Epidemiology and economic impact of moderate and severe neurotrophic keratopathy in Italy

Neurotrophic keratopathy is a rare corneal disease caused by impaired corneal innervation. There is a paucity of published evidence on neurotrophic keratopathy with no published studies on the economics of neurotrophic keratopathy in the Italian or international literature. This cost analysis aimed at assessing the economic impact of moderate (persistent epithelial defect) and severe (corneal ulcer without perforation) neurotrophic keratopathy from the perspective of the National Health Service and patients in Italy. Treatment algorithm and health resource use information were collected from a panel of nine experts from Italian centres specialized in ocular/corneal conditions. National ambulatory and inpatient hospital tariffs were applied to units of service, and Agenzia Italiana del Farmaco (AIFA) published prices to pharmaceuticals. Mean annual per patient cost was derived as an average cost weighted by the proportion of patients on each respective treatment and length of the treatment. The National Health Service + patient perspective additionally included patients' out-of-pocket expenses. The mean annual estimated National Health Service cost of treatment was €5167 (persistent epithelial defect) and €10,885 (corneal ulcer without perforation) per patient. Costs were largely driven by ambulatory visits and hospital interventions. The mean annual estimated National Health Service + patient cost was €5731 (persistent epithelial defect) and €11,478 (corneal ulcer without perforation) per patient, including cost of out-of-pocket expenses for pharmaceuticals and therapeutic contact lenses. Mean annual cost of neurotrophic keratopathy in Italy doubles with disease severity. Further research is warranted to provide more insight especially into societal costs

A fistful of candies for hypertension

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Management of recurrent corneal ulcers: Use of amniotic membrane

PURPOSE: Amniotic membrane (AM), or amnion, is a thin membrane on the inner side of the fetal placenta; it completely surrounds the embryo/fetus and delimits the amniotic cavity, which is filled by amniotic liquid. In recent years, the structure and function of the amnion have been investigated due to its pluripotent properties, which are an attractive source for tissue transplantation and reconstructive surgery. The pioneering use of AM in skin transplantation by Davis dates back to 1910; in 1913, Sabella and Stern employed it in the treatment of burns and superficial scars. Certain characteristics make the AM ideally suited to its application in ocular surface reconstruction. It can be easily obtained and its availability is nearly unlimited. We report a case of AM transplantation to treat ocular surface abnormality. METHODS: A 28-year-old man came to our attention for persistent foreign body feeling and pain in his right eye. Because of progressive clinical worsening, we decided to perform surgical apposition of AM. RESULTS: Clinical and instrumental follow-up was conducted with periodic complete checkups. At 1 year follow-up, best-corrected visual acuity was 4/10

Ocular argyrosis in a silver craftsman

This case report highlights the hazard of silver crafting without adequate eye protection, and indicates that occupational ocular argyrosis may still be observed in clinical practice today. In such cases, occupational anamnesis, ophthalmologic examination, confocal corneal biomicroscopy, and histopathology will allow the correct diagnosis that, in turn, is important for work-related medico-legal issues

Single-Pass Mikrokeratome and Anterior Chamber Pressurizer for the Ultrathin Descemet-Stripping Automated Endothelial Keratoplasty Graft Preparation

PURPOSE: To compare the reliability of microkeratome dissection with the anterior chamber pressurizer (ACP) system versus conventional pressurization for ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK) graft preparation.METHODS: A retrospective review of a consecutive series of dissected donor corneas processed at Pavia Eye Bank for UT-DSAEK surgery was performed. Grafts were prepared through single-pass microkeratome dissection with artificial anterior chamber internal pressure regulation through either ACP or the conventional method using a water column with tube clamp. The target central graft thickness (CGT) was ≤100 mum. Cutting predictability was determined as the difference between the microkeratome head size and the thickness actually removed. Graft regularity was investigated as central-to-peripheral thickness increase, central-to-peripheral (CP) ratio, and graft thickness uniformity. Thickness was measured with anterior segment optical coherence tomography (horizontal and vertical meridians).RESULTS: Of the 265 UT-DSAEK grafts, ACP achieved the target "CGT ≤ 100 mum" in 87 of 120 (72.5%), whereas the conventional technique achieved the same in 85 of 145 (58.6%) (P = 0.018). ACP predictability was -3.9 mum (SD: 2.3), whereas predictability of the conventional technique was -54.6 mum (SD: 3.7) (P 0.05).CONCLUSIONS: Compared with conventional pressurization, ACP improved microkeratome-assisted preparation reliability of UT-DSAEK grafts, achieving CGT ≤ 100 mum with significantly higher frequency (P = 0.018) and predictability (P < 0.001). ACP improved CP ratio only at 2 mm (P = 0.001); for other graft thickness, the 2 methods proved equivalent

Assessment of quasi-linear effect of RF power spectrum for enabling lower hybrid current drive in reactor plasmas

The main research on the energy from thermonuclear fusion uses deuterium plasmas magnetically trapped in toroidal devices. To suppress the turbulent eddies that impair thermal insulation and pressure tight of the plasma, current drive (CD) is necessary, but tools envisaged so far are unable accomplishing this task while efficiently and flexibly matching the natural current profiles self-generated at large radii of the plasma column [1-5]. The lower hybrid current drive (LHCD) [6] can satisfy this important need of a reactor [1], but the LHCD system has been unexpectedly mothballed on JET. The problematic extrapolation of the LHCD tool at reactor graded high values of, respectively, density and temperatures of plasma has been now solved. The high density problem is solved by the FTU (Frascati Tokamak Upgrade) method [7], and solution of the high temperature one is presented here. Model results based on quasi-linear (QL) theory evidence the capability, w.r.t linear theory, of suitable operating parameters of reducing the wave damping in hot reactor plasmas. Namely, using higher RF power densities [8], or a narrower antenna power spectrum in refractive index [9,10], the obstacle for LHCD represented by too high temperature of reactor plasmas should be overcome. The former method cannot be used for routinely, safe antenna operations, Thus, only the latter key is really exploitable in a reactor. The proposed solutions are ultimately necessary for viability of an economic reactor