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Background/Objectives: To report the cosmetic, clinical, and visual outcomes of a combined surgical approach for treating a corneal/limbal dermoid using excision and a three-layered amniotic membrane graft with fibrin glue. Methods: An 18-year-old female presented with impaired vision and ocular discomfort caused by a prominent dome-shaped limbal congenital dermoid on the inferotemporal cornea, resulting in a significant aesthetic concern. A full assessment, including refraction, best-corrected visual acuity (BCVA), corneal topography, aberrometry and anterior segment OCT (AS-OCT) was conducted to plan the surgical approach. The dermoid was excised under peribulbar anaesthesia using manual lamellar dissection, followed by the application of 0.02% Mitomycin C and a multilayered amniotic membrane graft with fibrin glue. A bandage contact lens was applied and removed after three weeks, with postoperative treatment including topical antibiotics and steroids. Follow-ups were conducted on day 1, at 1 week, 3 weeks, 2 months, 6 months, 1 year, and 2 years. Results: Histopathological examination confirmed the mesoblastic nature of the lesion. Significant improvements in BCVA and ocular symptoms were observed. Corneal topography showed ocular surface regularization with reduction of high order aberrations and point spread function. AS-OCT showed complete integration of the amniotic membrane, with full epithelial coverage of the defect. The healing process was uneventful and the ocular surface remained stable throughout the entire follow-up, without complications or recurrence. Conclusions: This approach of dermoid excision, multilayered amniotic membrane and fibrin glue restored vision effectively, with notable improvements in ocular surface and cosmetic outcomes, without recurrence over two years. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the repeatability of the Pentacam HR, comparing two different measurement modes (50-cornea fine and 25-3D scan) in patients affected by keratoconus. Methods: Multicenter retrospective study, conducted at Eye Clinic of the ASST-Spedali Civili-University of Brescia, Italy, and St. Paul's Eye Unit, Royal Liverpool University Hospital, United Kingdom. A total of 72 eyes from 72 patients with keratoconus underwent six consecutive measurements, three using the 25-3D scan mode and three with the 50-Cornea fine mode. Measurements were made by one single observer, using the Scheimpflug corneal tomographer camera (Pentacam HR, Oculus, Wetzlar, Germany). Repeatability was assessed using the within-subject SD (Sw) statistic from a two-way analysis of variance. Results: Both measurement modes had excellent repeatability. The interclass coefficient correlation (ICC) was excellent (>0.9) in all the parameters evaluated, apart from anterior and posterior astigmatic axes and posterior astigmatism (ICC > 0.8) and index of height asymmetry (IHA) (ICC < 0.6). However, in 18 of 29 parameters, the ICC was higher in case of 25-3D scan. Repeatability limit for Kmax was 1.00D in 25-3D scan mode and 1.02D in case of 50-cornea fine. Conclusions: 25-3D scan may be preferable to 50-Cornea fine, in view of having slightly higher ICC in case of patients with keratoconus. Repeatability limits reported may be helpful in clinical practice for assessing the progression of keratoconus. [ABSTRACT FROM AUTHOR]

Objective: 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. [ABSTRACT FROM AUTHOR]

Background: To analyse the effect of suprachoroidal injection (SChI) of triamcinolone acetonide (TA) on macular thickness (CRT), ectopic inner foveal layer thickness (EIFL-T) and best corrected visual acuity (BCVA) in pseudophakic patients undergoing vitrectomy for epiretinal membrane (iERM) compared to intravitreal injection of TA (IVTA). Methods: Prospective matched comparison of patients undergoing vitrectomy for Govetto stage 3 and 4 iERM. 25 eyes receiving IVTA (G-1) were compared to 23 eyes receiving SChI-TA (G-2) during vitrectomy. Primary outcome was change in BCVA, CRT, EIFL-T before surgery and 1, 3 and 6 months after surgery. Secondary outcome was the incidence of cystoid macular edema (CME). Results: Six months after surgery, G2 had a greater mean reduction in CRT (−222 µm vs −131 µm) and EIFL-T (−200 µm vs −104 µm) than G1. BCVA improved more in G2 than in G1 (p = 0.02). Foveal depression reformed in 43% of cases in G-2 and 16% of cases in G-1. Incidence of postoperative CME was 16% in G-1 and 4.3% in G-2. Conclusions: During vitrectomy for iERM, SChI-TA was more effective than IVTA in reducing CRT and EIFL-T and improving BCVA. SChI-TA was effective in preventing postoperative CME. SChI-TA treatment was safe and reproducible and did not affect postoperative IOP. Trial registration NP6289—June 18th, 2024 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Purpose: To report the association between keratoconus (KC) and pachychoroid pigment epitheliopathy (PPE). As secondary outcome, we explored the relation between subfoveal choroidal thickness (SFCT) and topometric indexes. Methods: Retrospective, observational, cross-sectional, case–control study. Multicentric study including patients with KC and healthy controls. Each subject underwent a complete ophthalmological visit, Placido-based corneal topography, Scheimpflug corneal tomography and spectral-domain OCT (SD-OCT) with the enhanced depth imaging (EDI) mode on. Linear mixed models (LMM) were employed for comparison between groups, and to examine the impact of different topometric factors on SFCT. KC stages were defined according to Belin grading. Results: Overall, 56 eyes from 35 KC patients and 52 eyes from 27 healthy, age- and axial length-matched control subjects were included in the study. PPE was found in 10 (17.9%) eyes from 8 KC patients, whereas was absent in all healthy controls. SFCT was statistically significantly higher in keratoconic eyes (median: 390 µm; interquartile range (IQR): 339 – 425 µm) compared to healthy eyes (median: 240 µm; IQR: 200 – 288 µm) (p < 0.001). SFCT did not differ across different KC stages and between keratoconic eyes with and without PPE. Conclusions: PPE is a relatively frequent finding in eyes with KC, being present in about 1 out of 6 cases, regardless of disease stage. Key messages: What is known: Keratoconus (KC) is a corneal disorder commonly associated with other chorioretinal abnormalities. It is well known that keratoconic eyes display increased choroidal thickness, and the rare association between KC and central serous chorioretinopathy (CSC) has already been reported in the literature. What is new: We identified an association between KC and pachychoroid pigment epitheliopathy (PPE), a precursor or forme fruste of pachychoroid diseases, such as CSC. PPE presence is independent from corneal parameters and is observed in about 1 out 6 KC eyes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the potential improvement in visual acuity and subjective perception of image quality in patients with keratoconus using non‐orthogonal correction (NOC) cylinder trial lenses where the steep and flat power meridians are set at angles less or greater than 90°. Methods: A set of NOC plano/cylindrical trial lenses, where the axes between the power meridians were set at a range of non‐orthogonal angles, were used to refract 18 participants with keratoconus in whom 23 eyes were used for testing. Corneal elevation data were processed by bespoke MATLAB code from Pentacam Scheimpflug tomographer scans. Each participant first underwent subjective refraction using standard orthogonal cylinder trial lenses, and the monocular best‐corrected visual acuity (BCVA, logMAR) was recorded for each eye. They then underwent a second subjective refraction using NOC cylinder trial lenses created for the study and completed a questionnaire to elicit their subjective appraisal of letter clarity and ghosting. Results: Fourteen (61%) eyes demonstrated an increase in objective BCVA with the NOC versus the orthogonal correction; seven (30%) eyes showed no change and in two (9%) eyes, the BCVA was slightly worse. Further, 87% and 79% experienced an increase in letter clarity and a reduction in ghosting, respectively, independent of changes in BCVA. The majority of non‐orthogonal angles were in the range of 80°–85°, and it was possible to refine the cylinder and axis of the NOC further compared with the orthogonal correction. All but one of the participants said they would be interested in trying non‐orthogonal spectacles if the opportunity arose. Conclusions: Correcting irregular astigmatism in keratoconic individuals with non‐orthogonal spectacle correction may provide benefit in terms of increased visual acuity, improvements in letter clarity and a reduction of ghosting effects. This type of correction has the potential to improve the overall quality of life for patients with keratoconus. [ABSTRACT FROM AUTHOR]

Purpose: To compare the aberrometric profile of the Artisan Aphakia lens (Opthec BV) and transscleral plug FIL-SSF lens (Soleko) and to assess the impact of tilt and decentration on their optical performance. Methods: This retrospective observational study was conducted at Azienda Ospedaliera Universitaria Careggi, Florence, Italy, with a consecutive cohort of aphakic eyes undergoing secondary lens implantation with an Artisan or FIL-SSF lens. Wavefront analysis was performed using a pyramidal wavefront-based aberrometer (Osiris-T; CSO). Tilt and decentration were calculated using anterior segment optical coherence tomography (MS-39; CSO). Results: The study included 47 eyes from 45 patients: 24 eyes in the FIL-SSF group and 23 eyes in the Artisan group. Decentration was 0.39 ± 0.14 mm in the FIL-SSF group and 0.51 ± 0.16 mm in the Artisan group (P =.02). The mean tilt value was 6.6 ± 2.35 degrees in the FIL-SSF group and 5.9 ± 1.86 degrees in the Artisan group (P =.13). Internal higher order aberrations (HOAs) were 0.23 ± 0.07 μm in the FIL-SSF group and 0.29 ± 0.13 μm in the Artisan group (P =.02). The point spread function (PSF) Strehl ratio was 0.12 ± 0.05 in the FIL-SSF group and 0.10 ± 0.04 (P =.11) in the Artisan group. The PSF Strehl ratio without lower order aberration (PSFw2) was 0.28 ± 0.12 in the FIL-SSF group and 0.23 ± 0.09 in the Artisan group (P =.01). Conclusions: The Artisan and FIL-SSF lenses provide comparable optical performance in terms of the PSF Strehl ratio. However, the Artisan lens appears to be more susceptible to decentration, which may result in increased higher order aberrations and a consequently lower PSFw2 Strehl ratio. [J Refract Surg. 2024;40(12):e926–e933.] [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to describe the outcomes of a staged procedure combining Descemet membrane endothelial keratoplasty (DMEK) and sutureless scleral fixation (SSF) of a one-piece intraocular lens (IOL) in a case series. Co-performing endothelial keratoplasty (EK) and SSF is associated with intraoperative and postoperative complications such as graft deployment difficulties, air migration, graft detachment, and IOL opacification or tilt, all of which are evaluated in this study. Methods: This is a retrospective observational case series. Clinical data were collected from eight eyes of eight patients who underwent DMEK for endothelial failure and had previously received an SSF with one-piece IOL following complete vitrectomy. During DMEK surgery, an air leak test was conducted to check for air migration into the posterior chamber. If instability was detected, pupilloplasty was performed. Intraoperative and postoperative data, including DMEK graft unfolding time, were collected. Corrected Distance Visual Acuity (CDVA), refraction, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure (IOP), and complications were recorded over a 12-month follow-up period. Results: We performed pupilloplasty in four patients (50%). The median CDVA improved from preoperative 0.85 logMAR (range: 0.60 to 1.00) at baseline to 0.18 logMAR (range: 0.10 to 0.70, p = 0.012) at 12 months. The median refraction value changed significantly from −1.00 to −0.50 at 12 months. The median percentage reduction in ECD after 12 months was 33.4% (range 30 to 40). The median baseline CCT was 689 μm (range: 651 to 701) at baseline visit and 541.5 μm (range: 525 to 591, p = 0.008) at 12 months. The median IOP was reduced significantly during follow-up. The median graft unfolding time was 6 min (5 to 9). One patient required rebubbling for partial detachment on postoperative day one. No complications occurred within 12 months. Conclusions: The effective compartmentalization of the anterior and posterior chambers in vitrectomized eyes with an SSF one-piece IOL and pupilloplasty can facilitate critical steps of DMEK surgery in complex eyes. Additionally, the air leak test could prove useful in identifying the need for iris-lens diaphragm reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Despite an improved understanding of its pathogenesis, dry eye disease (DED) remains relatively underestimated and its treatment challenging. A better alignment between the clinical evaluation and the patient self-assessment also requires capturing the whole patient experience of DED. This project aimed to unveil this experience through narrative medicine (NM). Methods: The project involved 38 expert centres in Italy and one in San Marino, targeting adult patients with DED, their informal caregivers and their treating ophthalmologists. Written narratives and sociodemographic and quality of life (QoL)-related data were anonymously collected through the project's webpage. Narratives were analysed through MAXQDA (VERBI Software, Berlin, Germany), NM classifications and content analysis. Results: A total of 171 patients with DED, 37 informal caregivers and 81 ophthalmologists participated in the research. DED was defined as a disabling condition by 19% of patients and 35% of caregivers; 70% of patients reported that a therapeutic alliance is an integral part of DED treatment and 32% hope for more effective therapies. Forty-four per cent of patients assessed their own QoL as good; however, DED emerged as importantly impacting work performance and social events. DED physical, emotional and economic burden and the cruciality of a trusting care relationship represent the main themes that emerged across all narratives, while empathy and effective treatment are among the factors favouring coping with DED. Conclusion: This project marked a pioneering initiative investigating the lived experience of patients with DED through NM, simultaneously involving all viewpoints involved in the care pathway. NM enabled the unveiling of factors favouring the ability to cope with DED and its associated QoL implications and provided valuable insights to improve the therapeutic alliance. [ABSTRACT FROM AUTHOR]

Background/Objectives: The objective of this study was to examine the morphological corneal changes and outcomes following the implantation of an artificial endothelial layer (EndoArt) in patients with chronic corneal oedema. Methods: A systematic review of the literature was conducted alongside a detailed analysis of two clinical cases with chronic corneal oedema that were treated using EndoArt. Our experience with these two cases is included to provide practical insights and real-world outcomes. Results: Across the 24 cases reported (including the two presented here), an analysis was possible in 23 cases. Notably, 82% of patients had undergone at least one previous corneal transplant, with 39% having undergone three or more transplants. Additionally, 78% of cases had ocular comorbidities, with glaucoma surgery being the most prevalent (83%), which could have impacted visual outcomes. The follow-up period ranged from 3 to 17 months with a median of 3 months. After EndoArt implantation, the average reduction in the central corneal thickness (CCT) was 29%, and the rebubbling rate was 47.8%, with some cases requiring no rebubbling, while others required it up to 100% of the time. Visual acuity significantly improved from a mean best-corrected visual acuity (BCVA) value of 1.61 ± 0.5 logMAR to 1.07 ± 0.59 logMAR (p < 0.001). The CCT decreased from 771 ± 146 µm to 580 ± 134 µm (p < 0.001). These findings are consistent with our experience. Conclusions: EndoArt shows promise as an alternative treatment for chronic corneal oedema in complex cases where conventional corneal transplantation has failed or carries a high risk of failure. The morphological changes observed using anterior segment optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM) were similar to those reported after endothelial keratoplasty, with the notable exception of the absence of the hyper-reflective donor–host interface. [ABSTRACT FROM AUTHOR]

Background: To assess anatomical and functional outcomes of retrolental cohesive ophthalmic viscoelastic injection ("Viscolift technique") in patients with severely subluxated cataracts. Methods: In the present prospective study, we included patients older than 18 years with severely subluxated cataracts and phacodonesis. Full medical history was obtained at the baseline ophthalmological assessment. A single 25-gauge valved trocar was inserted 4 mm from the limbus and a 27G angled cannula was introduced through the trocar into the retrolental space, while cohesive viscoelastic was progressively injected, in order to center and elevate the cataract to facilitate capsulorhexis. After complete phacoemulsification, a 3-piece intraocular lens (IOL) with a scleral fixated Cionni ring or FIL-SSF scleral fixated IOL was implanted. Patients follow-up interval was 6 months after surgery. Results: Thirteen eyes of 13 patients were enrolled in the study, mean age was 61.5 ± 9.4 years and 53.8% were females. The "Viscolift technique" resulted in centered and more stable cataracts in all cases (100%). After complete phacoemulsification, 61.5% of patients were implanted with a 3-piece IOL with Cionni ring, and 38.5% with a FIL-SSF scleral fixated IOL after complete 25G vitrectomy. Mean BCVA improved from 0.5 ± 0.1 LogMar (20/63 Snellen) to 0.1 ± 0.1 LogMar (20/25 Snellen) (p < 0.001) at the last follow-up. No major complications were noted. Conclusions: The "Viscolift technique" proved to be a safe and effective surgical approach for recentering and elevating subluxated cataracts, thus allowing the surgeon to perform an easier and better-centered capsulorhexis. [ABSTRACT FROM AUTHOR]

The scent of Anacamptis species has been analyzed by using HS-SPME-GC–MS. The sample was collected in Basilicata (Southern Italy). Every species showed a different composition of the scent in the analyses we performed. 1,2,4-Trimethoxybenzene and methyl 4-mehoxybenzoate were the main components of that of Anacamptis coriophora subsp. fragrans. The scent of Anacamptis laxiflora was due to the presence of caryophyllene. Linear hydrocarbons but also decanal were components of the scent of Anacamptis pyramidalis. Eucalyptol was found in the scent of Anacamptis papilonacea. Finally, β-sesquiphellandrene was the main component of the scent of Anacamptis morio. [ABSTRACT FROM AUTHOR]

SPME analysis of the scent of Epipactis microphylla showed the presence of limonene as the main component of the scent. Other components were 2,4,4,6,6,8,8-heptamethyl-1-nonene, pentadecane, and heptadecane. The scent of Epipactis palustris was characterized by pentadecane, 2,4,4,6,6,8,8-heptamethyl-1-nonene, and heptadecane. The scent of Neottia nidus avis showed the presence of kaur-16-ene as the main component of the scent. Other components were heinecosane, tetradecane, pentadecane, hexadecane, heptadecane, and 5,9,13-trimethyl-4,8,12-tetradecanal. The scent of Neottia ovata is due to pentadecane, hexadecane, and heptadecane. The scent of Limodorum abortivum showed the presence of 2,4,4,6,6,8,8-heptamethyl-1-nonene, pentadecane, hexadecane, heptadecane, and 2-(dodecyloxy)-ethanol. [ABSTRACT FROM AUTHOR]

Topical antimicrobials and antiseptics are used perioperatively to reduce the ocular surface bacteria flora (OSBF) that are involved in the development of post‐operative infectious complications. However, their effectiveness is still a controversial topic. This systematic review, performed according to the PRISMA guidelines and registered in PROSPERO, aims to provide an overview of the efficacy of the agents currently used in peri‐cataract surgery and ‐intravitreal injections (IVI) in lowering the OSBF. Although effective in lowering OSBF, perioperative topical antimicrobials are associated with the risk of resistance development, with no obvious additional benefit compared with topical antisepsis. Conversely, the effectiveness of topical antiseptics before cataract surgery and IVI is strongly supported. Based on the available evidence, perioperative antimicrobials are not recommended, whereas the perioperative use of antiseptics is strongly recommended as prophylactic treatment for lowering the infection due to OSBF. Post‐operative antimicrobials may be considered in eyes at higher risk for infection. [ABSTRACT FROM AUTHOR]

Background: Traumatic injuries in eyes previously treated with Deep Anterior Lamellar Keratoplasty (DALK) can lead to ruptures in the Descemet Membrane (DM) and damage to the corneal endothelium, a crucial layer for maintaining corneal clarity. Due to cell cycle constraints, the human corneal endothelium cannot proliferate; instead, it compensates for injury through cell enlargement and migration from adjacent areas. Methods: This study examines a notable case of corneal endothelial cell migration following a penetrating eye injury in a patient previously treated with DALK for keratoconus, supplemented by a review of relevant literature to contextualize the regenerative response. Results: A 39-year-old male with a history of DALK suffered a traumatic eye injury, resulting in damage to the Descemet Membrane and loss of the crystalline lens. After primary repair and considerations for further surgery, the patient's cornea cleared remarkably, with an improved visual acuity. This demonstrates the DM's potential for self-repair through endothelial cell migration. Conclusions: The outcomes suggest that delaying corneal transplant surgery for up to 3 months following Descemet Membrane injury due to ocular trauma could be advantageous. Allowing time for natural healing processes might eliminate the need for further invasive surgeries, thereby improving patient recovery outcomes. [ABSTRACT FROM AUTHOR]

To report ocular manifestations, clinical course, and therapeutic management of patients with molecular genetically confirmed keratitis-ichthyosis-deafness syndrome. Four patients, aged 19 to 46, with keratitis-ichthyosis-deafness syndrome from across the UK were recruited for a general and ocular examination and GJB2 (Cx26) mutational analysis. The ocular examination included best-corrected visual acuity, slit-lamp bio-microscopy, and ocular surface assessment. Mutational analysis of the coding region of GJB2 (Cx26) was performed by bidirectional Sanger sequencing. All four individuals had the characteristic systemic features of keratitis-ichthyosis-deafness syndrome. Each patient was found to have a missense mutation, resulting in the substitution of aspartic acid with asparagine at codon 50 (p.D50N). Main ophthalmic features were vascularizing keratopathy, ocular surface disease, hyperkeratotic lid lesions, recurrent epithelial defects, and corneal stromal scarring. One patient had multiple surgical procedures, including superficial keratectomies and lamellar keratoplasty, which failed to prevent severe visual loss. In contrast, oral therapy with ketoconazole stabilized the corneal and skin disease in two other patients with keratitis-ichthyosis-deafness syndrome. The patient who underwent intracorneal bevacizumab injection showed a marked reduction in corneal vascularization following a single application. Keratitis-ichthyosis-deafness syndrome is a rare ectodermal dysplasia caused by heterozygous mutations in GJB2 (Cx26) with a severe, progressive vascularizing keratopathy. Oral ketoconazole therapy may offer benefit in stabilizing the corneal and skin disease. [ABSTRACT FROM AUTHOR]

To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature review and meta‐analysis performed according to the PRISMA guidelines and registered in PROSPERO. Literature searches were conducted in Medline and Scopus. Comparative studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), rebubbling rate and primary graft failure rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed using the Cochrane Robin‐I tool. A total of 667 eyes (5 studies) were included in this review, 292 eyes (43.77%) underwent a combined DMEK, while 375 (56.22%) eyes underwent a sequential DMEK surgery. We found no evidence of a difference between the two groups (mean difference, 95% CI) regarding: (1) CDVA improvement (−0.06; −0.14, 0.03 LogMAR; 3 studies, I2: 0%; p = 0.86); (2) postoperative ECD (−62; −190, 67 cells/mm2; 4 studies, I2: 67%; p = 0.35); (3) rebubbling (risks ratio: 1.04; 0.59, 1.85; 4 studies, I2: 48%; p = 0.89); and primary graft failure rate (risks ratio: 0.91; 0.32, 2.57; 3 studies, I2: 0%; p = 0.86). Of all the 5 non‐randomized studies, all (100%) were graded as low quality. The overall quality of the analysed studies was low. Randomized controlled trials are needed to confirm no difference or superiority of one approach in terms of CDVA, endothelial cell count and postoperative complication rate between the two arms. [ABSTRACT FROM AUTHOR]

Background: Tele-ophthalmology is gaining recognition for its role in improving eye care accessibility via cloud-based solutions. The Google Cloud Platform (GCP) Healthcare API enables secure and efficient management of medical image data such as high-resolution ophthalmic images. Objectives: This study investigates cloud-based solutions' effectiveness in tele-ophthalmology, with a focus on GCP's role in data management, annotation, and integration for a novel imaging device. Methods: Leveraging the Integrating the Healthcare Enterprise (IHE) Eye Care profile, the cloud platform was utilized as a PACS and integrated with the Open Health Imaging Foundation (OHIF) Viewer for image display and annotation capabilities for ophthalmic images. Results: The setup of a GCP DICOM storage and the OHIF Viewer facilitated remote image data analytics. Prolonged loading times and relatively large individual image file sizes indicated system challenges. Conclusion: Cloud platforms have the potential to ease distributed data analytics, as needed for efficient tele-ophthalmology scenarios in research and clinical practice, by providing scalable and secure image management solutions. [ABSTRACT FROM AUTHOR]

Several methods have been used to determine the volatile organic compounds emitted by Ophrys orchids. The use of different methods results in incomparable data. Solid-phase microextraction (SPME) has not been used extensively on Ophrys orchids. The main components found in the SPME analysis of the scent in Ophrys orchids were as follows: O. apifera: benzyl benzoate and α-copaene; O. crabronifera subsp. biscutella: pentadecane, heptadecane, and nonadecane; O. bertolonii subsp. bertolonii: pentadecane and heptadecane; O. passionis subsp. garganica: i-propyl palmitate and heptadecane; O. holosericea subsp. apulica: α-copaene, pentadecane, and heptadecane; O. lacaitae: α-copaene, pentadecane, and heptadecane; O. bombyliflora: cyclosativene, pentadecane, and ethyl dodecanoate; O. insectifera: 8-heptadecene and pentadecane; O. lutea: heptadecane and docosane; O. tenthredinifera subsp. neglecta: α-copaene, caryophyllene, and i-propyl palmitate. [ABSTRACT FROM AUTHOR]

Fuchs endothelial corneal dystrophy (FECD) is the leading indication for EK and may coexist with cataract and presbyopia. Notably, the outcomes of phacoemulsification in FECD patients are not as favorable as those in eyes without this condition. Historically, only monofocal intraocular lenses (IOLs) were recommended for these patients. However, recent reports have described the implantation of Premium-IOLs (such as Multifocal IOLs, Enhanced Depth of Focus IOLs, and Toric IOLs) in FECD eyes undergoing cataract surgery and Descemet membrane endothelial keratoplasty (DMEK). While the results are encouraging, they are not as optimal as those from unoperated eyes, especially when comparing simultaneous procedures to sequential ones. It's advised to perform the DMEK first to improve the accuracy of IOL calculations. Still, even successfully operated eyes may experience secondary graft failure or graft rejection after DMEK. The success rate of a secondary DMEK is typically lower than that of the initial procedure. Furthermore, if the postoperative thickness after DMEK is less than anticipated, laser enhancements might not be an option. There's a pressing need for more controlled and randomized clinical trials to ascertain the safety and effectiveness of Premium-IOLs for FECD eyes. This narrative review aims to collate evidence on the use of Premium IOL technologies in eyes receiving EK and to underscore key points for surgeons performing EK combined with cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK). Methods: A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review. Results: Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome. Conclusion: It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes. [ABSTRACT FROM AUTHOR]

Astigmatism is a visually significant condition that can develop after keratoplasty. The management of post-keratoplasty astigmatism can be performed both when transplant sutures are in place and when they have been removed. Fundamental for astigmatism management is its identification and characterization in terms of type, amount, and direction. Commonly, post-keratoplasty astigmatism is evaluated through corneal tomography or topo-aberrometry; however, many other techniques can be used in case these instruments are not readily available. Here, we describe several low-tech and high-tech techniques used for post-keratoplasty astigmatism detection in order to quickly understand if it contributes to low vision quality and to determine its characteristics. The management of post-keratoplasty astigmatism through suture manipulation is also described. [ABSTRACT FROM AUTHOR]

Intraoperative 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. [ABSTRACT FROM AUTHOR]

Here we describe a new, non-human, ex-vivo model (goat eye model) for training surgeons in DMEK surgeons. In a wet lab setting, goat eyes were used to obtain a pseudo-DMEK graft of 8 mm from the goat lens capsule that was injected into another goat eye with the same maneuvers described for human DMEK. The DMEK pseudo-graft can be easily prepared, stained, loaded, injected, and unfolded into the goat eye model reproducing the similar maneuvers used for DMEK in a human eye, except for the descemetorhexis, which cannot be performed. The pseudo-DMEK graft behaves similar to human DMEK graft and useful for surgeons to experience and understand steps of DMEK early in learning curve. The concept of a non-human ex-vivo eye model is simple and reproducible and obviates the need for human tissue and the issues of poor visibility in stored corneal tissue. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate anterior segment optical coherence tomography (AS‐OCT) features of Descemet's membrane endothelial keratoplasty (DMEK) grafts associated with graft attachment worsening over time. Methods: Retrospective case series on patients who received uncomplicated DMEK surgery and for whom subsequent AS‐OCT data were available for analysis. Patients' demographics and surgical details were collected. AS‐OCT was analysed for graft detachment axial extension, presence of posterior stromal ripples, quadrant involvement (location and number), degree of detachment extension, peripheral roll, presence and amount of air in the anterior chamber (AC). Features associated with re‐bubbling and graft detachment worsening over time were identified. Results: A total of 147 patients with a mean age of 70.8 ± 9.8 years (63% females) were included. AS‐OCT was performed at 2.9 ± 2.4 days after surgery. AS‐OCT factors associated with re‐bubbling were posterior stromal ripples (p = 0.004) and detachment axial extension (p < 0.001). At first follow‐up, of the 147 DMEK, 67 showed complete attachment and 80 partial detachment. In those cases of initially completely attached grafts, posterior stromal ripples were associated with the risk of subsequent graft detachment (p = 0.014) together with recipient age (p = 0.043), phaco‐combined surgery (p = 0.018) and AS‐OCT timing (p = 0.033); while, in the initially partially detached grafts, detachment worsening was associated with posterior stromal ripples (p = 0.025), detachment axial extension (p = 0.003), degrees of detachment involvement (p = 0.029), peripheral roll‐in shape (p = 0.033) and presence of air in the AC (p = 0.032). Relative risk (RR) of graft detachment worsening in patients with moderate/severe posterior stromal ripples was 1.75 (95% CI = 1.09–2.81). Conclusion: Posterior stromal ripples and detachment axial extension >1/3 of graft surface area were the main risk factors for detachment worsening over time, and patients showing these features should be monitored closely to identify the need for re‐bubbling at an early stage, thus improving surgical outcomes. [ABSTRACT FROM AUTHOR]

Descemet membrane endothelial keratoplasty (DMEK) is a popular procedure for the treatment of corneal endothelial diseases mainly targeting Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). Although DMEK has multiple advantages, it is challenging in terms of graft preparation and delivery. One of the crucial factors of DMEK graft preparation is determining the size of the graft. Evaluating risks and benefits of transplanting larger or smaller grafts compared with the descemetorhexis performed following a standard DMEK procedure thus becomes important. Advanced techniques like pre‐loaded DMEK requires pre‐selection of graft diameter without physical examination of the eye making it more challenging. Therefore, recognizing the benefits of graft size and the number of transplanted endothelial cells becomes essential. Smaller DMEK grafts have been preferred and accepted for grafting. Larger diameter grafts have advantages but can be challenging due to higher detachment rates. We thus aim to review the challenges of preparing and delivering DMEK tissues with small or large diameter based on selected descemetorhexis area, discuss the outcomes based on different graft sizes, highlight related complications and suggest which cases may benefit from adopting smaller or larger graft size. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess different temperature ranges for the preservation of pre-loaded Descemet Membrane Endothelial Keratoplasty (DMEK) grafts in the DMEK RAPID Mini device. Methods: Three groups of 15 DMEK grafts (five per group) were pre-loaded in the DMEK RAPID Mini and preserved in Optisol-GS for 72 h at different temperatures: group A at >8 °C, group B between 2–8 °C and group C at <2 °C. After stripping and preservation, the viability of the endothelium, cell loss and morphology were assessed through light microscopy following trypan blue and alizarin red staining. Results: Overall mortality was 4.07%, 3.97% and 7.66%, in groups A, B and C, respectively, with percentages of uncovered areas of 0.31%, 1.36% and 0.20% (all p > 0.05). Endothelial cell density variation was 5.51%, 3.06% and 2.82% in groups A, B and C, respectively (p = 0.19). Total Endothelial Cell Loss (ECL) was 4.37%, 5.32% and 7.84% in groups A, B and C, respectively (p = 0.39). Endothelial cell morphology was comparable in all three groups. Conclusions: In the DMEK RAPID Mini, low temperatures (<2 °C) may affect the quality of pre-loaded grafts, inducing a higher ECL after 72 h of preservation, although no significant differences among groups could be proved. Our data would suggest maintaining grafts loaded in the DMEK RAPID Mini at temperatures between 2–8 °C for appropriate preservation. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR), the most common microvascular complication of diabetes mellitus, represents the leading cause of acquired blindness in the working-age population. Due to the potential absence of symptoms in the early stages of the disease, the identification of clinical biomarkers can have a crucial role in the early diagnosis of DR as well as for the detection of prognostic factors. In particular, imaging techniques are fundamental tools for screening, diagnosis, classification, monitoring, treatment planning and prognostic assessment in DR. In this context, the identification of ocular and systemic biomarkers is crucial to facilitate the risk stratification of diabetic patients; moreover, reliable biomarkers could provide prognostic information on disease progression as well as assist in predicting a patient's response to therapy. In this context, this review aimed to provide an updated and comprehensive overview of the soluble and anatomical biomarkers associated with DR. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to describe vascular filling patterns in corneal neovascularization (CoNV) and evaluate the effect of corneal lesion location, CoNV surface area and multi-quadrant CoNV involvement on the filling pattern. It is a retrospective study of patients who were investigated for CoNV using fluorescein angiography (FA) or indocyanine green angiography (ICGA) between January 2010 and July 2020. Angiography images were graded and analyzed multiple independent corneal specialists. The corneal surface was divided into four quadrants and patient information was obtained through electronic records. A total of 133 eyes were analyzed. Corneal lesions were located on the peripheral (72%) or central (28%) cornea. Central lesions were associated with multi-quadrant CoNV more frequently than peripheral lesions (p = 0.15). CoNV located within the same quadrant of the corneal lesion was often first to fill (88.4%). In multi-quadrant CoNV, the physiological inferior–superior–nasal–temporal order of filling was usually respected (61.7%). Central lesions resulted in larger CoNV surface area than peripheral lesions (p = 0.09). In multi-quadrant CoNV, the largest area of neovascularization was also the first to fill in (peripheral lesion 74%, central lesion 65%). Fillings patterns in healthy corneas have previously been reported. Despite CoNV development, these patterns are usually respected. Several factors that may influence filling patterns have been identified, including corneal lesion location, CoNV surface area and aetiology of CoNV. Understanding filling patterns of neovascularization allows for the identification of areas at higher risk of developing CoNV, aiding in earlier detection and intervention of CoNV. [ABSTRACT FROM AUTHOR]

Background: The integration of innovative imaging technologies into clinical workflows requires the utilization of a standardized data exchange format. The "Digital Imaging and Communications in Medicine" (DICOM) standard is widely used in healthcare to process and transfer medical images. However, no simulation environment is ready to use for development. The objective of this paper is to provide an open-source DICOM platform for integrating a novel ocular photography system into a clinical setting. Methods: After a thorough analysis of the available open-source tools, a subset was selected and aligned with the UEyecare Profile of Integrating the Healthcare Enterprise (IHE). Results: Orthanc served as a PACS with a modality worklist and the OHIF-Viewer for image retrieval. Minimal interfaces for the electronic health record and image modality were created. Docker-compose further integrates all components and simulates the network protocols DICOM Message Service Element and DICOMWeb. Discussion: The platform was used to develop and integrate the developed image modality and will be further utilized for teleophthalmology and processing eye images. The platform could be useful for other researchers to integrate an image modality into a clinical environment along IHE. [ABSTRACT FROM AUTHOR]

Introduction: We report a case and discuss the clinical characteristics and treatment of spontaneous Descemet membrane detachment (DMD). Case description: We describe a rare case of spontaneous DMD in a patient with prior anterior uveitis and provide a review of the current literature. A 20-year-old woman with a prior history of anterior uveitis presented with vision loss in the left eye. The slit-lamp examination showed corneal edema secondary to DMD, confirmed by anterior segment optical coherence tomography (AS-OCT). The patient underwent an intracameral injection of 20% sulphur hexafluoride (SF6) with complete resolution of the DMD. Although rare, several cases of spontaneous DMD have been reported in the literature, mostly occurring after intraocular surgery. We searched the Pubmed database (1949–2021) for peer-reviewed publications relevant to the topic of spontaneous DMD. Discussion: The pathogenesis of spontaneous DMD is complex and depends on several factors. It can occur due to anatomical anomalies, inflammatory disease, trauma, chemical injuries, and surgical or laser procedures. In most cases, early diagnosis and appropriate management led to resolution. [ABSTRACT FROM AUTHOR]