Search

To report the preliminary results of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with chronic angle-closure glaucoma (CACG). Retrospective, single-center, case series of GATT procedures is performed on patients with CACG. The primary outcome was intraocular pressure (IOP). Success was defined as IOP reduction >30% from baseline at 6 and 12 months with (qualified) or without (complete) glaucoma medication. Secondary outcomes were best-corrected visual acuity (BCVA), visual field (VF), peripheral anterior synechiae (PAS), medications, and complications. Fifteen eyes (15 patients) with a minimum follow-up of 1 year were included for the analysis. Preoperatively, the mean (±SD) IOP was 30.27 (±4.20) mmHg and 15.20 (±2.08) mmHg at 1 year postoperatively (p

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

To review the current adoption of laser flare and cell photometry (LFCP) in the setting of modern cataract surgery to analyze inflammation aiming to identify evidence of a correlation between LFCP values and the risk of cystoid macular edema (CME) development. An extensive PubMed literature search was performed to review all the published studies investigating inflammation by LFCP after uncomplicated phacoemulsification. The following keywords were used: cataract surgery, cystoid macular edema, anterior chamber inflammation, laser flare, and cell photometry. Seventy-eight original articles investigating inflammation by LFCP were selected. Macula alterations were searched in 12 (15%) trials, by optical coherence tomography or fluorescein angiography in 11 (14%) and 1 (1%) studies, respectively. Among them, 9 (12%) papers investigated the correlation between LFCP values and cystic changes to the macula: 7 (9%) and 2 (3%) studies identified a positive and negative correlation, respectively. Three (4%) papers did not perform any correlation analysis. CME, as a consequence of uncontrolled postoperative inflammation, is a common cause for unfavorable visual outcomes following uncomplicated phacoemulsification with IOL implantation. After surgery, intraocular inflammation is generally assessed by qualitative methods. Although well-established and practical in uveitis, they are inadequate to detect the modest inflammatory response that usually occurs after uneventful phacoemulsification. LFCP correlate with the chance of macula alteration after surgery and higher the values higher the risk of CME. The quantitative analysis of intraocular inflammation by LFCP after cataract surgery might be a tool to predict the risk of pseudophakic CME.

PRCIS Trabeculectomy (TRAB) lowers the intraocular pressure (IOP) more than gonioscopy-assisted transluminal trabeculotomy (GATT) at 18 months, with a reduction in IOP of 30% or more and a significant reduction in the number of glaucoma medications compared with baseline. PURPOSE To compare the IOP-lowering efficacy of GATT with mitomycin-C augmented TRAB in patients with uncontrolled open-angle glaucoma. METHODS Single-center, retrospective, comparative cohort study. One hundred ten consecutive patients (110 eyes) underwent GATT (n=61) or TRAB (n=49). The primary outcome measure was IOP reduction, defined as a percentage decrease ≥30% and absolute IOP≤18 mm Hg at 18 months with (qualified) or without (complete) medications. Secondary outcomes were visual field change, number of glaucoma medications, complications, and reintervention. RESULTS The mean±SD baseline IOP was 30.04±7.5 and 27.59±4.70 (P=0.072) with the mean number of medications of 3.08±0.73 and 2.92±0.91 (P=0.310) in TRAB and GATT, respectively. At 18 months, the mean±SD IOP was 15.26±3.47 mm Hg and 12.48±4.58 mm Hg after GATT and TRAB, respectively (P=0.002). The percentage of IOP lowering from baseline was 56.05±17.72 after TRAB and 42.04±15.56 after GATT (P

To evaluate, by laser photometry, the persistency of anterior chamber flare after uneventful phacoemulsification in asymptomatic patients with no signs of inflammation on slit lamp examination. Seventy-five patients previously enrolled in a randomized clinical trial that evaluated inflammation after uneventful phacoemulsification in eyes treated with dexamethasone 0.1% ophthalmic suspension (group 1) or bromfenac 0.09% ophthalmic solution (group 2) for 2 weeks. Anterior chamber inflammation was investigated by laser flare photometry. At 30 days after surgery, laser flare showed persistently elevated values. For this reason, patients were further analyzed at 3 and 6 months. Additionally, optical coherence tomography was used to measure the central macular thickness (CMT) and to assess for postoperative pseudophakic macular edema. When compared to preoperative values, laser flare photometry demonstrated persistent ocular inflammation at postoperative days 90 and 180 in group 1, but not in group 2. Laser flare values showed a significant reduction in group 2 compared to group 1 throughout all the follow-up (p

Purpose: Previous reports described unfavorable visual outcomes after surgery for uveitic macular pucker. Our goal was to demonstrate that patients with history of uveitis may benefit from vitrectomy for epiretinal membrane if executed under appropriate circumstances. Methods: We performed pars plana vitrectomy with ERM and ILM peeling in patients with post-uveitic macular pucker who did not show signs of ocular inflammation for at least 3 months after the suspension of immunosuppressive therapy. Visual acuity, central macular thickness at OCT, ocular inflammation, and complications were recorded. Results: Twenty-six eyes were operated. Mean duration of follow-up was 67 months. Visual acuity significantly improved from 20/80 to 20/40 after surgery. Vision increased in 20 (77%), remained stable in 4 (15%), and decreased in 2 (8%) eyes. Best-corrected visual acuity ameliorated by at least 2 ETDRS lines in 14 eyes (54%). Contingency analysis did not show any statistical difference among the different types of uveitis ( p = 0.46). Mean central foveal thickness improved postoperatively (428 ± 104 vs 328 ± 130 microns; p = 0.017). Conclusion: Patients with uveitic epiretinal membrane benefit from vitrectomy with membranectomy if operated when intraocular inflammation had subsided.

BackgroundTo describe a case of a rare association of bilateral keratoconus and unilateral essential iris atrophy and to conduct a literature review of the current strategies of treatment of the corneal disease and glaucoma in patients with Iridocorneal Endothelial Syndrome (ICE).Case presentationWe report a rare association of bilateral keratoconus and unilateral essential iris atrophy in a 38-year-old man. Diagnosis of bilateral keratoconus was confirmed by corneal topography. Slit-lamp examination showed extensive iris atrophy with corectopia and policoria in one eye. Corneal specular microscopy revealed an abnormal endothelium morphology in the same eye with extensive peripheral anterior synechiae and closure of the drainage angle at gonioscopy. Intraocular pressure was 26 mmHg, despite maximal topical therapy. Optic disc examination showed severe glaucomatous cupping. Surgery by glaucoma drainage device implantation was performed.ConclusionEssential iris atrophy is a rare clinical variant of ICE syndrome characterized by profound anatomical alterations of the anterior segment associated with corneal edema and secondary glaucoma. In these patients, selective keratoplasties have replaced penetrating keratoplasty to treat corneal decompensation and glaucoma drainage devices are preferred to conventional trabeculectomy for the treatment of secondary glaucoma.

To compare the efficacy of bromfenac 0.09% and dexamethasone 0.1% in the treatment of anterior chamber inflammation after uncomplicated cataract surgery. Seventy-six patients with senile cataracts and no other ocular comorbidities who underwent uneventful phacoemulsification were randomized 1:1 to receive dexamethasone ophthalmic suspension 0.1% or bromfenac ophthalmic solution 0.09% for 2 weeks. All patients were examined on the day before surgery and postoperatively at day 1, 3, 7, 9, 11, 14 and 30. Laser flare photometry was used to quantify anterior chamber inflammation and optical coherence tomography to measure macular thickness. Bromfenac was as effective as dexamethasone in reducing inflammation in the anterior chamber of the eye. Laser flare increased the day after surgery and progressively decreased after starting the treatment with no statistically significant difference between dexamethasone and bromfenac at all time points. Visual acuity improved steadily after surgery in both groups. Mean macular thickness was similar in both the dexamethasone and bromfenac arms at 1 month. Short-term therapy with topical bromfenac alone is as effective as dexamethasone in low-risk cataract surgery patients. ClinicalTrials.gov # NCT03317847; EudraCT # 2016-004358-14. Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy.

Background: To evaluate macular pigment optical density (MPOD) after bimanual femtosecond laser-assisted cataract surgery (FLACS) compared to standard bimanual phacoemulsification (B-MICS). Methods: A prospective, case matched, comparative cohort study conducted at the Institute of Ophthalmology, University of Modena and Reggio Emilia (Italy); 30 eyes underwent bimanual FLACS with low-energy Ziemer LDV Z8 (FLACS) and 30 underwent B-MICS standard technique (B-MICS). All interventions were conducted by the same expert surgeon. MPOD using the Macular Pigment Screener II (MPS II) was evaluated at baseline, 7 and 30 days after surgery. As secondary outcomes, we considered best corrected visual acuity (BCVA) and central macular thickness (CMT) obtained using optical coherence tomography. Results: In all cases, a BunnyLens AF IOL was safely implanted in the capsular bag through a 1.4 mm incision. We found a significant reduction in MPOD in both groups at 7 and 30 days; 0.16±0.14 and 0.10±0.12 (FLACS) and 0.18±0.13 and 0.15±0.14 (B-MICS), respectively (P

To report the preliminary results of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with chronic angle-closure glaucoma (CACG).Retrospective, single-center, case series of GATT procedures is performed on patients with CACG. The primary outcome was intraocular pressure (IOP). Success was defined as IOP reduction30% from baseline at 6 and 12 months with (qualified) or without (complete) glaucoma medication. Secondary outcomes were best-corrected visual acuity (BCVA), visual field (VF), peripheral anterior synechiae (PAS), medications, and complications.Fifteen eyes (15 patients) with a minimum follow-up of 1 year were included for the analysis. Preoperatively, the mean (±SD) IOP was 30.27 (±4.20) mmHg and 15.20 (±2.08) mmHg at 1 year postoperatively (p0.001). The mean (±SD) percentage of IOP reduction from baseline was 49% (±9.41). At 6 and 12 months, the success rate complete and qualified was 93% (73% and 20%) and 100% (73% and 27%), respectively. BCVA and VF mean deviation were comparable before and after surgery (p=0.167 and p= 0.710, respectively). The median (range) number of glaucoma drugs decreased from 3 (3-4) before to 0 (0-2) after GATT (p0.001). The absence of PAS was observed in 80% of patients after surgery. Transient hyphema was a common complication requiring aspiration in one case.At 12 months of follow-up, our preliminary results indicate that GATT in CACG effectively reduces the IOP and the number of medication with a low risk of complications. Following ab interno trabeculotomy, an open-angle without PAS was achieved in the majority of patients.nr. 2016/0010904.

To review the current adoption of laser flare and cell photometry (LFCP) in the setting of modern cataract surgery to analyze inflammation aiming to identify evidence of a correlation between LFCP values and the risk of cystoid macular edema (CME) development.An extensive PubMed literature search was performed to review all the published studies investigating inflammation by LFCP after uncomplicated phacoemulsification. The following keywords were used: cataract surgery, cystoid macular edema, anterior chamber inflammation, laser flare, and cell photometry.Seventy-eight original articles investigating inflammation by LFCP were selected. Macula alterations were searched in 12 (15%) trials, by optical coherence tomography or fluorescein angiography in 11 (14%) and 1 (1%) studies, respectively. Among them, 9 (12%) papers investigated the correlation between LFCP values and cystic changes to the macula: 7 (9%) and 2 (3%) studies identified a positive and negative correlation, respectively. Three (4%) papers did not perform any correlation analysis.CME, as a consequence of uncontrolled postoperative inflammation, is a common cause for unfavorable visual outcomes following uncomplicated phacoemulsification with IOL implantation. After surgery, intraocular inflammation is generally assessed by qualitative methods. Although well-established and practical in uveitis, they are inadequate to detect the modest inflammatory response that usually occurs after uneventful phacoemulsification. LFCP correlate with the chance of macula alteration after surgery and higher the values higher the risk of CME. The quantitative analysis of intraocular inflammation by LFCP after cataract surgery might be a tool to predict the risk of pseudophakic CME.

Purpose. Comparative evaluation of morphological features of anterior capsules and apoptosis induction in epithelial cells after femtosecond laser-assisted cataract surgery (FLACS) and standard phacoemulsification surgery.Methods. Group 1: 30 FLACS anterior capsulotomies and Group 2: 30 manual anterior continuous curvilinear capsulorhexes. All patients were operated on by the same experienced surgeon. Morphological features of the anterior capsules and apoptosis induction in epithelial cells were evaluated.Results. All patients revealed a significant mean best-corrected visual acuity (BCVA) improvement 3 months after surgery, and no major intraoperative nor postoperative complications occurred. The capsular epithelium appeared to be preserved in both groups. Scanning electron microscopy analysis revealed irregular saw-tooth shaped edges in capsules from Group 1 whereas capsules from Group 2 showed regular and smooth edges. A statistically significant higher expression of the downstream apoptotic effector cleaved caspase 3 was observed in Group 1.Conclusions. The saw-tooth appearance was likely due to the progressive sequence of laser pulses on the capsule. The low energy/high frequency properties of the laser pulse, combined with an overlapped pulse pattern, resulted in highly continuous morphology of capsule edges. The higher apoptosis induction in FLACS group might be due to photodisruption-dependent plasma generation and formation of cavitation bubbles.

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

This study compared the outcomes of cataract surgery with intraocular lens (IOL) implantation in patients with juvenile idiopathic arthritis (JIA)-associated chronic anterior uveitis treated with antimetabolite drugs and systemic corticosteroids (Non-Biological Group) versus patients treated with antimetabolites and biological drugs (Biological Group). A cohort of patients with cataract in JIA-associated uveitis undergoing phacoemulsification with IOL implantation was retrospectively evaluated. The main outcome was a change in corrected distance visual acuity (CDVA) in the two groups. Ocular and systemic complications were also recorded. The data were collected preoperatively and at 1, 12, and 48 months after surgery. Thirty-two eyes of 24 children were included: 10 eyes in the Non-Biological Group and 22 eyes in the Biological Group. The mean CDVA improved from 1.19 ± 0.72 logMAR preoperatively to 0.98 ± 0.97 logMAR at 48 months (p = 0.45) in the Non-Biological Group and from 1.55 ± 0.91 logMAR preoperatively to 0.57 ± 0.83 logMAR at 48 months (p = 0.001) in the Biological Group. The postoperative complications, including synechiae, cyclitic membrane, IOL explantation, glaucoma, and macular edema, were not statistically different between the two groups. An immunosuppressive treatment with biological drugs can improve the visual outcome after cataract surgery in patients with JIA-associated uveitis, but it does not significantly reduce postoperative ocular complications.

Purpose:To evaluate the efficacy and safety of bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions compared to standard bimanual phacoemulsification (bimanual microincision cataract surgery).Design:Prospective, non-randomized comparative case series.Methods:Bimanual femtosecond laser-assisted cataract surgery with microincisions was performed on 80 eyes (Group A) with the low-energy Ziemer LDV Z8; a matched case–control series of 80 eyes performed with standard bimanual microincision cataract surgery technique was selected for comparison (Group B). All interventions were performed by the same experienced surgeon. Intraoperative parameters were recorded as well as intra- and postoperative complications. Best corrected visual acuity, surgically induced astigmatism, central corneal thickness and endothelial cell count were evaluated before surgery and at 1 and 3 months post intervention.Results:The mean effective phaco times were 3.79 ± 2.19 s (Group A) and 4.49 ± 1.84 s (Group B) (p = 0.041). No major intra- or postoperative complications occurred. An overall significant mean best corrected visual acuity improvement was noted at 3 months, but was not statistically different between the groups. No significant changes were observed for surgically induced astigmatism or corneal pachymetry. A significant loss of endothelial cell count in both groups was detected at 3 months, with Group A reporting a significantly lower endothelial cell count loss compared to Group B (p = 0.009).Conclusion:Bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions by an expert surgeon was proven to be safe and effective in this study. This technique has advantages compared with standard bimanual microincision cataract surgery in terms of endothelial preservation.

Purpose To demonstrate that in case of absence of capsular support intraocular lens (IOL) scleral fixation is both effective and stable over years. Methods A total of 13 eyes from 13 patients who underwent an IOL scleral fixation according to Lewis suturing technique between January 2001 and December 2008 were studied. Patients underwent a complete ophthalmologic evaluation. The IOL stability was assessed using slit-lamp and anterior segment optical coherence tomography (AS-OCT) examination. The IOL stability was evaluated in terms of centration and tilting. All the knots were photographed and their integrity assessed. Results Follow-up was 60–129 months. Eleven knots appeared evident and undamaged, 6 knots were eroded, and 9 knots were not detectable. All IOLs were stable in the sulcus. Two patients presented a slight decentration of the IOL at the slit-lamp examination, while the AS-OCT demonstrated slight tilting of the lenses in 4 patients. Conclusions The Lewis technique for IOL scleral fixation is an optimal surgical technique in case of absence of capsular support. No IOL luxation in the vitreous chamber has been reported; only 2 of the 10 patients with at least one eroded knot presented a minimal decentration of the lens with no influence on visual acuity. Although knot erosion is not an uncommon occurrence, IOL remains stable in the long term, probably due to a fibrotic process around the suture, and the IOL haptics, which prevent IOL dislocation.

We describe the clinicopathological and ultrastructural features of an opaque single-piece hydrophilic acrylic intraocular lens (IOL) explanted from a patient. The main outcome of this report is the documentation of calcium deposits confirmed by surface analysis. The decrease in visual acuity was due to the opacification of the IOL. The opacification involved both the optic plate and the haptics. The analysis at the scansion electron microscope revealed that the opacity was caused by the deposition of calcium and phosphate within the lens optic and haptics. This is the first case about the opacification of an Oculentis L-313. The opacification was characterized by calcium and phosphate deposition probably due to a morphological alteration of the posterior surface of the IOL.

To describe the intraoperative complications and the learning curve of microincision cataract surgery assisted by femtosecond laser (FLACS) with bimanual technique performed by an experienced surgeon.It is a prospective, observational, comparative case series. A total of 120 eyes which underwent bimanual FLACS by the same experienced surgeon during his first experience were included in the study; we considered the first 60 cases as Group A and the second 60 cases as Group B. In both groups, only nuclear sclerosis of grade 2 or 3 was included; an intraocular lens was implanted through a 1.4-mm incision. Best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), central corneal thickness and endothelial cell loss (ECL) were evaluated before and at 1 and 3 months after surgery. Intraoperative parameters, and intra- and post-operative complications were recorded.In Group A, we had femtosecond laser-related minor complications in 11 cases (18.3%) and post-operative complications in 2 cases (3.3%); in Group B, we recorded 2 cases (3.3%) of femtosecond laser-related minor complications with no post-operative complications. Mean effective phaco time (EPT) was 5.32 ± 3.68 s in Group A and 4.34 ± 2.39 s in Group B with a significant difference (p = 0.046). We recorded a significant mean BCVA improvement at 3 months in both groups (p 0.05) and no significant SIA nor corneal pachymetry changes in the two groups during the follow-up (p 0.05). Finally, we found significant ECL in both groups with a significant difference between the two groups (p = 0.042).FLACS with bimanual technique and low-energy LDV Z8 is associated with a necessary initial learning curve. After the first adjustments in the surgical technique, this technology seems to be safe and effective with rapid visual recovery and it helps surgeons to standardize the crucial steps of cataract surgery.

The province of Modena is one of the most industrialized areas of Northern Italy. The medical records of the Ophthalmological Emergency Department (OED) of Modena University Hospital were studied: there were 13,470 OED accesses in 2014 and in 754 cases that an occupational eye injury occurred. The frequency of work-related eye injuries (3‰) was lower compared to other published studies, but the absolute number is still relevant, showing the need for more adequate prevention, especially in metal work, construction work, and agriculture, where the worst prognoses were observed. Intervention programs must be implemented as early as possible in the working life, considering that the frequency in younger workers is about double that of the oldest age class (3.5‰ vs. 1.8‰), and special attention should also be given to foreigners, who have a 50% higher injury risk. Furthermore, the planning of specific interventions for eye-injured workers may be useful, considering that a previous injury does not appear to encourage the adoption of preventive interventions, and a subgroup of eye-injured workers have a potential risk for new injuries. Finally, the data presented here indicates how OED records, integrated with specific occupational information, can be applied for studies on work-related eye injuries.

Despite appropriate management of the systemic disease, patients with diabetes may develop severe forms of diabetic retinopathy that require surgery. Non-clearing vitreous haemorrhage (VH), traction retinal detachment involving the macula, combined traction and rhegmatogenous retinal detachment, progressive fibrovascular proliferation (PFP) and rubeosis with acute VH represent the main indications for surgery. Vitrectomy techniques and surgical tools have developed dramatically in the last decade in order to help the surgeon succeed in these challenging cases.

Purpose To evaluate visual outcomes and complications of bimanual microincision cataract surgery performed by surgeons in training. Setting Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy. Design Prospective case series. Methods The corrected distance visual acuity (CDVA), astigmatism, corneal pachymetry, and endothelial cell count were evaluated before and 7 and 30 days after bimanual MICS performed by surgeons in training. Intraoperative and postoperative complications were also recorded. Results Three surgeons in training performed bimanual MICS in 150 eyes of 131 patients. There were 18 intraoperative complications (12.0%) (10 iris traumas [6.6%]; 4 capsule ruptures without vitreous loss [2.7%]; 3 capsule ruptures with vitreous loss [2.0%]; 1 intraocular lens [IOL] implantation in the sulcus due to zonular laxity [0.7%]). There were 5 postoperative complications (3.3%) (2 iris prolapses [1.3%]; 1 IOL loop malposition [0.7%]; 1 narrowing of anterior chamber [0.7%]; 1 capsulorhexis phimosis [0.7%]). Thirty days postoperatively, the mean CDVA improvement was 0.53 ± 0.20 (Snellen decimal) ( P P = .29), and the mean increase in corneal pachymetry was 7.42 ± 22.01 μm ( P = .12). There was statistically significant endothelial cell loss (mean 496.50 ± 469.66 cells/mm 2 ) ( P Conclusions Bimanual MICS performed by surgeons in training was safe and effective. Visual outcomes and complication rates were similar to those reported for coaxial cataract surgery performed by surgeons in training. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

A database study to test a new model of surgical safety checklist for eye surgery in the outpatient operating room, especially for cataract surgery and intravitreal anti-VEGF injections.WHO Surgical Safety Checklist analysis, and changes to obtain a customized surgical safety checklist for eye surgery. Testing of the new checklist in the outpatient operating room of the Institute of Ophthalmology, University of Modena during a period of 4 months (January-April 2011). All cataract surgery and intravitreal anti-VEGF operations were included in the study, and controlled by the new surgical safety checklist. The percentage of answers to each safety check was calculated to obtain an estimate of adherence to our new checklist.Eight hundred and forty nine procedures (390 cataract, 452 anti-VEGF injections, seven combined surgery) were analyzed. The study showed a high level of adherence to the majority of the safety checks in the checklist. Important differences were identified in consent confirmation (correct confirmation in 99.76 %, no confirmation in 0.24 %), surgical site marking (correct marking in 99.29 %, no marking in 0.71 %), patient cooperation during operation (95.17 % of patients were cooperative, 4.83 % of patients were uncooperative), adherence to antibiotic prophylaxis (correct prophylaxis in 93.17 %, no prophylaxis in 6.83 %), critical situation during surgical procedures (no critical situation in 91.76 %, critical situation in 8.24 %)The study showed a high level of adherence to the checklist. A surgical safety checklist could improve the management of an eye surgery operating room.

Gian Maria Cavallini, Tommaso Verdina, Matteo Forlini, Veronica Volante, Michele De Maria, Giulio Torlai, Caterina Benatti, Giancarlo Delvecchio Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena,Italy Purpose: To determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons. Patients and methods: Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software. Results: Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P

Background Limbal stem cell (LSC) deficiency leads to corneal opacity due to a conjunctivalization of the corneal surface. LSC transplantation, which can be followed by corneal keratoplasty, is an effective procedure to restore corneal transparency; however, a common cause of failure of this procedure is neovascularization (NV). Methods A 59-year-old man with a 21-year history of a corneal chemical burn caused by phosphoric acid in his left eye was examined. He presented with unilateral total LSC deficiency with severe conjunctivalization and a corrected distance visual acuity that was limited to hand motion. Results We reported the short-term in vivo efficacy of subconjunctival bevacizumab for progressive corneal NV in a patient with LSC deficiency that underwent LSC transplantation. Four months after autologous LSC transplantation and 1 month after the second subconjunctival bevacizumab injection, the patient’s corrected distance visual acuity was 1/10. Conclusion Subconjunctival injection of bevacizumab can reduce the corneal NV, reducing conjunctival inflammation and supporting restoration of a stable ocular surface that is able to counteract graft failure, with no toxicity for the transplanted LSC.