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Sergio Zaccaria Scalinci,1 Nicola Valsecchi,2 Elena Pacella,3 Edoardo Trovato Battagliola3 1Ophthalmology Unit, DIMEC (Department of Medical and Surgical Sciences), Department of Ophthalmology, Alma Mater Studiorum University of Bologna, Bologna, Italy; 2Ophthalmology Unit, DIMES (Department of Experimental, Diagnostic and Specialty Medicine), Department of Ophthalmology, Alma Mater Studiorum University of Bologna, Bologna, Italy; 3Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, ItalyCorrespondence: Nicola ValsecchiOphthalmology Unit, DIMES (Department of Experimental, Diagnostic and Specialty Medicine), Department of Ophthalmology, Alma Mater Studiorum University of Bologna, Via Pelagio Pelagi 9, Bologna, 40138, ItalyTel +39 3407783914Email nicola.valsecchi2@studio.unibo.itPurpose: Stargardt disease (STGD1) is the most common hereditary macular degeneration and currently no treatments have been approved to interrupt the progression of the disease. The aim of this study was to evaluate the efficacy of photo-biomodulation in patients with Stargardt disease 1 year after treatment, considering as primary outcomes improvements in best corrected visual acuity (BCVA), microperimetry, and pattern electroretinography (PERG) amplitude.Materials and Methods: Ninety eyes of 45 patients with a diagnosis of Stargardt disease stage 1 were prospectively recruited at the University of Bologna. Selected patients were treated with photo-biomodulation therapy for 1 year for 10 minutes a day, twice a day, and 5 days per week for 12 months. A light emitting diode (LED) of 10 Hz and wavelength 650 nm was used. BCVA and microperimetry were assessed before treatment and 1 year after photo-biomodulation, whereas PERG was assessed at baseline, 1, 3, 6, and 12 months after treatment.Results: BCVA improved from 0.7 [interquartile range (IQR)=0.6– 0.9)] to 0.4 (IQR=0.2– 0.5)] after treatment (95% CI=− 0.3, − 0.35; p=< 0.001) and PERG negative wave at 35 ms (N35)-positive wave at 50 ms (P50) amplitude improved from 0.9 (IQR=0.74– 1.21) to 2.12 (95% CI=1.11, 1.28; p< 0.001). MP-1 Microperimetry improved from 26.5% (IQR=16.75– 40) of median preferred retinal loci (PRL) within an area of 2° of diameter to 38% (IQR=29– 50.25; 95% CI=10.50, 14.50; p=< 0.001); on the other hand, PRL within 4° of diameter raised from 72% (IQR=51.5– 80) to 80% (IQR=76– 87) after photo-biomodulation (95% CI=4.50, 7.50; p< 0.001). Also, patients with an improvement of more than 1.205 PERG N35-P50 ratio amplitude at 3 months and more than 1.29 at 6 months tended to present an improvement of more than 0.2 logMar in BCVA at 12 months (p=0.28, AUC=0.630; p=0.30, AUC=0.636).Conclusion: BCVA, PERG, and MP-1 significantly improved 1 year after treatment. Also, improvement of PERG N35-P50 amplitude at 3 and 6 months was correlated to BCVA improvement at 1 year, suggesting that PERG could be useful in predicting visual outcome after photo-biomodulation.Keywords: Stargardt disease, PERG, microperimetry, LED, photo-biomodulation

Purpose To explore the risk factors for central retinal vein occlusion (CRVO) by comparing a large sample of patients with healthy controls. Materials and Methods Multi-center case-control study. The study group includes patients affected by central retinal vein occlusion, confirmed angiographically, aged 50 years old or above (Group A). The control group includes healthy subjects without an history of retinal vein occlusion (Group B). Outcome measures: age, gender, active smoking, presence of uncontrolled arterial hypertension (uHTN), presence of the following comorbidities: diabetes mellitus type II (DMII), chronic liver disease (CLD), chronic kidney disease (CKD), thyroid disease (TD), systemic lupus erythematosus (SLE), hyperhomocystenemia (HHcy), dyslipidemia (DLip), carotid artery disease (CAD), glaucoma, atrial fibrillation (AF), migraine headache (MH), chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), history of myocardial infarction (MI). Odds-ratios were calculated with logistic regression analysis. Results A total of 203 patients (Group A) and 339 controls (Group B). Statistically-significant differences were found for the following variables: age (OR: 1.109 [1.081–1.138], p Conclusions Older age, active smoking, as well as presence of DMII, HHcy, DLip, CAD, glaucoma, OSAS, and uHTN, all increase the risk for CRVO. A comprehensive assessment of patients with CRVO is paramount. Adequate control of all the aforementioned risk factors is likely of great significance in reducing the incidence of CRVO among the general population, and it likely plays an important role in improving the prognosis following the occlusive event.

Elena Pacella,1 Lorenzo Loffredo,2 Mariaelena Malvasi,1 Edoardo Trovato Battagliola,1 Daniela Messineo,3 Fernanda Pacella,1 Loredana Arrico1 1Department of Sense Organs, University of Rome La Sapienza, Rome, Italy; 2Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy; 3Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Rome, ItalyCorrespondence: Fernanda PacellaDepartment of Sense Organs, University of Rome La Sapienza, Policlinico Umberto I, Viale del Policlinico 155 – 00161, Rome, ItalyTel +39 3333534396Email fernanda.pacella@gmail.comPurpose: Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants.Materials and Methods: A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards.Results: Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and − 0.41 mmHg (T3) (p < 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and − 0.66 mmHg (T3) (p < 0.05).Conclusion: Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30– 90 days following the implantation procedure and responds well to topical pressure-lowering medications.Keywords: intravitreal dexamethasone implant, Ozurdex injection, hypertension, side effect, complications, retinal vein occlusion