Baseline factors predicting the risk of conversion from ocular hypertension to primary open-angle glaucoma during a 10-year follow-up

PurposeTo evaluate the ability of baseline clinical, morphological, and functional factors to predict the conversion to primary open-angle glaucoma (POAG) in ocular hypertensive (OHT) patients.MethodsThis single-center prospective longitudinal observational study included 116 eyes of 116 OHT patients followed for a 10-year period. All patients had intraocular pressure (IOP) ≥24 mm Hg in one eye and >21 mm Hg in the other eye, normal visual fields (VFs) and normal optic disc (OD) appearance in both eyes at baseline. All OHT patients were untreated at baseline with subsequent treatment upon need according to clinical judgement. Only one eye per subject was randomly selected. Patient age, gender, IOP, central corneal thickness (CCT), and ibopamine test results were collected at baseline. All patients underwent standard automated perimetry, short-wavelength automated perimetry (SWAP), frequency-doubling technology, confocal scanning laser ophthalmoscopy (CSLO), and scanning laser polarimetry (SLP) at baseline and every 6 months thereafter. Main outcome measure was the conversion to POAG, defined as the development of reproducible VF and/or OD abnormalities attributable to glaucoma. Cox proportional hazards models were used to identify the baseline factors predictive of POAG conversion.ResultsDuring the 10-year follow-up, 25% of eyes converted to POAG. In multivariate Cox models, baseline factors that were significant predictors of POAG development included: older age (hazard ratio (HR) 1.0, 99% confidence intervals (CIs) 1.0-1.2, per 1 year older); SWAP Glaucoma Hemifield test 'outside normal limits' (HR 4.3, 99% CIs 1.2-17.9); greater SLP 'Inter-eye Symmetry' (HR 1.1, 99% CIs 0.4-3.0, per 1 unit lower); lower CSLO Rim Volume (HR 1.1, 99% CIs 0.3-3.2, per 0.1 mm(3) lower); and greater CSLO cup-to-disc ratio (HR 6.0, 99% CIs 3.6-16.8, per 0.1 unit greater).ConclusionsThe baseline parameters that proved to be useful in assessing the likelihood of an OHT patient to develop POAG included age, functional variables provided by SWAP, and structural variables provided by SLP and CSLO. In this cohort of patients, baseline IOP, CCT, and ibopamine provocative test results were not significant predictors of POAG conversion.

Higher order aberrations after keratoplasty for keratoconus

PURPOSE

To compare higher order aberrations (HOAs) caused by the anterior and posterior corneal surfaces after conventional penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and automated lamellar therapeutic keratoplasty (ALTK) in patients undergoing corneal transplantation for keratoconus (KC).

METHODS

This retrospective, observational, cross-sectional study included one eye of the following subjects: 40 patients with KC, 23 KC patients after PK, 17 KC patients after DALK, 18 KC patients after ALTK, and 38 healthy controls. All underwent imaging with a rotating Scheimpflug camera (at least 6 months after complete suture removal in grafted subjects) to assess the HOAs from the anterior and posterior corneal surfaces within the central 4-mm and 6-mm zones. The conversion of the corneal elevation profile into corneal wavefront data was performed using Zernike polynomials. Total and third- and fourth-order HOAs were considered. The root mean square of the Zernike vector magnitude, expressed in micrometers, was used. Differences among groups were assessed using the Kruskal-Wallis and Duncan multiple range tests. Statistical significance was defined as p < 0.05.

RESULTS

In both 4-mm and 6-mm central zones, the total HOAs from the anterior corneal surfaces were significantly lower in DALK than in ALTK and PK groups (p < 0.05). The total HOAs from the posterior corneal surface were comparable amongst postoperative groups (p > 0.05). The aberration components that were significantly greater included coma in the KC and ALTK eyes, trefoil and coma in the DALK eyes, and trefoil in the PK eyes.

CONCLUSIONS

The corneal anterior surface optical quality appeared significantly better after DALK than after ALTK and PK.

Lower lid reconstruction utilizing auricular conchal chondral-perichondral tissue in patients with neoplastic lesions

PURPOSE

To assess surgical outcomes of lower lid reconstruction surgery using auricular conchal tissue.

METHODS

This prospective study included 20 patients that underwent reconstructive lower lid surgery using autologous auricle chondral-perichondral graft tissue. Auricle tissue was used to provide adequate support and protection with similar conjunctiva tarsal structures on overlying soft tissues in patients with pathologic inferior lid tissue loss requiring reconstructive surgery. Biopsies with histopathology and cytology analysis were taken after 1 year. Cytology analysis using CK19 was used to confirm newly formed conjunctiva overlying the graft.

RESULTS

All patients showed no graft rejection. Surgical outcomes were generally good, with minimal or no ocular complications. 16 of 20 patients had excellent results, showing good lid symmetry and esthetics, minimal auricular discomfort, patient satisfaction and proper lid function. Surgical outcomes were highly dependent on proper post-op conjunctiva formation. All patients were positive for CK19, thus indicating proper conjunctiva tissue formation.

CONCLUSIONS

Lower lid reconstruction surgery using auricular chondral-perichondral conchal tissue is a good alternative in patients with neoplastic lesions. Autologous chondral-perichondral tissue provides good functional and mechanical support in the reconstructed lid, thus reducing the risks of ectropion and corneal exposure and ensuring a protected ocular surface.

Humphrey matrix frequency doubling technology perimetry and optical coherence tomography measurement of the retinal nerve fiber layer thickness in both normal and ocular hypertensive subjects

PURPOSE

The purpose of this study was to determine by means of the Humphrey Matrix frequency doubling technology (FDT) perimetry and the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurement whether functional and/or structural differences exist between normal and ocular hypertensive (OHT) subjects.

PATIENTS AND METHODS

One eye of 60 consecutive normal individuals and 60 OHT subjects was enrolled in this prospective observational comparative case series study. All subjects were examined at either the Ophthalmology Clinic, University of Chieti-Pescara, Chieti, Italy or the Department of Ophthalmology, S. Maria della Misericordia Hospital, Udine, Italy. All subjects underwent a full ophthalmic examination, including visual acuity, slit-lamp biomicroscopy, central corneal thickness ultrasound pachymetry measurement, achromatic automated perimetry, Matrix FDT perimetry, stereoscopic optic nerve head photography, and OCT. Matrix FDT perimetry mean deviation (MD), pattern standard deviation, glaucoma hemifield test, and 12 OCT RNFL thickness parameters were examined. Student t test, Bonferroni correction for multiple comparisons and receiver operator characteristics curve areas (AUROCs) were used to find any discrimination function between healthy and OHT eyes. Sensitivities at 83% and 92% specificities were reported.

RESULTS

The FDT MD scores ranged from -1.10 to +3.80 decibels (db) in normal individuals and from -4.75 to +3.20 db in OHT subjects. The comparison between the average MD in the 2 groups showed a statistically significant difference (P=0.024). OCT showed a statistically significant difference between the 2 groups when examining the ratio between the inferior and the superior mean RNFL thickness (P=0.004). For OCT, the parameter with the largest AUROC for discriminating between healthy and hypertensive eyes was the ratio between the mean inferior and superior RNFL thickness (AUROC=0.85, sensitivity=75% at specificity=83%, sensitivity=67% at specificity=92%). For Matrix FDT perimetry, the parameter with the largest AUROC was MD (AUROC=0.78, sensitivity=67% at specificity=83%, sensitivity=58% at specificity=92%).

CONCLUSIONS

Our results suggest that OHT eyes having a normal achromatic automated perimetry and a normal clinical disc appearance cannot be differentiated from normal eyes using conventional OCT parameters. When analyzing the ratio between inferior and superior average RNFL thickness, however, a significant difference is evident between healthy and hypertensive eyes. Using Matrix FDT perimetry, a significant difference in MD seems to exist between these 2 groups of eyes. The AUROCs confirm that OCT Iavg/Savg and Matrix FDT MD show the greatest sensitivity and specificity among the examined OCT and Matrix FDT parameters.

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.

360° Ab-Interno Schlemm's Canal Viscodilation with OMNI Viscosurgical Systems for Open-Angle Glaucoma-Midterm Results

PURPOSE

To evaluate the effectiveness of ab-interno microcatheterization and 360° viscodilation of Schlemm's canal (SC) performed with OMNI viscosurgical system in open angle glaucoma (OAG) together or not with phacoemulsification.

SETTING

Two surgical sites.

DESIGN

Retrospective, observational.

METHODS

Eighty eyes from 73 patients with mild to moderate OAG underwent ab- interno SC viscodilation performed with OMNI system. Fifty eyes (Group 1) underwent only SC viscodilation, while 30 eyes (Group 2) underwent glaucoma surgery + cataract extraction. Primary success endpoint at 12 months was an intraocular pressure (IOP) reduction higher than 25% from baseline with an absolute value of 18 mmHg or lower, either on the same number or fewer ocular hypotensive medications, without further interventions. Secondary effectiveness endpoints included mean IOP, number of medications and comparison of outcomes between groups. Safety endpoints consisted of best-corrected visual acuity (BCVA), adverse events (AEs), and subsequent surgical procedures.

RESULTS

Primary success was achieved in 40.0% and 67.9% in Groups 1 and 2, respectively. Mean IOP at 12-month follow-up showed a significant reduction in both groups (from 23.0 to 15.6 mmHg, p < 0.001, and from 21.5 to 14.1, p < 0.001, in Groups 1 and 2, respectively). Mean medication number decreased in both groups (from 3.0 to 2.0, p < 0.001 and from 3.4 to 1.9, p < 0.001, in Groups 1 and 2, respectively). AEs included hyphema (2 eyes), mild hypotony (4 eyes), IOP spikes one month after surgery (1 eye). Twelve eyes (15.0%) required subsequent surgical procedures. No BCVA reduction was observed.

CONCLUSIONS

Viscodilation of SC using OMNI viscosurgical systems is safe and relatively effective in reducing IOP in adult patients with OAG.

Corneal thickness and functional damage in patients with ocular hypertension

PURPOSE

To correlate functional damage over time detected by standard automated perimetry (SAP) and frequency doubling technology (FDT) with central corneal thickness (CCT) in patients with ocular hypertension (OHT).

METHODS

Seventy-eight OHT patients underwent CCT measurements, SAP, and FDT (the latter two also after 12 and 18 months). Patients were divided into three equally sized groups of 26 patients each: thin (< 540 microm), normal (540-580 microm), and thick cornea (> 580 microm). The frequency of abnormal FDT and SAP results was analyzed over time (Pearson chi2 test).

RESULTS

Six of 26 patients with thin corneas (23.1%) presented an abnormal FDT test at baseline, compared to 1 of 26 (3.8%) in the normal thickness cornea group and 1 of 26 (3.8%) in the thick cornea group. After 12 months, the abnormal FDT tests were as follows, respectively: 9 of 26 (34.6%), 2 of 26 (7.7%), and 2 of 26 (7.7%). For SAP the abnormal results were as follows, respectively: 8 (30.1%), 5 (19.2%), and 2 (7.7%). After 18 months, the abnormal FDT tests were as follows, respectively: 16 (61.5%), 5 (19.2%), and 5 (19.2%). For SAP, the abnormal results were as follows, respectively: 10 (38.5%), 5 (19.2%), and 2 (7.7%).

CONCLUSIONS

OHT patients with thinner corneas have a greater risk of developing functional damage over time.

The impact of COVID-19 related national lockdown on ophthalmic emergency in Italy: A multicenter study

PURPOSE

To assess ocular pathologies admitted to Italian Emergency Eye Departments (EEDs) during the COVID-19 pandemic national lockdown in 2020 in comparison with the same period in 2019.

METHODS

Electronic records of all patients presenting at EEDs of two tertiary-care Eye Centers during the COVID-19 national lockdown in Italy (March 10-May 3, 2020) were compared with the equivalent period in 2019. Main outcomes were patient age, gender, and diagnoses. Statistical analysis included unpaired Student t-tests, Poisson regression, and chi-square test.

RESULTS

Overall EED visits significantly decreased by 54.1% during the 2020 lockdown compared to 2019 (851 vs 1854, p < 0.001). During lockdown, patients showed comparable mean age (52.8 years in 2020 vs 53.3 years in 2019, p = 0.52) and significant male gender bias (61.1% in 2020 vs 55.8% in 2019, p < 0.0001). The most frequent pathologies were eye inflammations, trauma-related incidents, and spontaneous acute vitreous detachment. Patients with inflammation, headache/hemicrania, and spontaneous subconjunctival hemorrhages were significantly less, whereas those with trauma-related diagnoses were significantly higher during the lockdown as compared with 2019 (p < 0.05). The proportion of non-urgent visits decreased from 17% in 2019 to 8% in 2020 (p < 0.001).

CONCLUSIONS

During the 2020 lockdown, there was a significant reduction of accesses to EED, especially for non-urgent pathologies. Potentially visual function threatening conditions, such as trauma-related pathologies, retinal detachment or ruptures, and wet AMD, showed lower number of cases but higher or stable proportion relative to the total caseload, suggesting a correct and efficient access to ophthalmic health care during the pandemic period.

Repeatability and accuracy of applanation resonance tonometry in healthy subjects and patients with glaucoma

PURPOSE

To evaluate the repeatability and accuracy of the applanation resonance tonometer (ART) used in the automatic servo-controlled version, and to evaluate the influence of central corneal thickness (CCT) on the ART intraocular pressure (IOP) measurements.

METHODS

This prospective, randomized, single-centre study included one eye of 153 subjects (35 healthy volunteers and 118 patients with glaucoma). All participants underwent ultrasonic CCT measurement, followed by IOP evaluation with Goldmann applanation tonometer (GAT) and ART in random order. A single operator measured the IOP with each tonometer three times. Intra-examiner variability was evaluated using the coefficient of variation (CoV), intraclass correlation coefficient (ICC) and test-retest differences. Intermethod agreement was assessed using the Bland-Altman method. Linear regression analysis was used to evaluate the relationship between IOP measurements and CCT.

RESULTS

The mean IOP was 17.7 ± 4.4 mmHg with GAT and 20.6 ± 5.3 mmHg with ART (p < 0.001). CoV and ICC were, respectively, 5 ± 3% and 0.99 for GAT, and 8 ± 4% and 0.96 for ART (intermethods differences, p = 0.001). The ART test-retest differences significantly increased with increasing mean IOP (p = 0.003). The mean IOP difference (ART minus GAT) was 3.0 ± 4.0 mmHg, which increased with increasing mean IOP (p < 0.001). Both GAT IOP and ART IOP readings were significantly directly related to the CCT values (p = 0.03 and p = 0.004, respectively; intermethods difference, p = 0.32).

CONCLUSIONS

The ART intra-examiner repeatability was excellent, although significantly lower than that of GAT, and decreased at higher IOP levels. ART significantly overestimated GAT IOP measurements, especially at higher IOP range. Both GAT and ART appeared similarly influenced by CCT value.

Pharmaceutical Approaches to Normal Tension Glaucoma

Normal tension glaucoma (NTG) is defined as a subtype of primary open-angle glaucoma (POAG) in which the intraocular pressure (IOP) values are constantly within the statistically normal range without treatment and represents approximately the 30-40% of all glaucomatous cases. The pathophysiology of this condition is multifactorial and is still not completely well known. Several theories have been proposed to explain the onset and progression of this disease, which can be divided into IOP-dependent and IOP-independent factors, suggesting different therapeutic strategies. The current literature strongly supports the fundamental role of IOP in NTG. The gold standard treatment for NTG tends to be based on the lowering IOP even if "statistically normal". Numerous studies have shown, however, that the IOP reduction alone is not enough to slow down or stop the disease progression in all cases, suggesting that other IOP-independent risk factors may contribute to the NTG pathogenesis. In addition to IOP-lowering strategies, several different therapeutic approaches for NTG have been proposed, based on vaso-active, antioxidant, anti-inflammatory and/or neuroprotective substances. To date, unfortunately, there are no standardized or proven treatment alternatives for NTG when compared to traditional IOP reduction treatment regimes. The efficacy of the IOP-independent strategies in decreasing the risk or treating NTG still remains inconclusive. The aim of this review is to highlight strategies reported in the current literature to treat NTG. The paper also describes the challenges in finding appropriate and pertinent treatments for this potentially vision-threatening disease. Further comprehension of NTG pathophysiology can help clinicians determine when to use IOP-lowering treatments alone and when to consider additional or alternatively individualized therapies focused on particular risk factors, on a case-by-case basis.

Visual field testing with the new Humphrey Matrix: a comparison between the FDT N-30 and Matrix N-30-F tests

PURPOSE

To determine if the N-30-F test with the new Humphrey Matrix instrument is comparable to the traditional frequency-doubling technology (FDT) N-30 test.

METHODS

A sample of 47 eyes from 47 patients (five normal subjects, 27 with ocular hypertension and 15 with glaucoma) underwent visual field (VF) testing with standard automated perimetry, and with FDT, using the FDT N-30 program, and the Matrix N-30-F program (using the same 19 tested points, full-threshold strategy, but with an enhanced algorithm to reduce testing time). The plots, mean deviation (MD), pattern standard deviation (PSD), defect locations and test time were compared.

RESULTS

The agreement between the two tests was shown to be good, except for subjects with large VF defects, in which greater PSD values were observed with the FDT test, whereas the Matrix test gave a higher MD and number of abnormal test locations in the total deviation plot. A lack of agreement was also found for the number of abnormal test locations on the pattern deviation plot at any VF loss severity level. The test time for the Matrix test was significantly shorter.

CONCLUSION

The FDT N-30 and Matrix N-30-F tests proved to be comparable in cases of early to moderate VF defects.

Tumor Microenvironment and Glioblastoma Cell Interplay as Promoters of Therapeutic Resistance

The invasive nature of glioblastoma is problematic in a radical surgery approach and can be responsible for tumor recurrence. In order to create new therapeutic strategies, it is imperative to have a better understanding of the mechanisms behind tumor growth and invasion. The continuous cross-talk between glioma stem cells (GSCs) and the tumor microenvironment (TME) contributes to disease progression, which renders research in this field difficult and challenging. The main aim of the review was to assess the different possible mechanisms that could explain resistance to treatment promoted by TME and GSCs in glioblastoma, including the role of M2 macrophages, micro RNAs (miRNAs), and long non-coding RNAs (lncRNAs) from exosomes from the TME. A systematic review of the literature on the role of the TME in developing and promoting radioresistance and chemoresistance of GBM was performed according to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. A dedicated literature review search was also performed on the immunotherapeutic agents against the immune TME. We identified 367 papers using the reported keywords. The final qualitative analysis was conducted on 25 studies. A growing amount of evidence in the current literature supports the role of M2 macrophages and non-coding RNAs in promoting the mechanisms of chemo and radioresistance. A better insight into how GBM cells interact with TME is an essential step towards comprehending the mechanisms that give rise to resistance to standard treatment, which can help to pave the way for the development of novel therapeutic strategies for GBM patients.

Canaloplasty in Corticosteroid-Induced Glaucoma. Preliminary Results

PURPOSE

to present the mid-term results of canaloplasty in a small cohort of corticosteroid glaucoma patients.

MATERIAL AND METHODS

Nine eyes from seven patients with various types of corticosteroid glaucoma in maximum medical therapy underwent canaloplasty. Patients underwent complete ophthalmic examination every six months. Success was defined as: post-operative intraocular pressure (IOP) ≤ 21 mmHg and ≤ 16 mmHg without ("complete success"), and with/without medical treatment ("qualified success"). The IOP reduction had to be ≥ 20. The number of medications before and after surgery was considered. The follow-up mean period was 32.7 ± 20.8 months (range 14-72 months).

RESULTS

The pre-operative mean IOP was 30.7 ± 7.2 mmHg (range: 24-45). The mean IOP at 6 and 12-month follow-up was 13.1 ± 2.6 mmHg, and 13.7 ± 1.9 mmHg, respectively. Qualified and complete success at 6 and 12 months was 100% for both of the two definitions. The number of medications used preoperatively and at the 12-month follow-up was 4.3 ± 0.7, and 0.2 ± 1.0, respectively. No serious complication was observed.

CONCLUSIONS

The mid-term results of canaloplasty in patients with corticosteroid-induced glaucoma appear to be very promising. Canaloplasty should be considered as a possible alternative to filtering surgery in this form of glaucoma, when medical therapy is not sufficient to maintain the IOP within reasonable limits.

Learning effect and test-retest variability of pulsar perimetry

PURPOSE

To assess Pulsar Perimetry learning effect and test-retest variability (TRV) in normal (NORM), ocular hypertension (OHT), glaucomatous optic neuropathy (GON), and primary open-angle glaucoma (POAG) eyes.

METHODS

This multicenter prospective study included 43 NORM, 38 OHT, 33 GON, and 36 POAG patients. All patients underwent standard automated perimetry and Pulsar Contrast Perimetry using white stimuli modulated in phase and counterphase at 30 Hz (CP-T30W test). The learning effect and TRV for Pulsar Perimetry were assessed for 3 consecutive visual fields (VFs). The learning effect were evaluated by comparing results from the first session with the other 2. TRV was assessed by calculating the mean of the differences (in absolute value) between retests for each combination of single tests. TRV was calculated for Mean Sensitivity, Mean Defect, and single Mean Sensitivity for each 66 test locations. Influence of age, VF eccentricity, and loss severity on TRV were assessed using linear regression analysis and analysis of variance.

RESULTS

The learning effect was not significant in any group (analysis of variance, P>0.05). TRV for Mean Sensitivity and Mean Defect was significantly lower in NORM and OHT (0.6 ± 0.5 spatial resolution contrast units) than in GON and POAG (0.9 ± 0.5 and 1.0 ± 0.8 spatial resolution contrast units, respectively) (Kruskal-Wallis test, P=0.04); however, the differences in NORM among age groups was not significant (Kruskal-Wallis test, P>0.05). Slight significant differences were found for the single Mean Sensitivity TRV among single locations (Duncan test, P<0.05). For POAG, TRV significantly increased with decreasing Mean Sensitivity and increasing Mean Defect (linear regression analysis, P<0.01).

CONCLUSIONS

The Pulsar Perimetry CP-T30W test did not show significant learning effect in patients with standard automated perimetry experience. TRV for global indices was generally low, and was not related to patient age; it was only slightly affected by VF defect eccentricity, and significantly influenced by VF loss severity.

Enhanced surgical technique for sutureless intrascleral fixation of intraocular lenses

A simplified intrascleral fixation technique involving implantation of the Carlevale intraocular lens (IOL) in the posterior chamber is described, which lodges the T-shaped IOL haptics in the scleral wall, not requiring scleral flaps. This surgical modification reduces operative time, limits iatrogenic damage to the sclera, and avoids friction between haptics and the conjunctiva, which may cause conjunctival erosion and infection in the long term. 13 patients with crystalline lens or IOL dislocation/subluxation had surgery to implant the Carlevale IOL in the posterior chamber. Mean corrected distance visual acuity preoperatively was 0.75 ± 0.5 logMAR (range, 0.2 to 1.5 logMAR) and improved to 0.28 ± 0.3 logMAR (range, 0 to 1.0 logMAR) postoperatively. Complications rarely occurred and were not sight-threatening. The sutureless scleral fixation of the Carlevale IOL using the modified surgical technique may represent a safe and effective procedure to restore visual function in patients with damaged zonular-capsular support.

An Overview of Corneal Transplantation in the Past Decade

The cornea is a transparent avascular structure located in the front of the eye that refracts light entering the eyes and also serves as a barrier between the outside world and the internal contents of the eye. Like every other body part, the cornea may suffer insult from trauma, infection, and inflammation. In the case of trauma, a prior infection that left a scar, or conditions such as keratoconus that warrant the removal of all or part of the cornea (keratoplasty), it is important to use healthy donor corneal tissues and cells that can replace the damaged cornea. The types of cornea transplant techniques employed currently include: penetrating keratoplasty, endothelial keratoplasty (EK), and artificial cornea transplant. Postoperative failure acutely or after years can result after a cornea transplant and may require a repeat transplant. This minireview briefly examines the various types of corneal transplant methodologies, indications, contraindications, presurgical protocols, sources of cornea transplant material, wound healing after surgery complications, co-morbidities, and the effect of COVID-19 in corneal transplant surgery.

Optic disc damage staging system

PURPOSE

To evaluate the optic disc damage staging system (ODDSS); a new clinical method of optic disc (OD) classification based on OD size, neural rim (NR) loss severity and localization. Accuracy, reproducibility, and reliability were studied. Agreement of ODDSS with the Heidelberg-Retina-Tomograph (HRT) results was evaluated.

METHODS

One eye of 68 consecutive open-angle glaucoma (POAG) patients and 40 controls underwent standard automated perimetry (SAP), HRT-II, and OD examination using the ODDSS classification by 3 independent graders in this prospective cross-sectional study. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) in discriminating between normal and POAG eyes were determined for ODDSS and HRT parameters. ODDSS intraobserver and interobserver agreement and agreement with HRT-Moorfield-Regression-Analysis (MRA) were assessed.

RESULTS

ODDSS sensitivity ranged from 72.0% to 89.7%; specificity ranged from 92.5% to 100%. Differences between AROCs for ODDSS (0.89 to 0.94) and for the best-performing HRT parameter (Vertical Cup/Disc Ratio 0.88) were not statistically significant. ODDSS interobserver agreement ranged from 0.33 to 0.78; intraobserver agreement ranged from 0.53 to 0.89. Agreement with HRT-MRA ranged from 0.50 to 0.87.

CONCLUSIONS

ODDSS is a new method for assessing, recording, and sharing information about the clinical OD appearance. Our preliminary results show that it provides good sensitivity and specificity in glaucoma detection. The interobserver and intraobserver agreement ranged from fair to good.

The Use of Artificial Intelligence Algorithms in the Prognosis and Detection of Lymph Node Involvement in Head and Neck Cancer and Possible Impact in the Development of Personalized Therapeutic Strategy: A Systematic Review

Given the increasingly important role that the use of artificial intelligence algorithms is taking on in the medical field today (especially in oncology), the purpose of this systematic review is to analyze the main reports on such algorithms applied for the prognostic evaluation of patients with head and neck malignancies. The objective of this paper is to examine the currently available literature in the field of artificial intelligence applied to head and neck oncology, particularly in the prognostic evaluation of the patient with this kind of tumor, by means of a systematic review. The paper exposes an overview of the applications of artificial intelligence in deriving prognostic information related to the prediction of survival and recurrence and how these data may have a potential impact on the choice of therapeutic strategy, making it increasingly personalized. This systematic review was written following the PRISMA 2020 guidelines.

Peripapillary retinal nerve fiber layer thickness analysis with scanning laser polarimetry (GDx VCC) in normal children

PURPOSE

To assess the use of scanning laser polarimeter with variable corneal compensation (GDx VCC) in children; to compare GDx VCC parameters between normal children and adults; and, to evaluate peripapillary retinal nerve fiber layer thickness variation with age in normals.

PATIENTS AND METHODS

Ninety-eight normal children (mean age 8.5+/-2.8 y; range: 3 to 17) and 96 normal adults (mean age of 47.0+/-20.4 y; range: 18 to 87) underwent GDx VCC testing. Eyes with small or large optic discs were excluded. The "extended parameter table" parameters and mean thickness values of the 4 quadrants and 64 sectors were considered. Differences between age groups, retinal thickness comparisons and age effect were assessed using unpaired t test, analysis of variance, and regression analysis.

RESULTS

GDx VCC parameters in children and adults showed wide intersubject variability. All parameters, excluding Symmetry, were significantly greater in children (P<0.05). TSNIT (temporal, superior, nasal, inferior, temporal) average, superior average and inferior average parameters showed a significant age-related thinning (P<0.01), at a rate of 0.043, 0.057, and 0.121 microm/y, respectively.

CONCLUSIONS

A significant age-related superior and inferior retinal nerve fiber layer thinning was found using GDx VCC. Considering the significant differences between children and adults for most GDx VCC parameters, the built-in adult normative database cannot be applied in children.

Postkeratoplasty Anterior and Posterior Corneal Surface Wavefront Analysis: Descemet's Stripping Automated Endothelial Keratoplasty versus Penetrating Keratoplasty

Purpose. To compare the higher-order aberrations (HOAs) due to the anterior and posterior corneal surfaces in patients that underwent either Descemet-stripping-automated-endothelial-keratoplasty (DSAEK) or penetrating keratoplasty (PK) for endothelial dysfunction and age-matched controls. Methods. This retrospective, observational, case series included 28 patients after PK, 30 patients after DSAEK, and 30 healthy controls. A Scheimpflug imaging system was used to assess the HOAs due to the anterior and posterior corneal surfaces at 4 mm and 6 mm optical zones. Total, 3rd and 4th order HOAs were considered. Intra- and intergroup differences were assessed using the Friedman and the Kruskal-Wallis tests, respectively; paired comparisons were performed using Duncan's multiple range test. Results. Total, 3rd and 4th order HOAs due to both corneal surfaces at 4 mm and 6 mm optical zones were significantly higher in the PK group, intermediate in the DSAEK group, and lower in controls (P < 0.05). The most important HOAs components in both PK and DSAEK groups were trefoil and coma from the anterior corneal surface (P < 0.05) and trefoil from the posterior corneal surface (P < 0.05). Conclusions. The optical quality of both corneal surfaces appeared significantly higher after DSAEK than after PK, which can increase the postoperative patient's quality of vision and satisfaction.

Canaloplasty in Pseudoexfoliation Glaucoma. Can It Still Be Considered a Good Choice?

Purpose: The aim of this study was to assess the long-term outcomes of canaloplasty surgery in pseudoexfoliation glaucoma (PEXG) patients. Material and Methods: A total of 116 PEXG patients with an intraocular pressure (IOP) > 21 mm/Hg and maximum tolerated local medical therapy who underwent canaloplasty from February 2008 to January 2022 were considered. Every six months, all subjects underwent a complete ophthalmic examination. The period of follow-up ranged from 2 to 167 months. Inclusion criteria included only patients for whom the entire procedure could be completed with a follow-up of at least 2 years. Results: Amongst the 116 PEXG patients, the entire procedure could not be performed in 10 eyes (8.6%), and thus they were not considered in the analysis. Twenty-three patients did not reach the two-year follow-up and another 16 patients during this time period were lost. A total of 67 patients with a mean follow-up of 49 ± 32.3 months were considered in the analysis. The pre-operative mean IOP was 31.2 ± 8.7 mm/Hg (range 20−60). The mean IOP at the two-year follow-up was 17.2 ± 6.7 mmHg, with a mean reduction from baseline of 44.9%. After two years, the qualified success rates according to three different criteria (IOP ≤ 21, ≤18 and ≤16 mmHg) were 80.6%, 73.1% and 61.0%, respectively. The total number of medications used pre- and at the follow-up at 2 years was 3.5 ± 0.8 and 1.2 ± 1.4, respectively. Early complications included: hyphema, in about 30% of cases; Descemet membrane detachment (4.9%); and IOP spikes > 10 mmHg (9.7%). A late failure with an acute IOP rise of up to 50 mmHg was observed in 41 cases (61.2%) after 3 to 72 months. Conclusions: Long-term post-operative outcomes of canaloplasty in PEXG patients appear to be quite good on average; however, an acute rise in IOP can be observed in more than 60% of the cases after a long period of satisfactory IOP control. For this reason, canaloplasty may not be suitable in eyes with PEXG, especially in patients with severe functional damage.

Role of stem cells-based in facial nerve reanimation: A meta-analysis of histological and neurophysiological outcomes

BACKGROUND

Treatments involving stem cell (SC) usage represent novel and potentially interesting alternatives in facial nerve reanimation. Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth, spreading, myelinization, in addition to limiting fibrotic dege neration after surgery. However, the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.

AIM

To investigate the histological, neurophysiological, and functional outcomes in facial reanimation using SC, compared to autograft.

METHODS

Our study is a systematic review of the literature, consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines. The review question was: In facial nerve reanimation on rats, has the use of stem cells revealed as effective when compared to autograft, in terms of histological, neurophysiological, and functional outcomes? Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.

RESULTS

After screening 148 manuscript, five papers were included in our study. 43 subjects were included in the SC group, while 40 in the autograft group. The meta-analysis showed no significative differences between the two groups in terms of myelin thickness [CI: -0.10 (-0.20, 0.00); I 2 = 29%; P = 0.06], nerve fibers diameter [CI: 0.72 (-0.93, 3.36); I 2 = 72%; P = 0.6], compound muscle action potential amplitude [CI: 1.59 (0.59, 3.77); I 2 = 89%; P = 0.15] and latency [CI: 0.66 (-1.01, 2.32); I 2 = 67%; P = 0.44]. The mean axonal diameter was higher in the autograft group [CI: 0.94 (0.60, 1.27); I 2 = 0%; P ≤ 0.001].

CONCLUSION

The role of stem cells in facial reanimation is still relatively poorly studied, in animal models, and available results should not discourage their use in future studies on human subjects.

Stratus-OCT imaging in early glaucomatous and in ocular hypertensive patients with and without frequency-doubling technology abnormalities

AIM

To compare Stratus-OCT measurements in controls, ocular hypertensive (OHT) patients with (FDT+) and without (FDT-) frequency-doubling technology (FDT) abnormalities, and in patients affected with early primary open-angle glaucoma (POAG).

METHODS

Thirty-two controls, 78 OHT patients (38 FDT- and 40 FDT+), and 45 early POAG patients (six FDT- and 39 FDT+) underwent the following tests within 3 months: standard automated perimetry (SAP) HFA 30-2; FDT N-30-F; and, Stratus-OCT imaging with retinal nerve fibre layer (RNFL) and optic nerve head (ONH) scans. One eye per patient was considered. Differences among groups were evaluated using the Kruskal-Wallis, analysis of variance, and Duncan's tests.

RESULTS

There were no significant differences in all Stratus-OCT parameters between POAG and OHT FDT+ patients. Statistically significant differences were found between the control group and both the POAG and OHT FDT+ groups for 15 of the 21 Stratus-OCT parameters. Control eyes compared to OHT FDT- showed significant differences in 13 of the 21 parameters. The comparison between the OHT FDT- group, and both the POAG and OHT FDT+ group resulted in 13 of the 21 parameters to be significantly different.

CONCLUSIONS

Stratus-OCT seems to show a higher ability in detecting significant differences between healthy, OHT, and early POAG eyes when compared to SAP and FDT. This suggests that the Stratus-OCT could show structural abnormalities before SAP or FDT visual field defects appear in patients at risk of developing glaucoma, which may be beneficial in making therapeutic decisions, especially in OHT patients.

Spontaneous posterior vitreous detachment: A glance at the current literature

Spontaneous posterior vitreous detachment (PVD) is a common age-related condition in which prevalence tends to increase with age. Acute PVD can cause the onset of symptoms that include visual disturbances, myodesopsia and photopsia. The goal of this short review was to provide a quick glance at the important factors related to PVD based on current literature in this field, which includes incidence, symptoms, diagnosis, risk factors, and education for patients with acute symptoms, and treatments. The take home message is that an ophthalmic examination at the onset of symptoms is of utmost importance, considering that irreversible sight-threatening complications can be prevented if diagnosed and treated promptly.