1,720,963 research outputs found
Nutritional optic neuropathies: State of the art and emerging evidences
Get PDFNutritional optic neuropathy is a cause of bilateral, symmetrical, and progressive visual impairment with loss of central visual acuity and contrast sensitivity, dyschromatopsia, and a central or centrocecal scotoma. The clinical features are not pathognomonic, since hereditary and toxic forms share similar signs and symptoms. It is becoming increasingly common due to the widespread of bariatric surgery and strict vegetarian or vegan diets, so even the scientific interest has recently increased. In particular, recent studies have focused on possible pathogenetic mechanisms, and on novel diagnostic and therapeutic strategies in order to prevent the onset, make a prompt diagnosis and an accurate nutritional supplementation, and to avoid irreversible optic nerve atrophy. Nowadays, there is clear evidence of the role of cobalamin, folic acid, thiamine, and copper, whereas further studies are needed to define the role of niacin, riboflavin, and pyridoxine. This review aims to summarize the etiology, diagnosis, and treatment of nutritional optic neuropathy, and it is addressed not only to ophthalmologists, but to all physicians who could come in contact with a patient with a possible nutritional optic neuropathy, being a fundamental multidisciplinary approach
Binocular treatment for amblyopia: a meta-analysis of randomized clinical trials
Get PDFBackground
To date, there is still no consensus regarding the effect of binocular treatment for amblyopia.
The purpose of this systematic review and meta-analysis was to summarize the available
evidence to determine whether binocular treatment is more effective than patching in children
with amblyopia.
Methods
Four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Central Register
of Controlled Trials) were searched for studies that compared binocular treatment and
patching in children with amblyopia. The outcome measures were visual acuity and stereopsis.
Pooled effects sizes were calculated with a random-effect model. The standardized difference
in means (SDM) with 95% confidence intervals (CI) was calculated. Sensitivity
analysis and assessment of publication bias were performed.
Results
Five randomized clinical trials were included. No significant difference in visual acuity
between patients treated with binocular treatment and patching was observed (SDM =
-0.12; 95% CI: -0.45–0.20; P = 0.464). No significant difference in stereopsis between
patients treated with binocular treatment and patching was observed (SDM = -0.07; 95% CI:
-0.61–0.48; P = 0.809). For both variables, the between-study heterogeneity was high
(respectively, I2 = 61% and I2 = 57%).
Conclusions
This meta-analysis found no convincing evidence supporting the efficacy of binocular treatment
as an alternative to conventional patching. Therefore, the binocular treatment cannot
fully replace traditional treatment but, to date, it can be considered a valid complementary
therapy in peculiar cases. Further studies are required to determine whether more engaging
therapies and new treatment protocols are more effective
The impact of COVID-19 pandemic on ophthalmological emergency department visits
Get PDFThe novel coronavirus (2019‐nCoV) appeared in the Chinese city of Wuhan and precipitously extended across the globe. On the evening of 9 March 2020, the Italian Government ordered a national lockdown to limit social interactions and contain the spread of the infection. As evident in other epidemics, peoples’ fear of infection may affect their utilization patterns of health services and reduce the access to health care (Chang et al. 2004). We have previously noted a significant change in the trends of eye injuries since the beginning of the lockdown (Pellegrini et al. 2020). Herein, we aimed to assess the influence of COVID‐19 on ophthalmological emergency department visits
Changing trends of ocular trauma in the time of COVID-19 pandemic
Get PDFTo reduce the spread of the novel coronavirus (2019-nCoV), countries have promoted a range of unprecedented public health responses. These measures aim at reducing the final size of the epidemic as well as its peak in order to decrease the acute pressure on the health-care system [1]. In Italy, the government ordered people to stay home, restricting movements with the exception of work, urgent matters and health reasons. Furthermore, all commercial and productive activities, except those providing essential services, were obligated to remain closed [2].
Ocular trauma represents a serious public health problem and leading cause of visual impairment [3, 4]. The COVID-19 social distancing measures might have a significant impact on the risk of ocular trauma. In this study, we retrospectively reviewed the charts of all patients presenting to an Italian ophthalmological emergency department (the Ophthalmology Unit of the S.Orsola-Malpighi University Hospital in Bologna) to identify all eye injuries. Data were analysed from 10th March 2020 (i.e. the day in which the quarantine measures were applied in our city) to 10th April 2020, and confronted with those of the same period of the previous year (from 10th March 2019 to 10th April 2019).
In the 2019 study period, there were 354 eye injuries (15.6% of all patients presenting to the emergency department). In the 2020 study period, eye injuries decreased to 112 (19.9% of all patients). The characteristics of eye injuries in the two study periods are reported in Table 1. During quarantine, the proportion of children and adolescents with eye injuries decreased (from 14.7% to 8.0%, Fig. 1a), while the proportion of males increased (from 66.7% to 75.0%, Fig. 1b). Regarding the mechanisms of injury, the percentage of falls and sport injuries had the highest decrease (respectively, from 6.5% to 0.9% and from 5.9% to 2.7%), while injuries during home activities and injuries with plants had the highest increase (respectively, from 12.4% to 17.0% and from 8.5% to 10.7%, Fig. 1c). The percentage of minor injuries with low risk of vision loss increased (from 93.2% to 94.6%), while major injuries requiring monitoring decreased (from 6.8% to 5.4%, Fig. 1d).
There was a striking 68.4% decrease in the number of eye injuries seen in our Unit during the last month. Behavioural changes during the quarantine could be associated with lower risk of trauma. The decreases of sport injuries and of injuries in children during school closure seem to support this hypothesis. However, the drop of patients seeking emergency care affected all injuries, including serious ones potentially associated with vision loss. We believe that some patients may intentionally avoid urgent care rather than risking coronavirus exposure at hospitals. Anecdotal reports suggest that this is also happening for life-threatening medical emergencies such as myocardial infarction and stroke [5, 6]. Since ocular trauma is a major cause of vision loss, the importance of not delaying or avoiding treatment should be stressed to all patients to prevent ocular morbidities
Multitarget microangiopathy in a young healthy man with COVID-19 disease: A case report.
Get PDFA 41‐year‐old man presented to the emergency department complaining of decrease of vision in his left eye. Initial examination was consistent with retrobulbar optic neuritis, and an intravenous drip of methylprednisolone was started. On the third day, the fundus examination revealed the appearance of multiple Purtscher‐like cotton‐wool spots in the posterior pole and nasally to the optic disc, slight retinal whitening around the fovea, and cherry‐red spot. The patient reported flu‐like symptoms, and he tested positive at PCR (polymerase chain reaction) test for 2019‐nCoV (2019 novel coronavirus) infection. Assuming possible 2019‐nCoV‐related vascular damage, we prescribed low‐molecular‐weight heparin. The lesions were regressing at follow‐up, and we registered a complete visual recovery
Non-Descemet Stripping Automated Endothelial Keratoplasty (nDSAEK) for Late Endothelial Failure After Mushroom Keratoplasty: A Retrospective Analysis of Visual and Anatomical Outcomes
Get PDFBackground: Mushroom penetrating keratoplasty (MPK) is an alternative to traditional penetrating keratoplasty (PK) that offers improved graft survival and reduced immunological rejection. However, MPK grafts may still experience endothelial failure over time. This study evaluates the outcomes of non-Descemet Stripping Automated Endothelial Keratoplasty (nDSAEK) as a surgical approach for endothelial decompensation following MPK. Methods: A monocentric, retrospective study was conducted at the Ophthalmology Department of Sant'Orsola-Malpighi Hospital, including patients who underwent nDSAEK for endothelial failure after MPK between 2022 and 2024. Pre- and postoperative best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were assessed. Results: Eighteen eyes from 18 patients (mean age: 39.94 years) were included. Primary MPK indications were post-keratitis leucoma (77.7%), traumatic scarring (16.7%), and keratoconus (5.6%). At one year, mean BCVA improved significantly from 1.40 +/- 0.42 logMAR to 0.46 +/- 0.19 logMAR (p < 0.05), and mean CCT decreased from 721 +/- 70.12 m to 616 +/- 52.80 mu m (p < 0.05). The mean postoperative ECD was 1748 +/- 100 cells/mm(2), with lower eye values requiring re-bubbling. No immunological rejection or graft failures were reported. Conclusions: nDSAEK is a promising treatment for MPK endothelial failure, demonstrating good visual and anatomical outcomes
Intraoperative OCT for Lamellar Corneal Surgery: A User Guide
Get PDFIntraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of corneal transplantation. Indeed, iOCT images provide a direct and meticulous visualization of the anatomy, which could guide surgical decisions. In particular, during both big-bubble and manual DALK, the visualization of the relationship between the corneal layers and instruments allows the surgeon to obtain a more desirable depth of the trephination, thus achieving more type 1 bubbles, better regularity of the plane, and a reduced risk of DM perforation. During EK procedures, iOCT supplies information about proper descemetorhexis, graft orientation, and interface quality in order to optimize the postoperative adhesion and reduce the need for re-bubbling. Finally, mushroom PK, a challenging technique for many surgeons, can be aided through the use of iOCT since it guides the correct apposition of the lamellae and their centration. The technology of iOCT is still evolving: a larger field of view could allow for the visualization of all surgical fields, and automated tracking and iOCT autofocusing guarantee the continued centration of the image
Efficacy of the combined intrastromal injection of voriconazole and amphotericin B in recalcitrant fungal keratitis
Get PDFThis study aims to report the efficacy of a combined intrastromal injection in optimizing the outcome of severe mycotic keratitis. Herein, we report a case series of 20 consecutive patients with positive fungal cultures not responding to topical antifungal treatment. Patients received cycles of intrastromal injections of voriconazole (50 μg/0.1 mL) and amphotericin B (2.5 μg/0.1 mL); all patients continued their topical antifungal therapy. The organisms isolated were Fusarium (n = 5), Aspergillus (n = 4), Candida (n = 4), Rhodotorula (n = 2), Penicillium (n = 2), Alternaria (n = 1), Bipolaris (n = 1), and Curvularia (n = 1). The size of the infiltrate varied from 6.5 to 1.5 mm. At presentation, the best corrected visual acuity (BCVA, namely, the best visual acuity achieved with glasses, if needed) was less than 20/400 in all patients, improving to better than 20/400 in eleven patients. Seven patients required surgical intervention; four of them underwent penetrating keratoplasty (PK) à chaud one month after the first intrastromal injection. Patients who underwent surgery achieved a BCVA of 20/40 or better. Combined intrastromal injections before therapeutic penetrating keratoplasty (TPK) effectively reduced ulcer size and graft diameter, preventing infection recurrence. Our results highlight the efficacy of combined intrastromal injections in optimizing outcomes for severe mycotic keratitis undergoing TPK
Big-bubble DALK: A technique in evolution
No full textDeep anterior lamellar keratoplasty (DALK) is considered a valuablealternative to penetrating keratoplasty (PK) for treatingcorneal disordersthat do not involve theendothelium. DALK preserves the host endothelium, eliminating the risk of endothelial rejection and reducing the risk of late graft failure due to endothelial decay. Despite its not recent introduction, DALK has been considered a difficult, lengthy, and poorly reproducible procedure, limiting its adoption worldwide. With the introduction of the big-bubble technique (BBT) the reproducibility and the time required to complete the procedure were significantly improved, encouraging many surgeons to approach DALK. With BBT air is injected into the stroma to induce separation between the layers of the cornea, facilitating the separation of the diseased or scarred stroma from the healthy endothelium; this allows the creation of a graft-host interface of pristine optical quality, granting clinical results equal to those obtained with PK.Understanding the anatomy and physics behind the big bubble (BB) formation is crucial for thesurgical success of this technique. The discovery of the pre-Descemet's layer (Dua's layer)played a significant role in understanding the principles behindBBformation, considerablyimpacting the safety and reproducibility of the technique. BB formation is influenced by preoperative pathology, trephination size, and instruments used for air injection.Continue advancements have helped to refine BBT's efficacy and reproducibility, broadening its applicability in corneal transplantation whenever the endothelium is healthy.This review provides a detailed account of the procedural steps involved in DALK using the BBT, addressing the most common challenges, highlightingtechnical innovations, and handlingthe most frequent complications
A Pilot Case Series on the Use of a Large Mushroom-Shaped Corneal Graft for the Surgical Management of Post-Penetrating Keratoplasty Ectasia and Endothelial Failure
No full textObjective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet’s membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 ± 4.5 D to 43.5 ± 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 ± 0.4 to 0.3 ± 0.2 LogMAR; the central corneal thickness was reduced from 629 ± 39 μm to 532 ± 45 μm; and the endothelial cell density was 1926 ± 199 cells/mm2. None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation
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