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Purpose: Age-related macular degeneration (AMD) presents a multifaceted etiopathogenesis involving ischemic, inflammatory, and genetic components. This study investigates the correlation between ocular hemodynamics, scleral rigidity (SR), and plasma endothelin-1 (ET1) levels in treatment-naive patients with asymmetrical AMD. Patients and Methods: This study included 20 treatment-naive patients (12 females and 8 males) with an average age of 76.4 ± 3.7 years, who presented with AMD with neovascular membrane formation (nAMD) in one eye, and intermediate grade 2 AMD (iAMD) in the other eye. The control group consisted of 20 healthy subjects (13 females and 7 males) with a mean age of 74.7 ± 3.9 years. All patients and healthy controls underwent color Doppler imaging (i) of the ophthalmic artery (OA), short posterior ciliary arteries (SPCAs), and central retinal artery (CRA); Plasma ET-1 levels were measured for all patients and healthy subjects. Corneal biomechanics were assessed using an Ocular Response Analyzer and two indices were obtained: corneal hysteresis (CH) and corneal resistance factor (CRF). Results: Results showed reduced blood flow velocities and increased resistance indices in AMD eyes, particularly affecting the short posterior ciliary arteries. According to mechanical theory, ARMD eyes exhibited elevated scleral rigidity and corneal resistance factor compared to controls, with a notable rise in SR in neovascular AMD (nAMD) eyes. As per the chronic subacute inflammation theory, plasma ET-1 levels were significantly higher in AMD patients, correlating with abnormal SPCAs blood flow and increased resistance indices. Conclusion: Findings suggest a multifactorial etiology of AMD involving an increase of ET-1 plasma levels with biomechanic damages of corneal and scleral tissue in nAMD. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we report particular begging strategies by Andean dogs and by humans on the unsurfaced road between the villages of Parotani and Cahiuasi in Bolivia, recording their position and behavioral displays. Begging locations, for both dogs and humans, were permuted with a score, according to the higher probability of receiving food. The occurrences of the correct positioning at the external and internal parts of the bend were compared using a statistical test. The dogs were always observed to lie down at the border of the road, mainly alone and where the hairpin bends had been formed because of the strong sloping, forcing vehicles to slow down. Humans were observed mainly in groups. The percentage of dogs lying down on the external parts of bends was 81.2%, while humans were observed at external bends in 63.6% of cases. The mean score of dogs was significantly higher than that of humans. In this study, we report a particular begging strategy by Andean dogs and by humans on the unsurfaced road between the villages of Parotani and Cahiuasi in Bolivia. The positions of the dogs and humans begging and their behavioral displays were recorded. In dogs, the distance from each other was also recorded. Begging locations, for both dogs and humans, were permuted with a score, according to the higher probability of receiving food. The highest scores were assigned to the positions where cars had to slow down and the subjects were well visible, thus meriting a score corresponding to the higher probability of receiving a treat. The occurrences of the correct positioning at the external and internal parts of the bend were compared by a chi-square test. On a range of 93.3 km, the dogs were observed to always lie down at the border of the road, mainly alone (96.3%) and on hairpin bends, present due to the steep slope, obliging the vehicles to slow down. Humans were observed mainly in groups. The percentage of dogs lying on the external part of the bends was 81.2%, which was above the level of chance (p < 0.01). Humans were observed at external bends in 63.6% of cases, which was at chance level. Begging locations, for both dogs and humans, were permuted with a score according to the higher probability of receiving food. The mean scores were 1.48 and 0.65 for dogs and humans, respectively, and the difference was highly significant (p < 0.001). [ABSTRACT FROM AUTHOR]

Central serous chorioretinopathy (CSCR) is a retinal disease that may be complicated by the development of serous retinal pigment epithelial detachment (PED). The exact molecular mechanisms of CSCR have remained uncertain as well as there is no effective medical therapy. Herein, we describe a case of a 43-year-old male suffering from chronic CSCR with PED and visual acuity reduction (20/40) that showed improvement in visual acuity (20/25) and metamorphopsia 2 weeks after daily intake of 20 mg sildenafil tablets. Optical coherence tomography (OCT) scan showed resolution of PED with residual degeneration of the photoreceptor inner and outer segment layer and retinal pigmented epithelium. The patient continued treatment with sildenafil 20 mg for 2 months. Six months after the discontinuation of therapy, visual acuity was maintained, with absence of PED at OCT. Our case supports the hypothesis that phosphodiesterase type 5 (PDE-5) inhibitors may be an alternative in the treatment of patients with CSCR, alone or combined with other medications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the anatomical and functional surgical outcomes of eyes affected by myopic traction maculopathy (MTM) with and without an outer lamellar macular hole (O-LMH). Methods: Forty-eight eyes affected by MTM were included: a study group of 24 eyes with an O-LMH and a control group of 24 eyes without an O-LMH. All patients underwent spectral-domain optical coherence tomography (SD-OCT) and were staged according to the MTM staging system. The surgical techniques applied were pars plana vitrectomy (PPV), macular buckle (MB), or combined surgery. The follow-up visit was 12 months after the latest intervention. Results: Best-corrected visual acuity (BCVA) improved significantly in both groups after surgery (p < 0.05). A successful surgical result was obtained in both groups at the final follow-up. In the study group, 3 eyes underwent PPV, 14 eyes underwent MB, and 7 underwent a combined surgery. Six patients developed an iatrogenic full-thickness macular hole (FTMH). In the control group, 5 eyes underwent PPV, 16 underwent MB, and 3 had combined surgery. Four patients developed a FTMH. In both groups, all the eyes with an iatrogenic FTMH received PPV as first surgery (alone or combined). A topographical correspondence between the interruption of the ellipsoid zone (EZ) and the backscattering phenomenon was found on OCT. Conclusion: The O-LMH is an OCT sign that may occur in eyes affected by MTM. Its presence is correlated with a higher risk of developing an iatrogenic FTMH after PPV (alone or combined) probably due to the thinner residual retinal tissue. Postoperative BCVA is not limited in eyes with an O-LMH and this may be explained by the restoration of the EZ after surgery. [ABSTRACT FROM AUTHOR]

Pathologic myopia (PM) is an ocular disorder characterized by a spherical equivalent (SE) of more than – 6.0 diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM is associated with myopic maculopathy (MM). The ATN classification describes all the aspects of MM which regroups atrophic, tractional and neovascular consequences to the sclera, choroid and retina of highly myopic eyes. The advent of OCT allowed to define the ultrastructural characteristics of the tractional changes in MM, described by the term myopic traction maculopathy (MTM). They include foveoschisis/maculoschisis/retinoschisis (FS/MS/RS), retinal/foveal detachment (RD/FD), lamellar macular holes (LMH) and full-thickness macular holes (FTMH) with or without RD (MHRD). The MTM staging system (MSS) describes all foveal and retinal changes related to MTM and their natural history interpreting them as different stages of a single progressive disorder. The management of MTM can be just observation for the earliest cases with good vision or surgery for the severe stages with vision loss. There are two possible surgical approaches: ab externo, that acts on the alteration of the scleral shape and includes posterior scleral reinforcement and macular buckle. Ab interno, that targets the alteration of the foveal profile and consists in pars plana vitrectomy with removal of all the epiretinal tractions, maneuvers on the internal limiting membrane, and the use of intravitreal tamponade and laser. As they target two different sides of the same pathology, the two techniques have to be selected on the base of the MTM stage, single or combined. [ABSTRACT FROM AUTHOR]

Purpose: Dyslexia is a reading disorder with neurological deficit of the magnocellular pathway. The aim of our study was to evaluate the functionality of the magnocellular–Y (M–Y) retinal ganglion cells in adult dyslexic subjects using steady-state pattern electroretinogram and frequency doubling perimetry. Methods: Ten patients with dyslexia (7 females and 3 males), mean age 28.7 ± 5.9 years, and 10 subjects without dyslexia (6 females and 4 males), mean age 27.8 ± 4.1 years, were enrolled in the study and underwent both steady-state pattern-electroretinogram examination and frequency doubling perimetry. Results: There was a significant difference in the amplitude of the steady-state pattern electroretinogram of the dyslexic group and the healthy controls (0.610±0.110 μV vs 1.250±0.296 μV; p=0.0001). Furthermore, in the dyslexic group we found a significant difference between the right eye and the left eye (0.671±0.11 μV vs 0.559±0.15 μV; p=0.001). With frequency doubling perimetry, the pattern standard deviation index increased in dyslexic eyes compared to healthy controls (4.40±0.81 dB vs 2.99±0.35 dB; p=0.0001) and in the left eye versus the right eye of the dyslexic group (4.43±1.10 dB vs 3.66±0.96 dB; p=0.031). There was a correlation between the reduction in the wave amplitude of the pattern electroretinogram and the simultaneous increase in the pattern standard deviation values (r=0.80; p=0.001). This correlation was also found to be present in the left eye (r=0.93; p<0.001) and the right eye (r=0.81; p=0.005) of dyslexic subjects. Conclusion: Our study shows that there was an alteration of the activity of M–Y retinal ganglion cells, especially in the left eye. It confirms that in dyslexia there is a deficit of visual attention with damage not only of the magnocellular-dorsal pathway but also of the M-Y retinal ganglion cells. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and tolerability of diclofenac and bromfenac ophthalmic solutions as adjunctive therapy after cataract surgery. Materials and Methods: This prospective randomized controlled study included 130 patients who underwent cataract surgery. One hundred patients were randomized to receive postoperatively diclofenac 0.1% (four times daily for 28 days, Group 1) or bromfenac 0.09% (twice daily for 14 days, Group 2) ophthalmic solutions in addition to steroid-antibiotic combination. Thirty patients instilled only steroid-antibiotic combination (Control Group 3). Laser flare-cell photometry and optical coherence tomography scans with central foveal thickness (CFT) measurement were performed before (V0) and 7 (V1), 14 (V2) and 28 days (V3) after surgery. Treatment tolerability was scored using the Ocular Comfort Grading Assessment. Results: Laser flare-cell photometry values were significantly higher at V1, V2 and V3 compared to V0 in all the groups (respectively 13.3 ± 1.0, 12.7 ± 0.9 and 9.6 ± 0.9 vs 8.4 ± 0.6 ph/ms for Group 1; 13.4 ± 1.0, 12.7 ± 0.9 and 12.7 ± 1.0 vs 8.1 ± 0.6 for Group 2; 15.9 ± 0.8, 15.4 ± 0.7 and 14.5 ± 0.7 vs 7.5 ± 0.5 for Group 3) (p < 0.001); flare increase was significantly lower in Group 1 compared to Groups 2 and 3 (p < 0.001). CFT values were higher after surgery in all the three groups; the increase was significantly lower in Group 1 compared to Groups 2 and 3 (p < 0.0002). The percentage of symptoms-free patients after study treatment was significantly higher in Group 2 compared to Group 1 (respectively 74% vs 14% of the total; p < 0.001). Conclusion: The addition of diclofenac or bromfenac ophthalmic solutions contributed to further reduce both inflammation and cystoid macular edema after cataract surgery compared to steroid-antibiotic combination alone. Diclofenac appeared to be more effective in reducing postoperative intraocular inflammation with a more intense and prolonged regimen, while bromfenac more tolerated with lower daily dose and treatment duration. [ABSTRACT FROM AUTHOR]

Background: Steady-state pattern electroretinogram (PERG) and frequency doubling technology (FDT) perimetry can be used to selectively investigate the activity of the M-Y ganglion cells in adult anisometropic amblyopes. Methods: Fifteen normal subjects (mean 27.8±4.1 years) and 15 adults with anisometropic amblyopia (mean 28.7±5.9 years) were analyzed using steady-state PERG and FDT. Results: The amplitude of steady-state PERG was significantly different not only among the control group and both the amblyopic eye (P=0.0001) and the sound eye group (P=0.0001), but also between the latter two groups (P=0.006). The difference in FDT mean deviation was statistically significant not only between the control group and amblyopic eye group (P=0.0002), but also between the control group and the sound eye group (P=0.0009). The FDT pattern standard deviation was significantly higher in the control group rather than in the amblyopic eye (P=0.0001) or the sound eye group (P=0.0001). A correlation was found between the reduction in PERG amplitude and the increase in FDT-pattern standard deviation index not only in amblyopic (P=0.0025) and sound (P=0.0023) eyes, but also in the healthy control group (P=0.0001). Conclusion: These data demonstrate that in anisometropic amblyopia, there is an abnormal functionality of a subgroup of the magnocellular ganglion cells (M-Y), and the involvement of these cells, together with the parvocellular pathway, may play a key role in the clinical expression of the disease. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the effects of Bangerter filters on the visual field in healthy and in amblyopic patients. Materials and Methods. Fifteen normal adults and fifteen anisometropic amblyopia patients were analysed with standard automated perimetry (SAP) and frequency doubling technology (FDT) at baseline and with filters 0.8 and 0.1. Results. With 0.1 filter in SAP there was an increase of MD compared with controls (−10.24 ± 1.09 dB) in either the amblyopic (−11.34 ± 2.06 dB; P<0.050) or sound eyes (−11.34 ± 1.66 dB; P<0.030). With filters 0.8 the PSD was increased in the amblyopic eyes (2.09 ± 0.70 dB; P<0.007) and in the sound eyes (1.92 ± 0.29 dB; P<0.004) compared with controls. The FDT-PSD values in the control group were increased with the interposition of the filters compared to baseline (0.8; P<0.0004 and 0.1; P<0.0010). We did not find significant differences of the baseline PSD between amblyopic eyes (3.80 ± 2.21 dB) and the sound eyes (4.33 ± 1.31 dB) and when comparing the filters 0.8 (4.55 ± 1.50 versus 4.53 ± 1.76 dB) and 0.1 (4.66 ± 1.80 versus 5.10 ± 2.04 dB). Conclusions. The use of Bangerter filters leads to a reduction of the functionality of the magno- and parvocellular pathway. [ABSTRACT FROM AUTHOR]

To assess the sex influence on sniffing behavior of rabbits, sets of three rabbits each were located for seven days in contiguous cages divided by a metal wall with holes that prevented the neighboring rabbits to see each other. A buck was located in the central cage, with a doe at each side. Rabbit behavior was video recorded to observe animals sniffing with the muzzle near the wall. The bucks displayed an olfactory preference towards one of the two does, which decreased in few days. The significance was p < 0.01 for the first three days, it lowered to p < 0.05 in the next three days and from the seventh, it turned insignificant (p > 0.05). The interest of bucks towards the does was also characterized by a frenetic scratching of the separation wall, contemporary with intense sniffing, displayed only for the first 35 min of the first day. The sniffing behavior of does at the central cage housing the male was not so marked as in bucks, and it progressively changed across the trial (p < 0.01). In conclusion, rabbits establish a transitory sex-oriented olfactory relationship with the conspecifics housed in contiguous cages, which looks no longer necessary once the rabbits have recognized each other. [ABSTRACT FROM AUTHOR]

Background: To assess the sensitivity and specificity of hemifield pattern electroretinogram (HF-PERG) for detecting early retinal ganglion cell (RGC) damage in ocular hypertensive (OH) patients. Methods: Fifty-two OH patients (mean age 56+9.6 years) with an intraocular pressure (IOP) >21 mmHg were assessed. All subjects underwent HF-PERG, optical coherence tomography (OCT), and frequency doubling technology (FDT) visual field. Results: OH patients showed a significant increase of peak-time of the N95 (P=0.027) compared to controls. The amplitude of the N95 of the lower and upper HF-PERG showed significant differences (P=0.037 and P=0.023, respectively) between the two groups. A significant intraocular (P=0.006) and interocular (P=0.018) asymmetry of N95 amplitude was found. Receiver operating characteristic (ROC) curve analysis revealed a sensitivity of 93% for the N95 of the lower HF-PERG, whereas full-field pattern electroretinogram (PERG) N95 peak-time had a sensitivity of 88%. In OH patients, we found a thinning of OCT - retinal nerve fiber layer (RNFL), especially in the superior and inferior quadrant, although not statistically significant, and a significantly higher FDT pattern standard deviation (FDT-PSD; P=0.001). In the OCT-RNFL inferior quadrant, a sensitivity of 82% was recorded. Finally, the sensitivity of the FDT-PSD was 92%. Conclusion: Our study shows that HF-PERG is a very sensitive test for detecting early damage of the RGC. [ABSTRACT FROM AUTHOR]

Purpose: To study the ocular blood flow, the corneal biomechanics, the scleral rigidity and the endothelin‐1 (ET‐1) plasma levels in patients with neovascular age‐related macular degeneration (ARMD). Methods: We enrolled 20 patients with ARMD and 20 age‐matched control patients. Retrobulbar blood flow was examined by Colour Doppler Aplio 500 (Toshiba Medical System, Tokyo, Japan). Peak systolic velocity (PSV) and resistivity index (RI) was measured from ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary arteries (PCA's). The corneal hysteresis CH and the corneal resistance force (CRF) values were achieved by Ocular Response Analyzer (ORA). Scleral rigidity (E) was determined by using Friedenwald nomograms. ET‐1 plasma levels were determined using a specific radioimmunoassay (Sigma‐Aldrich, Merck, Germany). Results: We found a statistically significant difference in the CRF between patients with ARMD and control subjects (ARMD 11.23 ± 1.30 vs. Controls 9.82 ± 1.37; p<0.0025) was found. The CH index between patients with ARMD and control subjects was not statistically significant (ARMD 10.15 ± 1.25 vs. Controls 10.02 ± 1.70; p<0.617). With CDI in PCA's we found PSV (ARMD 12.37 ± 2.80 cm/sec vs. Controls 15.44 ± 3.59 cm/sec; p<0.0063); RI (ARMD 0.80 ± 0.03 vs Controls 0.74 ± 0.02; p<0.0001). The E had a significant increase in ARMD group (ARMD 0.0358 ± 0.004 vs. Controls 0.0328 ± 0.004; p<0.008) as well as ET‐1 plasma levels (ARMD 2.060 ± 0.276 vs. Controls 1.492 ± 0.0.560; p<0.001). Finally, in ARMD we found that the decrease of PSV and the increase of RI in PCA's was correlated with the ET‐1 plasma levels (PSV r‐0.615; p<0.0039 and r 0.764; p<0.0001) and not with the values of E, CH and CRF. Conclusions: Our data indicate that patients with neovascular ARMD had a significant increase of RI in all vessels examined with increased corneal CRF index, scleral rigidity values and ET‐1 plasma levels. The decreased blood flow in APC's was correlated to the increase of ET‐1 plasma levels. These data indicate that elevated plasma ET‐1 and not the scleral rigidity may be an important risk factor in the development of neovascular ARMD. [ABSTRACT FROM AUTHOR]

Purpose: Central serous chorioretinopathy (CSCR) is a pathology of the retina that can be complicated by the appearance of a serous detachment of the pigment epithelium (PED). The exact molecular mechanisms of CSCR have remained uncertain as well as there is no effective medical therapy. We found it interesting to describe a case of CSCR with PED treated with Sildenafil. Case Report: 53‐year‐old male suffering from chronic CSCR with PED probably resulting from psychological stress and type A personality presented himself for an eye examination stating that he noticed an improvement in visual acuity and metamorphopsia after a daily intake of 15 mg of sildenafil tablets. The patient underwent fluorescein angiography (FA), indocyanine angiography (ICG), Optical coherence tomography angiography (OCTA) and Optical coherence tomography (OCT). The tests showed a resolution of the serous detachment of the neuroepithelium and pigment epithelium with residual dystrophy of the retinal pigment epithelium. Conclusions: Several oral medications have been proposed for the treatment of CSCR based on the putative inhibition of different pathogenic pathways. Recently mineralocorticoid receptors antagonists were proposed as a treatment for CSCR patients with persistent subretinal fluid and the results seem encouraging. We believe that in our case the resolution of the clinical picture is due to the improvement of the choroidal vascular picture and in particular of the endothelial function of the choroidal vessels. Recent studies have shown that Phosphodiesterase type 5 (PDE‐5) inhibitors (i.e. sildenafil) have been implicated in improving endothelial function and that this would be at the basis of the vasodilation induced by these molecules. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility and initial functional and anatomical outcomes of transplanting a full-thickness free graft of choroid and retinal pigment epithelium (RPE), along with neurosensory retina in advanced fibrosis and atrophy associated with end-stage exudative age-related macular degeneration with and without a concurrent refractory macular hole., Methods: During vitrectomy, an RPE-choroidal and neurosensory retinal free graft was harvested in nine eyes of nine patients. The RPE-choroidal and neurosensory retinal free graft was either placed subretinally (n = 5), intraretinally to cover the foveal area inside an iatrogenically induced macular hole over the RPE-choroidal graft (n = 3) or preretinally (n = 1) without a retinotomy wherein both free grafts were placed over the concurrent macular hole. Silicone oil endotamponade was used in all cases., Results: Mean follow-up was 7 ± 5.5 months (range 3-19). The mean preoperative visual acuity was ∼count fingers (logarithm of the minimum angle of resolution = 2.11, range 2-3), which improved to ∼20/800 (logarithm of the minimum angle of resolution 1.62 ± 0.48, range 0.7-2, P = 0.04). Vision was stable in 5 eyes (55.6%) and improved in 4 eyes (44.4%). Reading ability improved in 5 eyes (55.6%). Postoperative complications were graft atrophy (n = 1), epiretinal membrane (n = 1), and dislocation of neurosensory retina-choroid-RPE free graft (n = 1)., Conclusion: Combined autologous RPE-choroid and neurosensory retinal free graft is a potential surgical alternative in eyes with end-stage exudative age-related macular degeneration, including concurrent refractory macular hole.

Background: Postoperative endophthalmitis is a severe complication after intraocular surgery. The aim of this pilot study was to investigate the safety of intracameral cefuroxime in combined vitrectomy and phacoemulsification for cataract and various vitreoretinal disease., Methods: The charts of 152 patients who underwent combined phacoemulsification, intraocular lens implant and pars plana vitrectomy were reviewed. The final tamponade was chosen among fluid, air, gas or silicone oil, based on the requirement of each single case. Patients were operated on by four different surgeons. At the end of surgery, 1 mg/0.1 mL of intracameral cefuroxime (Aprokam) was administered., Results: The mean follow-up was 6.26±7.78 months (range 1-12). No retinal complication, such as retinal infarction or hemorrhages were observed. No acute macular serous detachment and no new intraretinal cysts were noted, in those patients who received optical coherence tomography within the fifth day after surgery. No endophthalmitis was recorded., Conclusion: Intracameral cefuroxime, at the end of combined phacoemulsification and pars plana vitrectomy, is safe as it has no toxicity on the retina and maybe could be considered effective in endophthalmitis prevention. Due to the relatively small number of patients, further studies are advisable., Summary Statement: The standard dose of intracameral cefuroxime at the end of combined phacoemulsification and pars plana vitrectomy has no toxic effects on the retina. This paper/The abstract of this paper was presented at the European Vitreo Retinal Society Conference 2017 as a conference talk with interim findings. The poster's abstract was not published., Competing Interests: Disclosure The authors report no conflicts of interest in this work.