease in the vessel density (VD) in the SCP in the operated eyes compared to control eyes (p < 0.05) in both the Macula-ON and Macula-OFF groups. Vessel length density (VLD) decrease in SCP was more extended in the Macula-OFF group. No difference in the DCP perfusion parameters was found, compared to controls. Subgroup analysis dependent on the type of surgery or tamponade showed no significant differences of VD and VLD. An inverse correlation was found between the SCP VD and the duration of silicone oil (SO) tamponade (p = 0.039). A significant correlation was observed between parafoveal SCP VD and final best corrected visual acuity (BCVA) (p = 0.028). The multivariate linear regression analysis showed that only the type of tamponade was significantly correlated with the final BCVA in the Macula-ON group (p = 0.004). Conclusions: Our study described long-term perfusion changes in RRD after surgery, with lower SCP VD and VLD in the operated eyes compared to the fellow ones, not influenced by type of surgery or tamponade. The choice of tamponade and SO removal timing may affect functional outcomes, especially in Macula-ON RRD. In conclusion, such functional and perfusion changes can be considered biomarkers that highlight the relevance of careful management of this sight-threatening disease

Qualitative and Quantitative Assessment of Vascular Changes in Diabetic Macular Edema after Dexamethasone Implant Using Optical Coherence Tomography Angiography

The aim of this study was to investigate retinal and choriocapillaris vessel changes in diabetic macular edema (DME) after the intravitreal dexamethasone implant (IDI) using optical coherence tomography angiography (OCTA). Moreover, a comparison between morphological and functional parameters of DME and healthy patients was performed. Twenty-five eyes of 25 type 2 diabetic retinopathy patients complicated by macular edema (DME group) and 25 healthy subjects (control group) were enrolled. Superficial capillary plexus density (SCPD) and deep capillary plexus density (DCPD) in the foveal and parafoveal areas, choricapillary density (CCD) and optic disc vessel density (ODVD) were detected using OCTA at baseline and after 7, 30, 60, 90 and 120 days post injection. Best corrected visual acuity (BCVA), retinal sensitivity, and central retinal thickness (CMT) were also evaluated in both groups of patients. A statistically significant difference between the two groups (DME and controls) was found in terms of functional (MP, p < 0.001 and BCVA, p < 0.001) and morphological (CMT, p < 0.001; SCPD in the parafoveal area, p < 0.001; DCPD in the foveal area, p < 0.05 and parafoveal area, p < 0.001; CCD, p < 0.001) parameters. After the treatment, SCPD and DCPD in the foveal and parafoveal areas did not modify significantly during the follow up

Rebound Tonometry in Cataract Surgery: Comparison with Goldmann Applanation Tonometry

Purpose: to compare the rebound tonometer ICare\uae (RT) with the Goldmann applanation tonometer (GAT) in cataract surgery and to assess the influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurements. Design: retrospective, comparative study. Methods: a total of 472 patients underwent IOP measurement using RT (time 0 = RTa). GAT IOP measurement was performed 5 minutes later, followed by a second RT IOP measurement after other 5 minutes (RTa + 10 min = RTb). CCT was obtained by ultrasound pachymetry. In 106 patients IOP was measured by means of RT and GAT before clear corneal cataract surgery (RT1 and GAT1) and at one day postoperatively (RT2 and GAT2). Results: RT IOP values > 5 mmHg were overestimated, while RT IOP values < 15 mmHg were underestimated. Every 100 \ub5m of CCT an increase of 0.97 mmHg and 0.33 mmHg was found for RT and GAT respectively. The difference between RT1 and RT2, GAT1 and GAT2, RT1 and GAT1 was not statistically significant; while the difference between RT2 and GAT2 was statistically significant (p < 0.04). The difference between RTa and RTb was not statistically significant whereas the difference between RTa and GAT and RTb and GAT was statistically significant (p < 0.001). Conclusion: our results showed a good agreement between measurements obtained with RT and GAT in pre and postoperative cataract surgery, although a significant statistically difference was found between RT and GAT measurements performed postoperatively. Moreover, CCT is a parameter to be considered for the IOP measurement, especially for values obtained with RT

Early retinal flow changes after vitreoretinal surgery in idiopathic epiretinal membrane using swept source optical coherence tomography angiography

(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA); (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling were evaluated pre- and postoperatively using SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 6x6-mm OCTA volume scans were acquired by two observers independently. The en face images of superficial capillary plexus (SCP) were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. Perfusion density (PD), vessel length density (VLD), vessel diameter index (VDI) and vessel tortuosity (VT) of SCP were evaluated in both the parafoveal (2.5 mm diameter) and perifoveal areas (5.5 mm diameter); (3) Results: At OCTA analysis statistically significant differences were found between controls and diseased eyes for all parameters in parafoveal and perifoveal regions (p &lt; 0.001; p &lt; 0.05) except for perifoveal VLD. During 6-month follow up, both anatomical/perfusion and functional parameters showed a statistically significant improvement if compared to preoperative values. In detail, at one-month post vitrectomy, VLD and VT significantly changed in parafoveal region (p = 0.043; p = 0.045), while PD and VDI showed a trend of increase in both parafoveal and perifoveal region. At 6 months after surgery, PD, VLD and VT of parafoveal region significantly improved (p = 0.021, p = 0.018, p = 0.047 respectively). (4) Conclusions: SS-OCTA provides a quantitative and qualitative analysis of the superficial capillary plexus allowing for early vascular changes assessment after vitrectomy with iERM and ILM peeling

Chemical and physical analysis of phaco handpiece tip surfaces before and after cataract\ua0surgery

PURPOSE: To evaluate the surface chemical composition and roughness of different phaco tips before and after their use during cataract surgery. SETTING: Eye Clinic, University of Trieste, Trieste, Italy. DESIGN: Experimental study. METHODS: Of the 66 tips studied, 33 (15 new, 15 after single use, and 3 after multiple uses) were studied with X-ray photoemission spectroscopy and 33 (15 new, 15 after single use, and 3 after multiple uses) were examined using scanning electron microscopy with energy dispersive X-ray spectroscopy analysis and contact profilometry. All analyses were performed on the far end of the tip. RESULTS: Used phaco tips showed signs of wear at the end of the tip, with the deposition of debris. The cutting edge appeared to be rounded and irregular. After surgery, an increase in the surface roughness was detected. The chemical analyses showed modification of the superficial alloy composition and the biological origin of some debris deposited after surgery. The deterioration and wear observed were more remarkable after multiple surgical procedures. CONCLUSIONS: Used phaco tips showed relevant signs of deterioration and deposition of biological material, mostly involving the cutting edge. Reusable tips might release remnants of previous procedures. The adoption of single-use disposable phaco tips seems to be highly advisable

Scanning Electron Microscopy Evaluation of an EX-PRESS Mini Glaucoma Shunt After Explantation

We report a case of an explanted stainless steel miniature glaucoma drainage device (EX-PRESS) implanted under a scleral flap for pseudoexfoliation open-angle glaucoma surgical treatment. The glaucoma shunt was implanted in a 75-year-old white man with medically refractive glaucoma. Cataract surgery was performed simultaneously. After 2 years, the shunt extruded through the scleral flap and the conjunctiva and it was, therefore, explanted. Scanning electron microscopy images of the EX-PRESS mini glaucoma shunt were acquired to verify the patency of the device lumen and the presence of fibrosis or cellular adhesion on the device. Energy dispersive spectroscopy for chemical surface characterization of the EX-PRESS shunt was performed. Scanning electron microscopy-acquired images showed minimal extracellular material proliferation on the lumen device. The energy dispersive spectroscopy analysis revealed a high peak of carbon suggesting the organic nature of the residuals found on the shunt lumen. The surface showed few superficial pits, likely due to an initial corrosion process

Surgical reposition of the trochlea in a case of acquired Brown\u2019s syndrome

Background: An orbital or frontal trauma dislocating the trochlea determines a strabismus by an acquired Brown\u2019s syndrome (BS). The maxillofacial surgeon and ophthalmologist combined management is needed before, during and after the surgical treatment. Methods: a 28yo man with cranial maxillofacial (CMF) trauma involving the left frontal bone and the roof of the left orbit was hospitalized. Clinical ophthalmological and radiological examinations were performed. Computerized Tomography (CT) scan showed medial and caudal dislocation of the left orbital roof together with the left orbital trochlear complex. At the ophthalmological evaluation 4-prism diopters hypotropia of the left eye and reduced convergence were detected. The patient underwent surgical treatment for frontal bone fracture reposition. A pre and postoperative Hess chart was obtained to evaluate the surgical results. Results: Two weeks after surgery the ophthalmological examination showed no diplopia, no muscular impairing, a good eye convergence and no head malposition. Prismatic lens correction was not necessary. Conclusions: Surgical reposition of the frontal bone fracture involving the superomedial orbital bone and the trochlea allowed to successfully solve the acquired diplopia by the BS. The role of the ophtalmologist is a key factor throughout the whole management of the craniomaxillofacial surgical treatment

Comparative clinical study of Whitestar Signature phacoemulsification system with standard and Ellips FX handpieces

To compare the intraoperative parameters and postoperative outcomes using two different phaco handpieces with different energy delivery systems of the same phacoemulsification machine

Diabetic eye disease in patients with diabetes mellitus secondary to chronic pancreatitis (DMsCP) Retrospective observational study

PurposeTo investigate diabetic retinopathy (DR) and maculopathy prevalence and severity in patients with DMsCP in Northern IrelandMethodsIn 2017-19, DMsCP patients living in Northern Ireland attending specialised clinics were audited for severity of DR using both diabetic eye-screening and hospital eye-services databases. The Northern Ireland Diabetic Eye Screening Program (NIDESP) was used for DR and maculopathy grades, and attendance information. Clinical and laboratory data were obtained from “Diamond” diabetes database and electronic medical records. Appropriate statistical analyses were carried out.ResultsA total of 94 DMsCP patients were included in the audit. Mean age was 57±10 years (81% males). Mean pancreatitis duration was 14 years, with mean DM duration at 11 years. In 75% of cases, alcohol abuse caused DMsCP, gallstones represented 9%, with high cholesterol levels, cystic fibrosis gene-carrier, drug-induced, and portal vein thrombosis each accounting for 1%. In 12% no underlying cause was attributed. HBA1C and Body Mass Index (BMI) were 74.3 mmol/mol and 25.3 Kg/m2 respectively. Mean Albumin Creatinine Ratio (ACR) was 13.37. Compared to the 2017 baseline data, did-not-attend rates dropped from 31% to 13%. Those with no DR reduced to 63% from 85%; while mild non-proliferative DR (NPDR), severe NPDR and proliferative DR were found in 30%, 2% and 5% of cases respectively (previously 12, 3 and 1%); maculopathy was present in 9% (previously 6%). There was no significant difference between DR or maculopathy grade and HBA1C, sex, BMI, weight, pancreatitis aetiology, clinic/screening attendance, or number of missed appointments (all p&gt;0.05). No-DR patients had mean DM duration of 7.5 years while PDRs had 18.5 years (p=0.001). Pancreatitis duration was significantly higher in those with PDR (11 years versus 19; P=0.001).ConclusionsWith fuller coverage of the patient population and increased attendance, the profile of DR in DMsCP patients in NI shifted, including more patients with advanced diabetic eye disease. This demonstrates the importance of reaching the full range of patients and providing accessible services to all.<br/