Utilization of apple vision pro in ophthalmic surgery: A pilot study.

PURPOSE: This paper explores the application of Apple Vision Pro in ophthalmic surgery, assessing its potential benefits in providing real-time imaging overlay, surgical guidance, and collaborative opportunities. MATERIALS AND METHOD: The device was worn by 10 ophthalmic surgeons during eyelid malposition surgery. All surgeons performed the entire surgery while wearing the visor. At the end of procedure, all operators had to rate Apple Vision Pro visor according to 10 specific item and system usability scale (SUS) questionnaire. RESULTS: The surgeons used the Apple Vision Pro during the entire procedure, and the results were positive, with high ratings for practicality, freedom of movement, integration into workflow, and learning. All surgeons rated the Apple Vision Pro above 85/100 in the SUS. CONCLUSION: The incorporation of Apple Vision Pro in oculoplastic surgery offers several advantages, including improved visualization, enhanced precision, and streamlined communication among surgical teams. According to our preliminary results Apple Vision Pro could represents a valuable tool in ophthalmic surgery, with implications for enhancing surgical techniques and advancing XR research in the surgical field.

Long-term effect of phacoemulsification on trabeculectomy function.

PURPOSE: To investigate the long-term effect of phacoemulsification on intraocular pressure (IOP) in trabeculectomized eyes and to identify the factors affecting the IOP changes. METHODS: In consecutive patients with previous trabeculectomy (TE) who underwent uncomplicated clear cornea phacoemulsification we evaluated intraocular pressure, need of antiglaucomatous medical therapy or glaucoma surgery, and length of glaucoma control without therapy. Glaucoma therapy was prescribed in the presence of IOP >18 mm Hg or worsening of the visual field. A group of trabeculectomized eyes that did not receive cataract surgery was retrospectively selected as a control. Multivariate analysis was used to test factors related to final outcome of the treatment. RESULTS: One hundred and eight eyes with previous TE that received phacoemulsification and 108 controls were included in the study. Phacoemulsification was performed 60±21 months after TE. After a mean follow-up of 66±28 months, mean IOP was significantly increased in the cataract surgery group (by 1.7±4.3 mm Hg) and in the control group (by 2.3±4.3 mm Hg)(both P<0.001); in two groups, respectively, 31 eyes (28.7%) and 17 eyes (15.7%) had received glaucoma therapy (chi-square P=0.030). Factors related to success (no need of therapy) were use of mitomycin-C (MMC) in previous TE (P<0.001), longer time from TE to cataract surgery (P=0.007), higher preoperative bleb score (P=0.021), and lower baseline IOP (P=0.042). CONCLUSIONS: Cataract surgery reduces the function of filtering bleb in some eyes. Factors related to low rate of failure are the previous use of MMC during TE, longer time from TE to cataract surgery, and good preoperative aspect of the bleb.

Long-term efficacy of latanoprost in primary congenital glaucoma.

PURPOSE: To investigate the success (glaucoma control) of latanoprost therapy of primary congenital glaucoma (PCG) and factors affecting the long-term outcome. METHODS: Patients with PCG treated with latanoprost were re-examined. At study visit and from clinical charts, we evaluated: intraocular pressure, length of glaucoma control with latanoprost, need of further medication or glaucoma surgery, systemic and topical side effects. Multivariate analysis was used to test factors related to the final outcome of the treatment. RESULTS: Eighty-one eyes of 44 patients with PCG, and 42 eyes of 29 patients with previous glaucoma surgery, had received latanoprost therapy. In the first group, a success (glaucoma control by latanoprost therapy) was found in 24 eyes (29.6%), whereas 57 eyes (70.4%) had received surgery (45 eyes (55.6%) in the first year); among the eyes with previous surgery, a success was found in 12 eyes (28.6%), 13 eyes (31%) required an additional therapy, and 17 eyes (40.5%) had received further glaucoma surgery. No patient discontinued the treatment because of side effects. Factors related to the failure of the latanoprost treatment were: the high score of severity of glaucoma (P=0.014) and low age at PCG presentation (P=0.042). CONCLUSIONS: Long-term treatment with latanoprost is effective in about 30% of the eyes; factors related to failure were severe glaucomatous alterations, and young age at PCG presentation.

Low-fluence photodynamic therapy in longstanding chronic central serous chorioretinopathy with foveal and gravitational atrophy.

PURPOSE: To describe anatomic and functional outcomes in two patients with long-standing severe chronic central serous chorioretinopathy (CSC) with foveal and gravitational atrophy treated with low-fluence photodynamic therapy (PDT). METHODS: Two patients with a history of over 10 years of chronic CSC and development of gravitational tracts, with best-corrected visual acuity

Retinal detachment after silicone oil removal is prevented by 360 degrees laser treatment.

AIM: To investigate the effect of 360 degrees laser retinopexy on the incidence of retinal detachment (RD) after silicone oil removal. METHODS: In a prospective, randomised clinical trial, 303 patients (303 eyes) affected with primary (n = 211) or recurring (n = 92) rhegmatogenous RD treated by vitrectomy with silicone oil (1000 cSt) and endolaser photocoagulation of retinal breaks were randomised to receive 360 degrees laser retinopexy or not. After at least 4 months, in eyes with a fully attached retina, the silicone oil was removed. The incidence of RD after silicone oil removal was evaluated. RESULTS: 151 eyes received 360 degrees laser retinopexy (completed intraoperatively in 93 eyes and postoperatively in 58 eyes, in nine of them after cataract extraction); 152 eyes served as controls. Silicone oil was removed from 139 laser-treated eyes (92.05%) and 129 controls (84.87%; NS). In the first group, 12 eyes (8.63%) developed an RD posterior to laser treatment (including the macula), three eyes (2.16%) had a localised posterior RD (treated by laser), and 14 (10.07%) had an RD anterior to the laser treatment. In the control group, RD occurred in 27 eyes (20.93%; p = 0.007). CONCLUSIONS: 360 degrees laser retinopexy reduces the incidence of RD after silicone oil removal; it should be completed intraoperatively.

Biocompatibility and biodegradation of intravitreal hyaluronan implants in rabbits.

To study the biocompatibility and the biodegradation rate in vivo of new intravitreal implants made with three different hyaluronic acid esters: Hyaff7, Hyaff11 and Hyaff11p75 (100% ethyl ester, 100 and 75% benzyl esters, respectively), the plugs were implanted through a sclerotomy at 3.5 mm from the limbus of rabbit eyes. In order to evaluate the in vivo biodegradation the shaft diameter of the plugs was measured by ultrasound biomicroscopy. Slit lamp microscopy, ophthalmoscopy and ERG were performed periodically. The effects of the implants on ocular tissues were also evaluated histologically. All the plugs showed a good biocompatibilitv. Plugs of both the total esters, Hyaff7 and Hyaff11, were found to undergo a slow dissolution process for 60 and 150 days, respectively. The partial benzyl ester, Hyaff11p75, was completely reabsorbed after 15 days. Analysis of variance showed a high correlation between biodegradation rate and the time of resorption (F = 90.5; p < 0.001). The biodegradation rate of each implant is related to the chemical structure of the three types of Hyaff (F = 4.51; p = 0.005). The present data suggest that intravitreal implants based on hyaluronic acid esters represent useful biocompatible and biodegradable devices for a potential drug delivery system in the treatment of posterior segment ocular diseases.

Multifocal intra-ocular lenses.

Multifocal intra-ocular lenses (IOLs) are designed to overcome the lack of accomodation to provide useful distance and near vision. Reduced contrast sensitivity has been reported. Refractive IOLs produce two or more focal points depending on the refractive power of the portion of the lens crossed by the light. Diffractive IOLs are strictly bifocal; each point of the lens can create both a distance and near focus. Several clinical investigations show that multifocal IOLs can be used as an alternative to monofocal lenses. However, patient selection, realistic expectations, and adequate control of surgical procedures are necessary.

Long-term visual results of bifocal intraocular lens implantation.

PURPOSE: To evaluate the long-term visual results and variability in contrast sensitivity in patients with heparin-surface-modified (HSM) diffractive bifocal intraocular lenses (IOLs). SETTING: Institute of Ophthalmology, University of Catania, Italy. METHODS: In this prospective study, visual acuity (distance and near) and contrast sensitivity were measured in 35 patients who had phacoemulsification with bifocal diffractive IOL (model 811E, Pharmacia) implantation. Patient satisfaction was also evaluated using a questionnaire. Mean follow-up was 20 months (range 18 to 24 months). RESULTS: At the last examination, mean distance visual acuity was 0.79 +/- 0.2 (SD) without correction and 1.0 +/- 0.15 with best correction. Mean uncorrected near visual acuity was J1.6 +/- J0.77 and with best distance correction, J1.19 +/- J0.49. No statistically significant changes in visual acuity were evident at the last follow-up (Student t test). No changes were found in contrast sensitivity reduction over time, nor were late postoperative complications noted. Overall patient satisfaction was rated as good by 94.3% of patients with best distance correction. CONCLUSIONS: The diffractive bifocal HSM IOL provided good visual performance for distance and near over time. In relation to the low rate of postoperative complications, the slight contrast sensitivity reduction was stable during follow-up.

Keratoconus staging with ultrasound biomicroscopy.

The diagnosis of keratoconus is based on slip-lamp and keratometric findings, and its classification includes 4 different stages. In this study, we compare the ultrasound biomicroscopy (UBM) findings and the keratoconus index (KI) determined using UBM with the severity of the disease. By means of UBM (Humphrey Instruments system model 840) using a 50-MHz probe, we studied 49 eyes affected with different forms of keratoconus. Using a method previously described, we calculated the KI and compared these data with the findings obtained using videokeratography. The mean thickness at the corneal apex in keratoconic eyes was 0.369 mm, while the mean peripheral corneal thickness was 0.568 mm. The mean KI was 1.449 in keratoconic eyes. The KI increased according to the severity of the disease. The mean central keratometry power was 56.95, while the mean amount of steepening of the inferior cornea compared with that of the superior cornea was 8.16. UBM can be considered a useful tool in the study of keratoconus. Using high-frequency ultrasound, it is also possible to obtain reliable measurements of corneal thickness related to the severity of the disease determined by videokeratography.

Corneal oedemas: diagnosis and surgical planning with ultrasound biomicroscopy.

We used the Humphrey Ultrasound Biomicroscope (UBM System 840 by Zeiss-Humprey Instruments, San Leandro, Calif. USA) to study various corneal oedemas and leucomas. This UBM system, using a high-resolution probe of 50 Mhz, has an axial and lateral resolution of about 50 micrometer. We analysed 36 eyes divided into two groups, 27 (group A) affected by corneal oedema caused by traumatic-mechanic or phlogistic-toxic lesions, 9 (group B) affected by postsurgery oedema. Thanks to its high-resolution power, we could study their pathogenesis and their clinical evolution and so arrange a suitable therapy and perform an accurate follow-up of these pathologies.

Ultrasound-biomicroscopic evaluation of filtering blebs after laser suture lysis trabeculectomy.

UNLABELLED: Sometimes in glaucomatous patients treated with trabeculectomy there is no correlation between bleb shape and intra-ocular pressure (IOP). In this study we evaluated the ultrasound biomicroscopy (UBM) features of filtering blebs after laser suture lysis (LSL) trabeculectomy in order to analyse whether its ultrasound-biomicroscopic image can predict the function (IOP). METHODS: The Humphrey ultrasound biomicroscope, using a high-frequency (50-Mhz) probe, provides high-resolution images of filtering blebs. A total of 103 filtering blebs after LSL trabeculectomy were analysed by UBM. Taking into account the characteristics of internal reflectivity and scleral flap, we classified the blebs into three groups (good, fair, poor) that indicate the bleb function and correlated this UBM pattern with the IOP control (good, borderline, failure). RESULTS: There was a statistically significant corelation between the UBM classification of function and the IOP control level. Both well-functioning and failed trabeculectomies could be identified by UBM. The UBM images of eyes with good IOP control are characterized by better visibility of the route under the scleral flap and a low reflectivity inside the bleb. CONCLUSIONS: In accordance with previous studies, we believe that UBM can be a useful method to study and explain the mechanisms of filtering structures and, together with IOP control, to evaluate the bleb function.

[Evaluation of the filtering bleb using ultrasound biomicroscopy]. / Beurteilung des Filterkissens mittels Ultraschallbiomikroskopie.

BACKGROUND: Sometimes in glaucomatous patients treated with trabeculectomy there is not a correlation between bleb shape and intraocular pressure. So we studied the functional anatomy of the filtering bleb by a ultrasound biomicroscope, using high frequency (50 Mhz) probe, which provides high resolution images of filtering blebs. MATERIALS AND METHODS: A total of 46 filtering blebs of 46 patients after trabeculectomy were analyzed by ultrasound biomicroscopy (50 Mhz). Dimensions, shapes and structure of blebs were evaluated in 2 groups of patients. RESULTS: It was possible to obtain longitudinal or transverse images of filtering blebs, to measure the height, to evaluate the reflectivity inside and to follow the route under the scleral flap. Blebs with lower reflectivity and a visible route under the scleral flap had a lower intraocular pressure while the height was not important for a good intraocular pressure. CONCLUSIONS: So ultrasound biomicroscopy can be a useful method to study filtering blebs and also to explain the mechanisms of filtering structures in patients who underwent trabeculectomy.

Evaluation of central and peripheral corneal thickness with ultrasound biomicroscopy in normal and keratoconic eyes.

PURPOSE: Our study was designed to calculate central and peripheral corneal thickness in patients affected with early stages of keratoconus and in normal subjects using ultrasound biomicroscopy (UBM). To obtain an objective and reliable assessment of the corneal thinning in affected eyes, we developed a keratoconus index (KI) by means of the UBM measurements. METHODS: By means of the commercial version of the ultrasound biomicroscope (system model 840; Zeiss-Humphrey Instruments, San Leandro, CA, USA) using a 50-MHz probe, we studied 30 normal and affected eyes. In keratoconic eyes, we measured the thinnest corneal thickness (TCT) at the apex of the conus and at four peripheral sites at a distance of 2.5 mm from the central site (peripheral corneal thickness: PCT). The same procedure was performed in the normal eyes. To obtain an objective and reliable assessment of the corneal thinning, we calculated the ratio between the mean PCT and the mean TCT (Keratoconus Index: KI = PCT/TCT), in keratoconic eyes. In normal eyes, the KI was calculated on the basis of the ratio between the mean PCT and the mean central corneal thickness (CCT). RESULTS: In keratoconic eyes, the mean corneal thickness at the thinnest part of the conus was significantly different from the CCT in normal patients (Student's t test, p < 0.001). The peripheral measurements were not significantly different from keratoconic and normal eyes. The mean KI was 1.482 (SD, 0.095) in the keratoconic eyes, whereas it was 1.189 (SD, 0.086) in the normal subjects. The statistical analysis of the KI calculated on the basis of the UBM measurements showed that the KI values are significantly different from healthy subjects and from keratoconic patients (Student's t test, p < 0.001). CONCLUSIONS: UBM can be considered a useful tool in the study of keratoconus. We believe that calculation of the KI by means of UBM gives the possibility of obtaining an objective assessment of corneal thinning. Therefore this parameter can be useful in the staging and in the follow-up of these patients.

MRI and intraocular tamponade media.

Thirteen patients who underwent surgery for retinal detachment and injection of intraocular tamponade media (silicone oil, fluorosilicone oil, or perfluorocarbon liquid) underwent magnetic resonance imaging (MRI), using spin-echo T1- and T2-weighted images. The ophthalmic tamponade media showed different signal intensity, according to their chemical structure. Unlike ophthalmoscopy or ultrasonography, MRI showed no oil-related artefact, making possible recognition of recurrent retinal detachment.

Iris receptors of fresh human eyes.

There are many reports describing the receptorial distribution in animal eyes but only a few reports concerned with human eyes. Because of this, we have studied five fresh human eyes, in vitro, by a very sensitive method. We have proved the existence of alpha exciting and beta 2 relaxing receptors on the iridial dilatator muscle and the absence of cholinergic, serotoninergic, dopaminergic, histaminergic receptors. On the contrary, on the circular muscle we have found muscarin cholinergic receptors without adrenergic ones.

[Preliminary study of the topical use of thymoxamine]. / Studio preliminare sull'uso topico della timoxamina.

In this work the Authors have tried to show the efficacy of TMX, as a miotic drug, and to find out the lowest concentration which can give the best results with the minor complications. Seven patients, in whom TMX was instilled in both eyes at 0.50%, 1%, 2% concentrations, were studied. A mydriatic was instilled before in the right eye, in order to obtain mydriasis whereas the left eye served as control. The 0.5% concentration was as efficacious as 1% and 2% ones, but had less side-effects.