1,720,989 research outputs found
In vivo confocal microscopy of verticillata-like paraproteinemic keratopathy in a patient with monoclonal gammopathy of uncertain significance evolving into smoldering multiple myeloma
Full text linkPurpose: To highlight the utility of in vivo confocal microscopy (IVCM) in the microstructural characterization of corneal deposits resembling vortex keratopathy in a case of secondary deposition keratopathy due to an evolving monoclonal gammopathy. Observations: A 56-year-old Caucasian woman previously diagnosed with monoclonal gammopathy of undetermined significance (MGUS), exhibited bilateral diffuse sub-epithelial and anterior stromal opacities distributed in a whorl-shaped pattern. IVCM examination permitted analysis of the microstructural features and distribution of the opacities in different corneal layers. Deposits resembling those reported in multiple myeloma rather than MGUS were detected, and the patient's hematologist was subsequently advised to re-evaluate the earlier diagnosis. Two months later, a bone marrow biopsy led to a diagnosis of plasma cell myeloma. Conclusions and importance: It is suggested that cornea verticillata-like paraproteinemic keratopathy (PPK) in MGUS might be predictive of disease evolution to plasma cell myeloma. Characteristic deposits and morphological features revealed by IVCM may be helpful for non-invasive assessment or screening in patients with hematological disorders
Cenegermin in pediatric neurotrophic keratopathy
No full textPURPOSE: We report a case of neurotrophic keratopathy (NK) arising after surgery for rhabdomyosarcoma of the jaw successfully treated with Cenegermin eye drops (Oxervate; Dompé Farmaceutici, Milan, Italy) in a 3-year-old boy. METHODS: At the age of 1 year, the boy underwent surgery for rhabdomyosarcoma of the jaw, followed by radiotherapy. Subsequent NK was initially treated with preservative-free artificial tears, topical combination of dexamethasone 0.1% and netilmicin 0.3% (Netildex; Sifi, Catania, Italy), and moxifloxacin 0.5% (Vigamox; Alcon, Fort Worth, TX), followed by 10 cycles of a topical eye biopolymer containing a poly-carboxymethyl glucose sulfate solution (Cacicol; Theà, Clermont-Ferrand, France) and 4 amniotic membrane transplantations. Keratopathy was recalcitrant to therapy and tissue transplant. Therapy was switched to Cenegermin eye drops 6 times daily for 8 weeks. RESULTS: Complete healing of the corneal epithelium was achieved at 3 weeks into treatment. CONCLUSIONS: Cenegermin was effective in restoring corneal integrity in this pediatric patient with NK
Glaucoma surgery during the first year of the COVID-19 pandemic
Full text linkPurpose: To summarize the actions taken to give continuity to the surgical treatment of glaucoma patients and to present the volume and characteristics of glaucoma surgery in the first year of pandemic at the Tertiary Glaucoma Center of the University Hospital of Verona (Veneto, Italy). Methods: Demographical and surgical features of patients who underwent glaucoma surgery from March 9th, 2020 to March 8th, 2021 have been collected and compared to the same date range of the previous year. The analyzed data included age, gender, region of origin, glaucoma staging, type of anesthesia and surgical procedure. Results: The surgical volume of glaucoma has dropped by 30.1%. In comparison with the previous year, we found a significant variation in the overall distribution of the performed surgical procedures (p < 0.001). There was a decline in Baerveldt tube implants (- 4.9%), and an increase of non-penetrating surgery (+ 2.6%), cyclo-photo ablative procedures (+ 4.2%) and MIGS (+ 5.7%). Only 24.3% of the procedures were performed under general anesthesia compared to 41.5% in the pre-pandemic period (p < 0.001). The number of procedures performed on eyes affected by advanced or end-stage glaucoma is doubled (p < 0.001). Conclusions: To give continuity to glaucoma surgery, we prioritized interventions on patients with poorer visual fields, rapidly progressing visual field deficit and elevated IOP uncontrolled by maximal medical therapy. Secondly, we have rescheduled the other interventions following the same priority criteria. Finally, we managed some lower priority cases with MIGS, minimizing the need for close post-intervention follow-up. Considering the negative consequences that a delay in the management of glaucoma can have in terms of visual loss, the closure of the operating rooms in the first quarter of the pandemic was detrimental. It appears that glaucoma surgery deserves urgencies that cannot be overshadowed and the greatest effort must be to give continuity to this type of eye surgery
Femtosecond laser-assisted implantation of corneal stroma lenticule for keratoconus
Full text linkPURPOSE: To review recent progress, challenges, and future perspectives of stromal keratophakia for the treatment of advanced keratoconus. METHODS: We systematically reviewed the literature in the PubMed database, last update June 30, 2020. No language restriction was applied. The authors checked the reference lists of the retrieved articles to identify any additional study of interest.RESULTS: Several techniques have been proposed for the treatment of keratoconus in order to avoid or delay keratoplasty. This was primarily due to the lack of accessibility to donor corneas in many countries. The ease and predictability of the more advanced femtosecond lasers used to correct ametropias by stromal lenticule extraction lead to hypothesize that generated refractive lenticules could be implanted into corneal stromal layers to restore volume and alter the refractive properties of the cornea in patients with corneal ectasias. At the same time, new techniques for preservation, customization, and cellular therapy of the corneal stromal have been developed, directing to the valorization of otherwise discarded byproducts such as donor corneas unsuitable for either lamellar of penetrating keratoplasty.CONCLUSIONS: Femtosecond laser-assisted stromal keratophakia could be a suitable therapeutic option for the treatment of corneal ectasias, especially in patients with advanced keratoconus, providing biomechanical support recovering the pachimetry to nearly normal value at the same time. The accuracy and predictability of the refractive outcome are yet a critical issue and the patient eligible for the procedure still has to be characterized
Clinical performance of the pseudo-non diffracting beam Toric EDOF intraocular lens: visual function, rotational stability, and quality of life
No full textPurpose: To evaluate visual acuity, refractive outcomes, rotational stability, and patient-reported satisfaction 3 months after bilateral implantation of the Lucidis Toric extended-depth-of-focus (EDOF) intraocular lens in cataract patients with 1.00-3.00 D of regular corneal astigmatism. Methods: Prospective, single-arm study of 25 patients (50 eyes) undergoing phacoemulsification with bilateral Lucidis Toric IOL implantation. The primary endpoint was binocular uncorrected distance visual acuity (UDVA) at 3 months. Secondary endpoints included monocular/binocular UDVA, distance-corrected VA (DCVA) at 4 m; intermediate (80 cm, 66 cm) and near (40 cm) uncorrected and distance-corrected acuities; defocus curve; residual spherical equivalent (SE) and cylinder; IOL rotation; optical quality (MTF cutoff, Strehl ratio, HOA RMS); contrast sensitivity; halometry; and NEI-RQL-42. Paired t-tests or Mann-Whitney tests compared pre-/postoperative values. Results: At 3 months, the mean postoperative spherical equivalent was 0.17 ± 0.52 D (median 0.00 D; range -0.75 to +0.75 D) and the mean refractive cylinder was 0.04 ± 0.32 D (median 0.00 D; range -0.50 to +0.50 D). Median IOL rotation was 2.1 ± 2.3 degrees, with no eyes requiring repositioning. Mean binocular UDVA, UI80VA, UI66VA and UNVA were -0.01 ± 0.1, 0.08 ± 0.24, 0.04 ± 0.1, and 0.01 ± 0.14 logMAR, respectively. There were no statistically significant differences between uncorrected and distance-corrected visual acuities at any distance. The binocular defocus curve showed visual acuity better than 0.1 logMAR from +0.50 D to -3.00 D. NEI-RQL-42 scores indicated high patient satisfaction, particularly in clarity of vision, far, near vision, activity limitations, and glare domains. Conclusion: Bilateral Lucidis Toric EDOF IOL implantation delivers stable rotational performance, broad-range uncorrected vision, and high spectacle independence in astigmatic cataract patients. Future randomised, head-to-head trials with longer follow-up are warranted
Autologous simple conjunctival epithelial transplantation for primary pterygium
No full textPurpose: To evaluate the feasibility of a new method of conjunctival transplantation to achieve recovery of the normal conjunctival epithelium over the bare sclera after pterygium excision and prevent its recurrence. Methods: After excision of the primary pterygium, we performed simple conjunctival epithelial transplantation (SCET) in which we glued an amniotic membrane patch pre-loaded with tiny autologous conjunctival tissue fragments over the scleral defect. Slit-lamp evaluation was performed at 2 and 7-10 days, and then at 1, 3, 6, and 12 months after surgery, together with confocal microscopy at 3, 6, and 12 months. Results: Surgical excision and SCET for nasal primary pterygium were performed in 6 eyes (6 patients). No graft detachment occurred. An inflammatory granuloma was excised without sequelae in one patient 2 months after surgery. No signs of recurrence or sight-threatening complications were recorded at 12 months, and in vivo confocal microscopy showed progressive expansion of the conjunctival cell population and formation of a clear corneal-conjunctival transition. Conclusions: SCET takes advantage of the ability of the amniotic membrane and conjunctival cells to renew. Outcomes after SCET are comparable to conventional conjunctival flap surgery and can be achieved in less surgical time and with less donor tissue to be removed
Refractive outcomes of penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes for keratoconus
No full textTo compare the refractive outcomes following penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes in patients with keratoconus
Small-incision lenticule addition in ex vivo model of ectatic human corneas
No full textPURPOSE: To investigate the feasibility of intrastromal lenticule insertion to restore corneal shape in a model of ectatic human cornea. METHODS: For this experimental ex vivo study on 34 human corneas unsuitable for transplantation, 17 corneas were thinned by decentralized posterior excimer laser ablation to 200 μm thickness and 6.5 mm diameter and then inflated up to 100 mm Hg to expose the ectasias (recipient corneas). Pachimetry and topography were obtained. Stromal lenticules of the same diameter and thickness as the ectasias were shaped with a femtosecond laser from the remaining 17 donor corneas. An intrastromal pocket was created with femtosecond laser within the ectatic recipient corneas and the donor lenticule was inserted inside it. Changes in corneal architecture and profile were evaluated by means of corneal topography and anterior segment optical coherence tomography. RESULTS: All stromal lenticules were successfully implanted. Tomography confirmed regularity of the lenticule profile within the stromal pocket. Corneal thickness was significantly increased after the procedure (P < 0.0001). Maximal posterior elevation from the best-fitted toric ellipsoid was significantly reduced (P < 0.0001). Significant flattening of posterior K1 and K2 was also obtained (P = 0.041 and P = 0.004, respectively). Anterior and posterior astigmatism, anterior and posterior asphericity, and spherical aberration did not differ significantly after the procedure. CONCLUSIONS: Femtosecond laser-assisted stromal lenticule addition is feasible for restoring corneal thickness to an ectatic area and for regularizing posterior corneal elevation. The technique opens new perspectives for the treatment of corneal ectasias
Simple Epithelial Transplantation for Ocular Surface Reconstruction After Severe Ocular Burn Injury
No full textPurpose: To manage ocular surface complications and recover conjunctival and corneal epithelia after unilateral severe chemical burn. Methods: We performed simple conjunctival epithelial transplantation (SCET) to obtain renewal of fornix and bulbar-tarsal conjunctiva epithelium, followed by simple limbal epithelial transplantation (SLET) to recover limbal function and epithelial corneal surface. Slit-lamp examination, fluorescein staining, in vivo confocal microscopy, Kheirkhah grading system for symblepharon severity, Wong-Baker FACES Pain Rating Scale, and best-corrected visual acuity were assessed before surgery, at 1 to 3 months after SCET and SLET, and thereafter at 6 to 12 to 36 months. Results: Two patients with unilateral burn injuries underwent surgery. Eye mobility and fornix reconstruction were promptly achieved, and conjunctival epithelium with goblet cells was observed on the bulbar and tarsal conjunctiva 3 months after SCET. After SLET, corneal epithelium and cornea-conjunctiva transition zone were observed at 3 and 6 months, respectively. From before surgery to 6 months after SLET, symblepharon improved from grade IVa2 and IIIb2 to Ic0 and Ib0, the Wong-Baker FACES Pain Rating Scale changed from grade 6 and 4 to 0, and best-corrected visual acuity upgraded from 1.40 and 1.10 logarithm of the minimum angle of resolution to 0.5 logarithm of the minimum angle of resolution, in patient 1 and 2, respectively. After 3 years, results remained stable. Conclusions: SCET effectively healed the bare conjunctival area relieving subjective symptoms and discomfort. Sequential SCET and SLET showed to be feasible in restoring a normal ocular surface with long-lasting results suggesting the aim in patients with severe ocular burn is not merely corneal epithelium renewal but also the regeneration of ocular surface homeostasis
The development of checklists and reference charts for activities of daily living of normal developing children
No full textAim: To measure the performance in activities of daily living and obtain reference charts in normal developing children. Method: This is a cross-sectional survey study. We identified relevant items suitable to describe a wide range of daily life activities and set up a self-administered questionnaire. An initial set of items underwent a correlation analysis integrated with clinical judgment, to remove those items providing limited additional information. Factor analysis was used to identify latent variables, enabling the grouping of selected items into specific skill-related areas. For each latent variable, a model was developed to represent the progression of performance in activities of daily living as the child advanced in age. Results: We collected data related to 3079 children, 1478 females and 1601 males, of median (IQR) 10.7 (7.2) years of age. The initial 268-item set was reduced to 154-item related to 14 domains and gathered into 30 latent variables. Interpretation: The results describe the age-related performance in activities of daily living and produce reference values associated to an Italian population of normal children less than 18 years of age
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