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Yanis Bouchou,1 Lorine Giffard-Quillon,2 Luc Fontana,2,3 Frédéric Roche,1 Carole Pélissier,2,3,* Mathieu Berger1,4,* 1Sainbiose, Inserm U1059, Service of Clinical Physiology, University Hospital and University Jean Monnet of Saint-Etienne, Saint-Etienne, France; 2Occupational Medicine, University Hospital of Saint-Etienne, Saint-Étienne, France; 3Université de St Etienne, Université Lyon 1, Université Gustave Eiffel, UMRESTTE, UMR T9405, Saint-Etienne, France; 4Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), EA 7424, Université Jean Monnet, Saint-Etienne, France*These authors contributed equally to this workCorrespondence: Mathieu Berger, Sainbiose, DVH Team, Inserm U1059, University Hospital of Saint-Etienne and University of Saint-Etienne, Mines Saint-Etienne, Saint-Etienne, France, Tel +33 477829014, Email mathieuberger@outlook.comPurpose: To describe the sleep habits (bedtime hours, waking hours, sleep duration) and to assess the prevalence of sleep disturbances (acute and chronic insomnia, insufficient sleep, perceived sleep debt) among French healthcare workers.Participants and Methods: Nurses and assistant nurses working in public hospitals from the Loire department at different work schedules (2x12h, 2x8h, fixed daytime, fixed nighttime) were asked about their socioprofessional and demographic information, their sleep habits and disturbances during night shifts, and the acceptability of a 20-min nap opportunity.Results: A total of 297 healthcare workers completed the survey with 76% reporting a sleep debt with a lower prevalence for fixed nighttime workers (62%) and a higher prevalence for 2x12 h (84%) workers. The prevalence of acute insomnia was 76% with a significant difference between fixed nighttime (60%) and 2x12 h (82%); whereas the prevalence of chronic insomnia was 35% without any significant difference between working schedules. Moreover, 18% of healthcare workers reported excessive daytime sleepiness, while 13% admitted to using sleep medication at least once a week.Conclusion: French healthcare workers reported poor sleep quality with a high prevalence of sleep debt, acute and chronic insomnia symptoms without an obvious impact of working schedules.Keywords: Sleep habits, healthcare workers, shift work, epidemiology, nurses

Alessandro Finzi,1 Simone Ottoboni,1 Mauro Cellini,1 Beniamino Corcioni,2 Caterina Gaudiano,2 Luigi Fontana1 1Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyCorrespondence: Alessandro Finzi, Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, Bologna, 40138, Italy, Tel +39 051 2142831, Email finzialessandro@gmail.comPurpose: 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.Keywords: AMD, endothelin-1, corneal biomechanics, scleral rigidity, hemodynamics

Danilo Iannetta,1 Michele De Maria,1 Elena Bolletta,2 Valentina Mastrofilippo,1 Antonio Moramarco,1 Luigi Fontana1 1Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; 2Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, ItalyCorrespondence: Danilo IannettaOphthalmology Unit, AUSL-IRCCS Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, ItalyTel +39 0522296520Fax +39 0522295839Email iannettadanilo@gmail.comPurpose: To analyse the efficacy of subretinal injection of recombinant tissue plasminogen activator (rtPA) and gas tamponade for the displacement of submacular haemorrhage (SMH).Methods: This single-centre, retrospective, case series included 25 consecutive patients (25 eyes) who underwent pars plana vitrectomy (PPV) with subretinal rtPA injection and 20% sulphur hexafluoride (SF6) tamponade. The primary outcome was SMH displacement rate, defined as the absence of subretinal blood within (complete) or outside (partial) 1500 μm centred on the fovea one month after PPV. Secondary outcomes were final best-corrected visual acuity (BCVA), central macular thickness (CMT), recurrence probability, number of anti-vascular endothelial growth factor (VEGF) injections after PPV, and intra- and post-operative complications.Results: Successful displacement was obtained in all 25 eyes (100%), with complete and partial displacement obtained in 15 (60%) and 10 (40%), respectively. BCVA significantly improved from 1.81± 0.33 to 1.37± 0.52 LogMar at 12 months from surgery (p = 0.001). The bivariate correlation analysis revealed that earlier the surgery had better visual prognosis at the end of the follow-up (p = 0.007). CMT significantly decreased from 922 ± 273.69 μm at baseline to 403.53 ± 314.64 μm at 12 months follow-up (p < 0.001). SMH recurrence was observed in two (8%) patients with a mean survival time of 11.6 ± 0.339 months and a cumulative survival probability of 88% at the end of follow-up. After PPV, the mean number of anti-VEGF injections was 3.00 ± 0.957 with no correlation with final visual acuity (p = 0.365). No intraoperative complications were recorded. Only one patient developed open funnel retinal detachment 40 days after primary PPV.Conclusion: PPV with rtPA subretinal injection and SF6 tamponade is a safe and effective technique in displacing acute SMHs secondary to neovascular AMD. It is recommended to perform within 14 days from the onset of the symptoms to achieve BCVA improvement at 12 months and proper imaging to plan future anti-VEG treatment.Keywords: macular degeneration, submacular haemorrhage, recombinant tissue plasminogen activator, pars plana vitrectomy, subretinal injection

Michele De Maria,1,2 Danilo Iannetta,1 Luca Cimino,3 Marco Coassin,4 Luigi Fontana1 1Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy; 2Clinical and Experimental Medicine Ph.D. Programme, University of Modena and Reggio Emilia, Modena, Italy; 3Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; 4Ophthalmology, University Campus Bio-Medico of Rome, Rome, ItalyCorrespondence: Luigi FontanaOphthalmology Unit, AUSL-IRCCS of Reggio Emilia, Viale Risorgimento 80, Reggio Emilia 42122, ItalyEmail luifonta@gmail.comAbstract: Cystoid macular edema (CME) is an infrequent, though potentially visually impairing, complication after uneventful cataract surgery. Rupture of the blood-aqueous barrier, with leakage of serum proteins into the aqueous humour, is the main pathogenic factor. However, only a few studies investigated the potential correlation between anterior chamber (AC) inflammation and the risk of cystoid macular changes occurring after surgery. This review aims to identify evidence of a correlation between AC inflammation and the risk of pseudophakic CME. One hundred eighty-seven prospective trials investigating AC inflammation after uncomplicated cataract surgery were identified. Methods of analysis of AC inflammation and the frequency of macular changes were recorded. In the majority (51%) of the studies, inflammation was assessed by clinical grading, followed by laser flare and cell photometry (LFCP) (42%) and aqueous humour sample (4%). Few studies (4%) adopted a combined LFCP and aqueous sample or clinical grading analysis. Sixteen (9%) studies investigated AC inflammation and macular changes by OCT (7%) or fluorescein angiography (2%). Correlation between the amount of postoperative AC inflammation and frequency of CME was documented in 7 studies, not confirmed in 2 studies, and not examined in the other 7. LFCP, more than the other methods of analysis, correlated with the frequency of CME postoperatively. Investigation of the relationship between AC inflammation and the risk of CME changes requires the adoption of quantitative methods of analysis of the inflammatory response after surgery. For this purpose, due to the low level of inflammation in the AC after uncomplicated cataract surgery, LFCP, more than subjective clinical grading, seems a more sensitive and reproducible method of measurement. Inflammation assessment after cataract surgery has a potential role in predicting the risk of CME development and may help to titrate the duration and intensity of treatment in relation to the surgical inflammatory response.Keywords: anterior chamber inflammation, cataract surgery, clinical grading, laser flare photometry, anterior segment optical coherence tomography, aqueous humour sample, cystoid macular edema

Luigi Fontana, Marco Coassin, Alfonso Iovieno, Antonio Moramarco, Luca Cimino Ophthalmology Unit, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. Keywords: pseudoexfoliation syndrome, cataract surgery, zonular laxity, intraocular lens implant, complications

The present paper investigates TiO2 nanoparticle (TiO2-NP) deposition on cotton fabric through a pulsed electrical current in a water/TiO2-NP solution. The experiments used short voltage pulses with an amplitude around 1200 V, an intermediate value between those used in electrophoretic deposition (tens of V) and plasma discharge in liquids (tens of thousands of V). A sequence of pulse trains with five pulses of 1.0 μs delivered electrical energy to the mixture. The electrodes were kept 28 mm apart. An asymmetry appeared in the current waveform when the medium contained TiO2-NPs. The pieces of cotton fabric were characterized using X-ray Photoelectron Spectroscopy (XPS), X-Ray Diffraction (XRD), and Fourier Transform Infrared Spectroscopy (FTIR). The electrical discharge treatment increased the Ti concentration on the fabric surface by as much as 6% according to XPS analysis. XRD analysis confirmed the XPS results for treated samples, indicating the presence of anatase TiO2. In the FTIR analysis, a shoulder at 800 cm−1 was observed and can be associated with coordination interactions between Ti and the OH groups of glucose. The nanoparticle adhesion was verified by observing the cotton fabric surface through field emission gun scanning electron microscopy after multiple washes. Even after 20 washing cycles, there was a considerable amount of nanoparticles on the sample surface. [ABSTRACT FROM AUTHOR]