The effect of pars plana vitrectomy with internal limiting membrane peeling on the durability of the intravitreal dexamethasone implant in the treatment of diabetic macular edema

Purpose: To evaluate the influence of pars plana vitrectomy with internal limiting membrane peeling on recurrence time of diabetic macular edema in eyes under treatment with dexamethasone intravitreal implant injections. Material and methods: Twelve pseudophakic eyes of 12 patients with non-proliferative diabetic retinopathy and non-tractional diabetic macular edema were included. All eyes had already been treated with two or more dexamethasone intravitreal implant injections evidencing a recurrence time of three months or less (early recurrence). At baseline, they underwent pars plana vitrectomy with internal limiting membrane peeling, ending with dexamethasone intravitreal implant injection. Patients were then followed-up monthly, treated with a second injection at the first recurrence, and followed up to the second recurrence. Measurements of best corrected visual acuity, intraocular pressure, and central foveal thickness by spectral-domain optical coherence tomography were performed at each follow-up examination. Results: Vitrectomized eyes showed a significant extension of recurrence time of diabetic macular edema, and specifically from 3.4 (3.2-3.7) to 6.5 (5.7-8.2) months after the first injection, and to 7.0 (5.7-8.2) months (p < 0.01) after the second injection (p < 0.01). Conclusions and importance: Pars plana vitrectomy with internal limiting membrane peeling seems not to influence functional and anatomical results in eyes under treatment with dexamethasone intravitreal implant injections for diabetic macular edema, but appears to significantly extend the benefit of the drug

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious

Primary congenital glaucoma surgery: outcomes and visual function

Purpose: To assess the long-term visual outcomes of children with PCG, irrespective of the type of surgical procedure, and to create visual acuity curves to help in predicting the development of visual function in these patients. The secondary aim is to identify associated factors for visual decline or loss, highlighting differences between neonatal and infantile subgroups. Methods: The medical records of pediatric glaucoma patients from 1996 to 2017 at the University Hospital of Verona (Verona, Italy) were retrospectively reviewed. Visual acuities, surgeries, PCG subtype and etiology of vision impairment were recorded. Statistical analyses were performed to detect factors associated with vision decline. Results: Sixty-seven eyes (40 patients) were included in the study. Developmental predictive curves of visual acuity showed that children with infantile PCG had a better visual outcome than children with neonatal PCG at each step of follow-up. A good-to-moderate VA (< 1 LogMAR) was achieved in 56 eyes (83.6%), while 11 eyes (16.4%) had poor VA ( 65 1 LogMAR). The age at onset, sex, number of surgeries, intraocular pressure (IOP) control (with or without antiglaucoma drugs), axial length (AL) and corneal opacities were statistically associated with vision impairment (p < 0.01). The main cause of visual impairment was amblyopia. Conclusions: Visual outcomes of PCG significantly correlate with the age at diagnosis. Although a good long-term IOP control can often be achieved in PCG, often the visual acuity remains below the lower limits of the normal range. Poor vision in childhood is related to global developmental problems, and referral to third-level services should not be delayed to prevent vision impairment. In this regard, visual acuity curves can be a useful tool for the consultant ophthalmologist to define the visual development of children affected by PCG

Early and late onset sepsis and retinopathy of prematurity in a cohort of preterm infants

This study investigates the impact of antenatal and postnatal infection or inflammation on the onset and progression of Retinopathy of Prematurity (ROP). We retrospectively collected clinical and demographic data of preterm infants with birth weight ≤ 1500 g or gestational age < 30 weeks admitted to the neonatal intensive care unit of Verona from 2015 to 2019. Uni- and multivariable analysis was performed to evaluate the potential effect of selected variables on the occurrence of any stage ROP and its progression to severe ROP, defined as ROP requiring treatment. Two hundred and eighty neonates were enrolled and 60 of them developed ROP (21.4%). Oxygen need for 28 days and late-onset sepsis (LOS) increased the risk of any grade ROP after adjusting for birth weight and gestational age (OR 6.35, 95% CI 2.14-18.85 and OR 2.49, 95% CI 1.04-5.94, respectively). Days of mechanical ventilation and of non-invasive ventilation increased the risk of progression to severe ROP after adjusting for birth weight and gestational age (OR 1.08, CI 1.02-1.14 and OR 1.06, CI 1.01-1.11, respectively). Exposure to infection with production of inflammatory mediators may contribute to increase the risk of ROP occurrence in very preterm neonates

Visual-motor involvement in autism spectrum disorder: could the stereopsis deficit affect motor coordination?

PurposeGiven the known difficulty in sensory processing and in motor skills in patients with Autism Spectrum Disorder (ASD), and since visual impairment could interfere with children’s behaviour, early detection and management of visual-motor difficulties are crucial. This exploratory study aims to evaluate the visual-motor status in a cohort of children affected by ASD.MethodsThe records of patients affected by ASD and admitted between 2018 and 2022 to the Pediatric University Hospital of Verona were reviewed. Best Corrected Visual Acuity, cycloplegic refraction, stereopsis, convergence, complete ocular motility, strabismus examination, slit-lamp anterior segment examination and fundus ophthalmoscopy were collected and reviewed.ResultsA total of 253 patients (203 ASD and 50 healthy controls) were included in the study. A higher number of total orthoptic defects were detected in the ASD group, in comparison with the control group. Specifically, a higher percentage of stereopsis deficit and convergence insufficiency was observed.ConclusionIn our cohort of children with ASD stereopsis deficit, convergence insufficiency and refractive errors are the most observed ocular conditions. These findings are consistent with the known alterations of motor skills and sensory processing in ASD. Moreover, our study supports the hypothesis that visual acuity is not compromised in children with ASD. As a result, a complete ophthalmic evaluation is highly recommended in children with ASD, to guarantee early detection and treatment of possible visual-motor defects

Genotype-phenotype characterization of novel variants in six Italian patients with familial exudative vitreoretinopathy

Familial exudative vitreoretinopathy (FEVR) is a complex disorder characterized by incomplete development of the retinal vasculature. Here, we report the results obtained on the spectrum of genetic variations and correlated phenotypes found in a cohort of Italian FEVR patients. Eight probands (age range 7-19 years) were assessed by genetic analysis and comprehensive age-appropriate ophthalmic examination. Genetic testing investigated the genes most widely associated in literature with FEVR: FZD4, LRP5, TSPAN12, and NDP. Clinical and genetic evaluations were extended to relatives of probands positive to genetic testing. Six out of eight probands (75%) showed a genetic variation probably related to the phenotype. We identified four novel genetic variants, one variant already described in association with Norrie disease and one previously described linked to autosomal dominant FEVR. Pedigree analysis of patients led to the classification of four autosomal dominant cases of FEVR (caused by FZD4 and TSPAN12 variants) and two X-linked FEVR probands (NDP variants). None of the patients showed variants in the LRP5 gene. This study represents the largest cohort study in Italian FEVR patients. Our findings are in agreement with the previous literature confirming that FEVR is a clinically and genetically heterogeneous retinal disorder, even when it manifests in the same family

Convolutional neural network based on fluorescein angiography images for retinopathy of prematurity management

Purpose: The purpose of this study was to explore the use of fluorescein angiography (FA) images in a convolutional neural network (CNN) in the management of retinopathy of prematurity (ROP).Methods: The dataset involved a total of 835 FA images of 149 eyes (90 patients), where each eye was associated with a binary outcome (57 "untreated" eyes and 92 "treated"; 308 "untreated" images, 527 "treated"). The resolution of the images was 1600 and 1200 px in 20% of cases, whereas the remaining 80% had a resolution of 640 and 480 px. All the images were resized to 640 and 480 px before training and no other preprocessing was applied. A CNN with four convolutional layers was trained on 90% of the images (n = 752) randomly chosen. The accuracy of the prediction was assessed on the remaining 10% of images (n = 83). Keras version 2.2.0 for R with Tensorflow backend version 1.11.0 was used for the analysis.Results: The validation accuracy after 100 epochs was 0.88, whereas training accuracy was 0.97. The receiver operating characteristic (ROC) presented an area under the curve (AUC) of 0.91.Conclusions: Our study showed, we believe for the first time, the applicability of artificial intelligence (CNN) technology in the ROP management driven by FA. Further studies are needed to exploit different fields of applications of this technology.Translational Relevance: This algorithm is the basis for a system that could be applied to both ROP as well as experimental oxygen induced retinopathy

Pediatric eye emergency department activity during the first wave of Covid-19 pandemic

Background: We investigated the volume and the characteristics of pediatric eye emergency department (PEED) consultations performed at our tertiary eye center during the early months of the COVID-19 pandemic and we compared them to those carried out in the same time interval of the previous three years. Methods: Ophthalmic emergency examinations of patients aged 6418 years old and done during the national COVID-19 lockdown (March 9th, 2020 - May 3rd, 2020) and in the corresponding date range of the previous three years (2017, 2018, and 2019) have been considered and reviewed. The following features were retrieved and analyzed: age, gender, duration and type of accused symptoms, traumatic etiology, and the discharge diagnosis. Results: 136, 133, and 154 PEED visits have been performed respectively in 2017, 2018, and 2019, while 29 patients presented in 2020. Therefore, the volume of PEED activity decreased by 79.4% (p < 0.0001). Demographical and clinical characteristics were comparable to those of the pre-COVID period. Despite the absolute reduction in the number of traumas, urgent conditions increased significantly from 30.7 to 50.7% (p = 0.024). Conclusions: PEED activity decreased consistently after the onset of the pandemic and it was mainly attended by those children whose conditions required prompt assistance, reducing the number of patients diagnosed with milder pathologies. At the end of the emergency, better use of PEED could avoid overcrowding and minimize waste, allowing resource optimization for the management of urgent cases

Choroidal thickness changes during Anti-VEGF therapy for AMD.

Purpose:to evaluate variations in choroidal thickness during anti-VEGF therapy for neovascular AMD Methods:We retrospectively measured choroidal thickness (CT) in all eyes treated in the last six months with intravitreal ranibizumab for subfoveal choroidal neovascularization (CNV) secondary to AMD. CT was calculated with SD-OCT (Spectralis, Heidelberg) by two independent observers from the outer border of RPE line to the iperreflective line behind the large vessel layer of the choroid. We compared CT before the first injection (T0) with CT one month after the third monthly injection (T1). Type of CNV and BCVA (ETDRS chart) were also registered. Results:We analyzed 33 consecutive eyes of 33 patients (mean age 76 yo). At T0 mean BCVA was 32 letters and the range of the refractive error was ± 2.3 SE. Twentyfour eyes had an occult CNV, 3 eyes had a classic CNV and 6 eyes had a minimally classic CNV. After four months of therapy, the mean foveal CT decreased from 187µm (± 71) to 166 µm (±67), and this difference resulted highly statistically significant (p <0.0001). CT remained stable in only 4 eyes, while in 29 eyes it decreased from 9 to 72 µm (mean 21 µm). Conclusions:Anti-VEGF therapy seems to reduce choroidal thickness in neovascular AMD. Further studies with longer follow-up and higher number of eyes are necessary to confirm these data

Role of OCT in the diagnosis and follow up of diabetic macular edema

The aim is to present, along with a brief literature review, the results of OCT scan in eyes with diabetic macular edema (DME), as well as examples of the utility of OCT for different therapeutic approaches. One-hundred and thirty-six eyes with diabetic retinopathy were analyzed with OCT to explore the different patterns of DME. Some eyes with DME were studied with OCT pre and postoperatively to determine the efficacy of photocoagulation and vitrectomy to restore a normal macular profile. Sixty-eight eyes with a central foveal thickness of 200 mu or more were considered "edematous". Three different patterns of DME were recognized and analyzed: macular thickening, cystoid macular edema and shallow retinal detachment. The change in macular profile and internal retinal structure after laser or surgical treatment are well visible with OCT. OCT contributes in understanding the anatomy of DME and the intraretinal damage and seems to be the technique of choice for the follow-up of macular edema. We think that this tool should always be used in monitoring the effect of therapies in future studies