Prolonged face mask use might worsen dry eye symptoms

Purpose: The aim of this study was to explore whether prolonged and consistent face mask use might be associated with worsening of dry eye symptoms in patients with dry eye disease (DED). Methods: Subjects with a previous diagnosis of DED. Their OSDI scores were compared with those recorded in Fall 2019 using the Wilcoxon paired test. Participants were stratified by face mask use: heavy (Group A) or standard (Group B) face mask users. Heavy use was defined as wearing any type of face mask for at least 6 hours a day, at least 5 days per week in the last 2 months. Results: 67 subjects (mean age: 45.27 ± 10.06 SD years, 40% males and 60% females). Median OSDI score in Fall 2019: 18.75. Median OSDI in Spring 2020: 20.83. The Hodges‑Lehmann median difference was 2.09 (95% CI [1.05, 4.17]) (P < 0.0001). The population was then stratified into heavy and standard face mask users: Group A included heavy users (31 subjects; mean age: 42.81 ± 10.48 SD years; 35% males and 65% females), Group B included standard users (36 subjects; mean age: 47.39 ± 9.31 SD years; 44% males and 56% females). The Hodges‑Lehmann median difference was 5.21 (95% CI [3.13, 7.29]) in Group A (P < 0.0001), and 1.04 (95% [0, 2.08]) in Group B (P = 0.0177). Conclusion: Prolonged and consistent face mask use is associated with an increase in OSDI scores. Whether face mask use is responsible for the worsening of symptoms of DED remains to be elucidate

The perception of psychosocial risks and work-related stress in relation to job insecurity and gender differences: a cross-sectional study

Introduction.The perception of psychosocial risks exposesworkers to developwork-related stress. Recently the attention of scientific research has focused on a psychosocial risk already identified as “job insecurity” that regards the “overall concern about the continued existence of the job in the future” and that also depends onworker’s perception, different for each gender. Aimof the Study. The aim of this cross sectional study is to show if job insecurity, in the formof temporary contracts, can influence the perception of psychosocial risks and therefore increase worker’s vulnerability to work-related stress and how the magnitude of this effect differs between genders. Materials and Methods. 338 administrative technical workers (113 males and 225 females) were administered a questionnaire, enquiring contract typology (permanent or temporary contracts), and the Health Safety Executive questionnaire to assess work-related stress. The Health Safety Executive Analysis Tool software was used to process collected questionnaires and theWilcoxon rank-sum test was used to evaluate the statistical significance of the differences obtained. Results. Workers with temporary contracts obtained lower scores than workers with permanent contracts in all the domains explored by theHealth Safety Executive Analysis questionnaire, statistically significant (P<0,05). The female workers obtained lower scores than male workers in all domains explored by the Health Safety Executive questionnaire. Conclusions. Authors conclude that perception of psychosocial risks can be influenced by job insecurity, in the form of temporary contracts, and increases worker’s vulnerability to work-related stress and differs between genders

Effects of repeated intravitreal injections of dexamethasone implants on intraocular pressure: a 4-year study

Purpose: Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants. Materials and Methods: A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards. Results: Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and −0.41 mmHg (T3) (p &lt; 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and −0.66 mmHg (T3) (p &lt; 0.05). Conclusion: Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30–90 days following the implantation procedure and responds well to topical pressure-lowering medications

Utility of ocular motility tests in orbital floor fractures with muscle entrapment that is not detected on computed tomography

Purpose: Determine the usefulness of ocular motility testing to detect the presence of muscle entrapment. Materials and Methods: Cross-sectional study of patients with symptoms of diplopia secondary to facial trauma. Inclusion criteria: age between 20 and 80 years; symptoms of diplopia following facial trauma; presence of orbital floor fracture confirmed radiologically; presence of muscle entrapment confirmed at the time of surgery; best-corrected visual acuity of 0.6 or more. Exclusion criteria: muscle entrapment visible on computed tomography; candidate for immediate surgical correction; prior history of strabismus surgery. Outcome measures: Abnormal Head Position (AHP), Hirschberg Corneal Reflexes (CR), Cover/Uncover and Alternating Cover Test, Hertel exophthalmometry, Near Point of Convergence (NPC), Kestenbaum Limbus test, Red Filter test, and Hess screen test. Results: Forty-six subjects (38 males, 8 females, mean age 27 ± 3.3 SD years). Pre-operative assessment: forty-six (100%) reported diplopia on the Red Filter test and showed some degree of abnormality on the Hess Screen test. Forty-two (91%) showed AHP. Forty-one (89%) had exophthalmometry values that differed 2 mm or more between the two eyes and insufficient NPC. Thirty-two (69.6%) showed deficits of 3 mm or more on the Kestenbaum Limbus test. Sixteen (35%) had abnormal Hirschberg corneal reflexes. Eleven (24%) demonstrated constant or intermittent strabismus. Conclusion: Ocular motility testing can differentiate non-invasively, pre-operatively, and cost-effectively the presence of muscle entrapment even when this is not visible on computed tomography

Optical coherence tomography of retinal and choroidal layers in patients with familial hypercholesterolaemia treated with lipoprotein apheresis

Detect and quantify morpho-functional alterations of the retina and choroid in patients affected by familial hypercholesterolemia (FH) treated with lipoprotein apheresis (LA) using optic coherence tomography (OCT) and optic coherence tomography-angriography (OCTA).Observational study.To be diagnosed: A group of 20 patients (40 eyes) being clinically and genetically diagnosed as FH and under treatment (FH-Group)", for at least 2 years, was compared to a control group of 20 healthy subjects (40 eyes), with a normal lipid profile and no ocular disease (CT-Group).Participants were studied with the slit lamp, binocular indirect fundoscopy, OCT and OCTA.Best corrected visual acuity (BVCA), spherical equivalent (SE), intraocular pressure (IOP), central macular thickness (CMT), choroidal thickness (CHT), retinal nerve fiber layer in four quadrants (RNFL (Superior = Sup; Inferior = Inf; Nasal = Nas Temporal = Temp), and the mean value across the four quadrants (RNFL G), foveal avascular zone (FAZ) and vascular density (VD).FH subjects had smaller RNFL superiorly (108 ± 19,38 μm OD/111 ± 16,56 μm OS FH-Group vs 127 ± 7,42 μm OD/129 ± 14,64 μm OS CT-Group; P  0,001 for both OD and OS) and inferiorly (108 ± 23,58 μm OD/115 ± 17,33 μm OS FH-Group vs 128 ± 18,15 μm OD/133 ± 17,38 μm OS CT-Group; P = 0,002 OD; P = 0,001 OS). G RNFL was consequently smaller (93 ± 12,94 μm OD/94 ± 10,49 μm OS FH-Group vs 101 ± 9,01 μm OD/101 ± 10,20 μm OS CT-Group; P = 0,03 OD; P = 0,02 OS). FH subjects had a larger FAZ (0,31 ± 0,08 mmEarly signs of retinal vessel damage in FH patients can be detected and quantified with OCT and OCTA

Conjunctivitis can be the only presenting sign and symptom of COVID-19

Five cases of non-remitting conjunctivitis turned out to be the sole presenting sign and symptom of COVID-19. These patients tested positive on RT-PCR of naso-pharyngeal swabs and developed no fever, malaise, or respiratory symptoms throughout the course of their illness. They all fully recovered. In the current efforts to fight the spread of this virus, authors want to emphasize that atypical clinical presentations of COVID-19 can occur and a high level of suspicion should be maintained. Ocular involvement and transmission of SARS-CoV-2 should never be overlooked. In fact, conjunctival mucosae are susceptible to respiratory viruses and remain an important point of entry. For this reason, eye protection in the form of goggles or a face shield should be considered essential for all healthcare providers, even when taking care of patients who are not showing typical symptoms of COVID-19

Topography-guided transepithelial photorefractive keratectomy for the treatment of persistent and visually-significant adenoviral corneal infiltrates

Purpose: To evaluate visual and refractive outcomes of customized photorefractive keratectomy (PRK) in subjects with persistent subepithelial corneal opacities secondary to adenoviral epidemic keratoconjunctivitis (EKC). Patients and methods: Prospective study, which recruited patients with persistent and visually-significant post-EKC corneal opacities unresponsive to prolonged topical therapy (6 months or more). Outcome measures: uncorrected and best-corrected distance visual acuity, subjective refractive astigmatism, keratometric astigmatism, spherical equivalent, minimum corneal thickness, and corneal morphological irregularity index. Subjects were followed for 12 months post-treatment. Results: Eighteen eyes of 18 patients aged between 32 and 75 years treated with topography-guided transepithelial PRK with iRes excimer laser (iVIS Technologies, Taranto, Italy) from June 2020 to July 2021. After 12 months, the mean UDVA improved from 1.0±0.00LogMAR pre-op to 0.15±0.154LogMAR, and the mean CDVA improved from 0.4±0.41LogMAR pre-op to 0.0±0.00LogMAR. With respect to UDVA, all treated eyes (100%) showed an improvement of 6 ETDRS lines or more and with respect to CDVA, 9 out of 18 eyes (50%) showed an improvement of 6 ETDRS lines or more. The mean ablation depth was 54.7±5.9μm. A statistically significant improvement was observed in all topographic indices. No infiltrate recurrence, post-treatment corneal haze, ocular hypertension or other side effects were observed throughout the follow-up period. Conclusion: Topography-guided PRK could be considered an effective and safe treatment option to improve visual acuity in patients affected by persistent and visually-significant subepithelial corneal infiltrates caused by EKC

Effects of photo-biomodulation in Stargardt disease

Scopo: la malattia di Stargardt (STGD1) è la degenerazione maculare ereditaria più comune e attualmente non sono stati approvati trattamenti per interrompere la progressione della malattia. Lo scopo di questo studio era di valutare l'efficacia della foto-biomodulazione nei pazienti con malattia di Stargardt 1 anno dopo il trattamento, considerando come risultati primari i miglioramenti dell'acuità visiva corretta (BCVA), della microperimetria e dell'ampiezza dell'elettroretinografia (PERG). Materiali e metodi:Novanta occhi di 45 pazienti con diagnosi di malattia di Stargardt stadio 1 sono stati reclutati prospetticamente presso l'Università di Bologna. I pazienti selezionati sono stati trattati con terapia di foto-biomodulazione per 1 anno per 10 minuti al giorno, due volte al giorno e 5 giorni alla settimana per 12 mesi. È stato utilizzato un diodo a emissione di luce (LED) di 10 Hz e lunghezza d'onda 650 nm. BCVA e microperimetria sono state valutate prima del trattamento e 1 anno dopo la foto-biomodulazione, mentre il PERG è stato valutato al basale, 1, 3, 6 e 12 mesi dopo il trattamento. Risultati: BCVA è migliorato da 0,7 [intervallo interquartile (IQR)=0,6–0,9)] a 0,4 (IQR=0,2–0,5)] dopo il trattamento (IC 95%=− 0,3, − 0,35; p=&lt; 0,001) e onda negativa PERG a 35 ms (N35)-onda positiva a 50 ms (P50) di ampiezza è migliorata da 0,9 (IQR=0,74–1,21) a 2,12 (IC 95%=1,11, 1,28; p &lt;0,001). La microperimetria MP-1 è migliorata dal 26,5% (IQR=16,75–40) dei loci retinici preferiti mediani (PRL) entro un'area di 2° di diametro al 38% (IQR=29–50,25; IC 95%=10,50, 14,50; p =&lt; 0,001); d'altra parte, la PRL entro 4° dal diametro è aumentata dal 72% (IQR=51,5–80) all'80% (IQR=76–87) dopo foto-biomodulazione (IC 95%=4,50, 7,50; p &lt;0,001). Inoltre, i pazienti con un miglioramento dell'ampiezza del rapporto PERG N35-P50 superiore a 1,205 a 3 mesi e superiore a 1,29 a 6 mesi tendevano a presentare un miglioramento di oltre 0,2 logMar in BCVA a 12 mesi ( p =0,28, AUC=0,630; P=0,30, AUC=0,636). Conclusione: BCVA, PERG e MP-1 sono migliorati significativamente 1 anno dopo il trattamento. Inoltre, il miglioramento dell'ampiezza del PERG N35-P50 a 3 e 6 mesi era correlato al miglioramento del BCVA a 1 anno, suggerendo che il PERG potrebbe essere utile nel predire l'esito visivo dopo la foto-biomodulazione.Purpose: Stargardt disease (STGD1) is the most common hereditary macular degeneration and currently no treatments have been approved to interrupt the progression of the disease. The aim of this study was to evaluate the efficacy of photo-biomodulation in patients with Stargardt disease 1 year after treatment, considering as primary outcomes improvements in best corrected visual acuity (BCVA), microperimetry, and pattern electroretinography (PERG) amplitude. Materials and Methods: Ninety eyes of 45 patients with a diagnosis of Stargardt disease stage 1 were prospectively recruited at the University of Bologna. Selected patients were treated with photo-biomodulation therapy for 1 year for 10 minutes a day, twice a day, and 5 days per week for 12 months. A light emitting diode (LED) of 10 Hz and wavelength 650 nm was used. BCVA and microperimetry were assessed before treatment and 1 year after photobiomodulation, whereas PERG was assessed at baseline, 1, 3, 6, and 12 months after treatment. Results: BCVA improved from 0.7 [interquartile range (IQR)=0.6–0.9)] to 0.4 (IQR=0.2– 0.5)] after treatment (95% CI=−0.3, −0.35; p=&lt;0.001) and PERG negative wave at 35 ms (N35)-positive wave at 50 ms (P50) amplitude improved from 0.9 (IQR=0.74–1.21) to 2.12 (95% CI=1.11, 1.28; p&lt;0.001). MP-1 Microperimetry improved from 26.5% (IQR=16.75– 40) of median preferred retinal loci (PRL) within an area of 2° of diameter to 38% (IQR=29– 50.25; 95% CI=10.50, 14.50; p=&lt;0.001); on the other hand, PRL within 4° of diameter raised from 72% (IQR=51.5–80) to 80% (IQR=76–87) after photo-biomodulation (95% CI=4.50, 7.50; p&lt;0.001). Also, patients with an improvement of more than 1.205 PERG N35-P50 ratio amplitude at 3 months and more than 1.29 at 6 months tended to present an improvement of more than 0.2 logMar in BCVA at 12 months (p=0.28, AUC=0.630; p=0.30, AUC=0.636). Conclusion: BCVA, PERG, and MP-1 significantly improved 1 year after treatment. Also, improvement of PERG N35-P50 amplitude at 3 and 6 months was correlated to BCVA improvement at 1 year, suggesting that PERG could be useful in predicting visual outcome after photo-biomodulation

Familial hypercholesterolaemia: the influence of lipoprotein apheresis on choroid and retina. an oct and octa retrospective study

Purpose: High cholesterol levels in untreated familial hypercholesterolemia (FH) can significantly compromise retinal microvasculature. This type of dyslipidemia is commonly treated with combination drug therapy and lipoprotein apheresis (LA). We conducted a retrospective observational study by means of optical coherence tomography (OCT) and optical coherence tomography-angiography (OCTA) on patients affected by familial hypercholesterolemia (FH) treated by LA and healthy controls. Methods: A group of 20 patients (40 eyes; 8 males and 12 females; mean age±SD: 50, 05±13, 68) with FH were compared to a group of 20 matched healthy controls (CT group). Inclusion criteria: genetically-confirmed diagnosis of FH, treatment with combination drug therapy and LA for at least 2 years, spherical equivalent (SE)-3 to+ 3 diopters. Exclusion criteria: pre-existent retinal or choroidal damage (including macula

Expression of Pro-Angiogenic Markers Is Enhanced by Blue Light in Human RPE Cells

Inherited retinal dystrophies are characterized by photoreceptor death. Oxidative stress usually occurs, increasing vision loss, and oxidative damage is often reported in retinitis pigmentosa (RP). More than 300 genes have been reported as RP causing. In contrast, choroidal neovascularization (CNV) only occasionally develops in the late stages of RP. We herein study the regulation of RP causative genes that are likely linked to CNV onset under oxidative conditions. We studied how the endogenous adduct N-retinylidene-N-retinylethanolamine (A2E) affects the expression of angiogenic markers in human retinal pigment epithelium (H-RPE) cells and a possible correlation with RP-causing genes. H-RPE cells were exposed to A2E and blue light for 3 and 6h. By transcriptome analysis, genes differentially expressed between A2E-treated cells and untreated ones were detected. The quantification of differential gene expression was performed by the Limma R package. Enrichment pathway analysis by the FunRich tool and gene prioritization by ToppGene allowed us to identify dysregulated genes involved in angiogenesis and linked to RP development. Two RP causative genes, AHR and ROM1, can be associated with an increased risk of CNV development. Genetic analysis of RP patients affected by CNV will confirm this hypothesis