Aflibercept as First-Line Therapy in Patients with Treatment-Naïve Neovascular Age-Related Macular Degeneration: Prospective Case Series Analysis in Real-Life Clinical Practice.

PURPOSE: To assess the 13-month effectiveness and safety of aflibercept in naïve patients with neovascular age-related macular degeneration (nvAMD) in a real-life clinical setting. METHODS: Thirty-two treatment-naïve patients with nvAMD participated in a prospective two-center study. Patients received intravitreal injections of aflibercept (Eylea®), a loading dose of three monthly injections (2 mg/0.05 ml) every 4 weeks for the first 3 months, followed by intravitreal injections every 2 months. RESULTS: At 3 and 13 months, the mean best-corrected visual acuity improved significantly as compared with baseline (logMAR 0.53 ± 0.30 and 0.55 ± 0.32 vs. 0.30 ± 0.24, respectively, p < 0.001). At 3 and 13 months, 46.8% of patients (15/32) gained ≥15 ETDRS letters. The mean decrease in central macular thickness was also significant at 3 months (252 ± 35 µm) and at 13 months (249 ± 38 µm) as compared with pretreatment values (383 ± 76 µm) (p < 0.01). Also, 50% resolution of pigment epithelial detachment (PED) was observed in 8 out of 9 eyes (88.9%) with PED at baseline. Intravitreal injections were well tolerated and no adverse events were recorded. CONCLUSION: Aflibercept was effective and safe for treating nvAMD in naïve patients in routine daily practice.

Trachoma and the Importance of Sexual Infective Route in Developed Countries. Comment on Gallenga et al. Why the SAFE-S Strategy for Trachoma? Are Musca sorbens or Scatophaga stercoraria Really the Culprit?-A Brief Historical Review from an Italian Point of View. Pathogens 2023, 12, 1419.

We have read the review article entitled "Why the SAFE-S Strategy for Trachoma [...].

Optical Performance of a Segmented Extended-Depth-of-Focus Intraocular Lens under the Influence of Different Values of Spherical Aberration Generated by Refractive Surgery.

BACKGROUND: Corneal refractive surgery induces high-order aberrations, specifically spherical aberration (SA). These aberrations can have implications when patients later develop cataracts and require the implantation of multifocal intraocular lenses (MIOLs). MIOLs with asymmetric designs pose challenges in predicting outcomes, particularly in these cases. The aim of this study was to evaluate how different values of SA, resulting from various types of refractive surgeries, affect the optical performance of the FEMTIS Comfort intraocular lens. METHODS: The through-focus modulation transfer function (TF-MTF) curve and high-contrast images of tumbling E were used as parameters to assess the optical performance of the MIOL. These parameters were measured using an adaptive optics visual simulator. RESULTS: Increasingly negative values of SA make the MIOL more bifocal, moderating its extended-depth-of-focus characteristic. Conversely, higher positive SA values cause the TF-MTF curve to shift towards positive vergences, leading to worsened distance vision in the +1.00 to +2.00 D range, but improved vision in the +0.50 D to +1.00 D range. CONCLUSIONS: Assessing SA in patients prior to implanting MIOLs with asymmetric designs is necessary for predicting outcomes and making informed decisions based on the visual requirements of patients.

Comparison of the Polychromatic Image Quality of Two Refractive-Segmented and Two Diffractive Multifocal Intraocular Lenses.

Evaluating chromatic aberration for a multifocal intraocular lens (MIOL) in vitro is essential for studying its performance because it helps determine the most appropriate lens for each patient, enhancing surgical outcomes. While refractive MIOLs with angular power variation have shown positive clinical outcomes, studies of these MIOLs on optical benches primarily employed monochromatic green light, neglecting the impact of longitudinal chromatic aberration (LCA) on MIOL performance. To address this gap, we evaluated the through-focus modulation transfer function (TF-MTF) and the point spread function (PSF) of two refractive segmented extended depth of focus intraocular lenses (IOLs) (Femtis Comfort and Precizon Presbyopic), comparing the results with those obtained with two widely known diffractive multifocal intraocular lenses (AcrySof IQ ReSTOR and FineVision Pod F). Measurements of the TF-MTF were conducted using both monochromatic and polychromatic light in a customized optical bench. The refractive designs exhibited distinct haloes in the PSFs. When comparing the refractive and diffractive designs, opposite signs of LCA were observed at near foci. These findings emphasize the influence of the optical design of IOLs on their performance under polychromatic light, providing valuable information for vision care professionals when selecting the most suitable lens for each patient.

Optical performance of a new design of a trifocal intraocular lens based on the Devil's diffractive lens.

In this work, we propose a new diffractive trifocal intraocular lens design with focus extension, conceived to provide a high visual performance at intermediate distances. This design is based on a fractal structure known as the "Devil's staircase". To assess its optical performance, numerical simulations have been performed with a ray tracing program using the Liou-Brennan model eye under polychromatic illumination. The simulated through the focus visual acuity was the merit function employed to test its pupil-dependence and its behavior against decentering. A qualitative assessment of the multifocal intraocular lens (MIOL) was also performed experimentally with an adaptive optics visual simulator. The experimental results confirm our numerical predictions. We found that our MIOL design has a trifocal profile, which is very robust to decentration and has low degree of pupil dependence. It performs better at intermediate distances than at near distances and, for a pupil diameter of 3 mm, it works like an EDoF lens over almost the entire defocus range.

Polychromatic Assessment of a Refractive Segmented EDOF Intraocular Lens.

This study aimed to evaluate in vitro performance refractive segmented EDOF intraocular lenses under polychromatic light using an optical bench that complies with the ISO 11979-2 Norm. The through focus modulation transfer function (TF-MTF) of the Femtis Comfort LS-313 MF15 (Oculentis GmbH, Berlin, Germany) IOL was evaluated for IOLs with three different base powers. The effect of the asymmetry of the segmented designs was evaluated with 3 different wavelengths and with polychromatic light at a 3.0 mm and 5.0 mm pupil diameter. It was demonstrated that the TF-MTF curves exhibit a bifocal profile that, in practice, results in an EDOF design. As a consequence of the LCA, the TF-MTF values in white light were lower than in monochromatic light. Images of the USAF test chart were obtained to confirm the prediction of the TF-MTFs. We found that Femtis Comfort is a bifocal low-addition IOL and this fact can result in an EDOF effect which was obtained previously in clinical trials. Moreover, we showed that the base power influences the IOL optical quality, which results as more effective for high powers (hyperopic eyes) than for low powers (myopic eyes). The LCA of the segmented refractive design was very low and presumably not clinically relevant.

Neurotrophic Keratopathy Treated with Topical Recombinant Human Nerve Growth Factor (Cenegermin): Case Series Study with Long-Term Follow-Up.

The authors report the use of topical recombinant human nerve growth factor cenegermin 0.02% in 5 patients diagnosed with neurotrophic keratopathy (NK) in a real-life setting. These 5 patients affected with stage II and III NK mainly of herpetic cause received cenegermin six times daily for 8 weeks. It was initiated upon refractoriness to prior conventional topical treatment. Visual acuity, corneal sensitivity test at four corneal quadrants, fluorescein staining, OC,T and photography were performed weekly during 9 weeks of follow-up from the completion of treatment. At the ninth week of follow-up, corneal sensitivity improvement and healing of corneal ulcers were found in all patients. No adverse events were reported, and no corneal ulcer recurrence was observed over a 4-year follow-up period. Cenegermin should be used in combination with conventional therapy for advanced NK, as it is an effective treatment for healing corneal ulcers, improving the corneal surface homeostasis and avoiding surgery.

In Vitro Chromatic Performance of Three Presbyopia-Correcting Intraocular Lenses with Different Optical Designs.

Most of the new premium models of intraocular lenses for presbyopia correction use diffractive optics in their optical design. The presence of multiple foci and the difference of the diffractive efficiency for different wavelengths have a great impact in the lens optical performance. In this context, there is a limited information available for clinicians to understand the optical principles that differentiate each design and their potential influence on clinical outcomes. Optical bench studies with polychromatic light are necessary to solve this limitation. In this work, a custom made optical bench was employed to assess with polychromatic light the through the focus optical quality of three different IOL designs: trifocal, EDOF effect; and enhanced monofocal. By using different and complimentary approaches: images of the USAF test, axial PSFs and TF-MTFs, each design revealed its intrinsic features, which were not previously reported for these IOLs models in a comparative way. It was found that the chromatic aberration plays a very important role in the performance of each IOL. Our results could help clinicians to understand the optical principle of each lens and also provide useful information for choosing the lens that best suits the needs of the individual patient.

Impact of Different Clinical Baseline Characteristics on Intravitreal Dexamethasone Implant Ozurdex® Outcomes.

PURPOSE: To determine the impact of different baseline clinical characteristics on the improvement in best corrected visual acuity (BCVA) in patients with diabetic macular edema (DME) who underwent the intravitreal dexamethasone implant (DEX) Ozurdex®. METHODS: This was a single center retrospective study conducted on patients with DME, either naïve or previously treated, who were treated with one or more DEX and had a follow-up of at least 6 months. The main outcome measure was the proportion of DEX achieving an improvement ≥15 letters in BCVA. RESULTS: The study analyzed 192 DEX implants administered to 97 eyes (65 patients). Among the 192 DEX analyzed, 57 (29.7%) implants achieved a BCVA improvement ≥15 letters (ETDRS) from baseline, with a mean time for achieving such improvement of 89.2 (39.7) days. Eyes who received an additional DEX and those with a duration of DME < 6 months had a greater probability of achieving a BCVA improvement ≥15 letters (odds-ratio: 2.55, p = 0.0028 and odds-ratio: 1.93, p = 0.0434). The mean (standard deviation) change in BCVA from baseline was 7.5 (14.5) letters, p < 0.0001. The mean change in central macular thickness (CMT) from baseline was -128.0 (151.0) µm, p < 0.0001. The mean number of DEX implanted was 1.9 (0.8). Four (2.1%) DEX experienced an intraocular pressure increased ≥10 mm Hg; all the cases were successfully managed with topical antiglaucoma medication. CONCLUSION: The results of this study confirmed previous evidence suggesting that DEX is effective for improving BCVA and CMT in patients with DME.

A new trifocal corneal inlay for presbyopia.

Corneal inlays (CIs) are the most recent surgical procedure for the treatment of presbyopia in patients who want complete independence from the use of glasses or contact lenses. Although refractive surgery in presbyopic patients is mostly performed in combination with cataract surgery, when the implantation of an intraocular lens is not necessary, the option of CIs has the advantage of being minimally invasive. Current designs of CIs are, either: small aperture devices, or refractive devices, however, both methods do not have good performance simultaneously at intermediate and near distances in eyes that are unable to accommodate. In the present study, we propose the first design of a trifocal CI, allowing good vision, at the same time, at far, intermediate and near vision in presbyopic eyes. We first demonstrate the good performance of the new inlay in comparison with a commercially available CI by using optical design software. We next confirm experimentally the image forming capabilities of our proposal employing an adaptive optics based optical simulator. This new design also has a number of parameters that can be varied to make personalized trifocal CI, opening up a new avenue for the treatment of presbyopia.

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures.

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th ) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic.

Aqueous humor neutrophil gelatinase-associated lipocalin levels in patients with idiopathic acute anterior uveitis.

PURPOSE: The purpose of this study was to evaluate the levels of neutrophil gelatinase-associated lipocalin (NGAL) in the aqueous humor in eyes with idiopathic acute anterior uveitis (AAU). METHODS: A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with idiopathic AAU. The control group included 20 aqueous samples from 20 patients about to undergo cataract surgery and without any other ocular or systemic diseases. The level of NGAL was determined with a commercially available ELISA kit. RESULTS: The concentration of NGAL in aqueous humor was markedly higher in patients with idiopathic AAU than in control subjects (Mann-Whitney U test, p<0.001). The level of NGAL was 139,197.38+/-183,426.36 (mean+/-SD) pg/ml in eyes with AAU and 3,169.96+/-1,595.78 pg/ml in the eyes of the control group. CONCLUSIONS: The aqueous humor NGAL level is increased in eyes with idiopathic AAU. These results imply that NGAL is associated with the regulation of inflammation in patients with AAU and could be used as a biomarker of ocular inflammation and immunomodulatory treatment response.

Fusarium keratitis 3 weeks after healed corneal cross-linking.

PURPOSE: To report a case of Fusarium solani keratitis after corneal cross-linking (CXL) treatment. METHODS: A 23-year-old woman presented with corneal ulcer 4 weeks following a CXL procedure. RESULTS: Microbiological studies revealed Fusarium species as the etiological pathogen. CONCLUSIONS: Fusarium species may cause infectious crystalline keratopathy after corneal CXL treatment.

Imaging quality of bifocal piggyback intraocular lens versus ReSTOR and TECNIS multifocal lenses.

PURPOSE: The imaging quality provided by a piggyback integrated by a monofocal intraocular lens (IOL) + a bifocal IOL of zero power and +3.75 diopters of addition is compared with the optics quality of a simple multifocal IOL of the same power and addition. METHODS: The imaging quality was evaluated by determining the modulation transfer function (MTF), using an artificial eye simulating in vivo conditions of the anterior chamber, including an artificial cornea and a wet cell containing physiologic solution where the IOL was positioned. The MTFs of the bifocal piggyback for near and distance vision were measured, with pupil diameters of 3 and 5 mm, and compared with the MTFs of an equivalent power of ReSTOR and TECNIS multifocal IOLs measured under the same conditions. RESULTS: The MTFs for distance and near focus of the bifocal piggyback are similar to the MTFs of the ReSTOR and TECNIS multifocal IOLs with the two diameters of pupil. A more accurate comparison, values of average modulation, and Strehl ratio show a greater similitude with ReSTOR than with TECNIS. CONCLUSIONS: The bifocal piggyback system provides a similar imaging quality to that obtained with a ReSTOR multifocal IOL and, like the ReSTOR, provides better performance in distance vision than in near vision, whereas the TECNIS multifocal IOL provides the best performance.

Cyclosporine 0.1% (Ikervis®) as a corticoid-sparing agent in Lyell syndrome with KeraKlear® keratoprosthesis.

Cyclosporine 0.1% was used in a patient with Lyell syndrome, which had undergone a KeraKlear® keratoprosthesis implant due to the severe ocular involvement to avoid overuse of corticoid agents. To the best of our knowledge, this is the first reported case of cyclosporine 0.1% eye drops to use in Lyell syndrome previously treated with keratoprosthesis implant.

Use of Vivostat PRF® in Acanthamoeba keratitis.

We present a case of a 27-year-old contact lens male user who was diagnosed with Acanthamoeba keratitis. Given the inefficiency of medical treatment and high risk of corneal perforation, we decided to use Vivostat PRF®, with satisfactory results. To our knowledge, this is the first described case in medical literature in which Vivostat PRF® is used as part of Acanthamoeba keratitis treatment.

Usefulness of Liquid Biopsy Biomarkers from Aqueous Humor in Predicting Anti-VEGF Response in Diabetic Macular Edema: Results of a Pilot Study.

The objective was to investigate the usefulness of the "liquid biopsy" of aqueous humor (AH) to predict the clinical response after intravitreal injections (IVT) of anti-VEGF agents for treating diabetic macular edema (DME). For this purpose, AH samples obtained during the first anti-VEGF IVT from 31 type two diabetic patients were analyzed. Patients were classified into three groups according to their anti-VEGF response: rapid responders (n = 11), slow responders (n = 11), and non-responders (n = 9). In addition, patients (n = 7) who showed good response to corticosteroids but a delayed or no response to anti-VEGF therapy were analyzed. Levels of 17 different cytokines, chemokines, and growth factors in AH were measured using a multiplex immunoassay. We found higher concentrations of VEGF in rapid responders to anti-VEGF therapy compared to non-responders. In addition, slow responders to anti-VEGF treatment showed higher levels of inflammatory markers than rapid responders, but did not reach statistical significance. Finally, those patients who responded to corticosteroids but not to anti-VEGF therapy showed significantly lower levels of VEGF than patients with rapid response (p = 0.01). In conclusion, "liquid biopsy" of AH could be useful to determine whether the predominant pathogenic event is primarily angiogenic or inflammatory in nature. This approach would allow physicians to select a more rational and cost-effective treatment. Further studies to validate these preliminary results are warranted.

Clinical magnification and residual refraction after implantation of a double intraocular lens system in patients with macular degeneration.

PURPOSE: To evaluate the efficacy of a standard double intraocular lens (IOL) system (IOL-Vip) in patients with low vision and central scotoma due to macular degeneration and assess the predictability of the residual refraction and magnification. SETTING: Ophthalmology Department, Hospital General Universitario, Valencia, Spain. METHODS: This interventional prospective noncomparative case series comprised 13 consecutive surgical procedures in 10 patients with central scotoma. Follow-up was 12 months. Evaluation included the difference between preoperative and postoperative best corrected visual acuity (BCVA), refraction, position of the IOLs, endothelial cell density, and occurrence of postoperative complications. Residual refraction and eye magnification were calculated using a theory developed in a previous study, and the values were compared with the clinical results. RESULTS: The mean BCVA was 1.37 logMAR preoperatively and 0.68 logMAR 1 year postoperatively. The mean best corrected clinical gain was 44%. There was no statistically significant difference between the clinically evaluated and theoretically calculated residual refractions (P = .17). No intraoperative or postoperative complications occurred. CONCLUSIONS: Implantation of the double IOL system improved BCVA in patients with low vision due to advanced maculopathy. The results were best in myopic patients (long eyes); patients with hyperopia (short eyes) had high residual refraction. The postoperative clinical gain and residual refraction were predictable, showing the feasibility of implanting a customized double IOL.

Chronic alcohol feeding induces biochemical, histological, and functional alterations in rat retina.

AIMS: Ethanol consumption originates a wide spectrum of disorders, including alteration of visual function. Oxidative stress is included among the mechanisms by which alcohol predisposes nervous tissue to injury. Retina, which is the neurosensorial eye tissue, is particularly sensitive to oxidative stress. METHODS: In this study we analyze the effect of long-term alcohol consumption on oxidative stress parameters of the rat retina, and its correlation to retinal function, as well as to the expression of the antiapoptotic protein Bcl-2. We also study the protective effect of ebselen, a synthetic selenoorganic antioxidant. RESULTS: Herein we show that ethanol has a toxic effect on rat retina associated with oxidative stress. Decreases in retina glutathione concentration and increases in malondialdehyde content in whole eye homogenate significantly correlate with ERG b-wave decrease and Bcl-2 overexpression. We also show how ebselen is able to prevent all the alterations observed. CONCLUSION: Chronic ethanol consumption induces oxidative stress in rat retina associated with an impairment of ERG and Bcl-2 overexpression, suggesting a role for glial cells. All these alterations in the rat allow the proposal of an alcoholic retinopathy in this species.

Adalimumab therapy for refractory uveitis: a pilot study.

PURPOSE: The aim of this study was to assess the efficacy and safety of adalimumab in treating refractory autoimmune uveitis. METHODS: This work was a prospective, noncomparative, nonrandomized, clinical trial. Nineteen (19) patients meeting eligibility criteria received a 40-mg subcutaneous (s.c.) injection of adalimumab every other week during 1 year. RESULTS: All patients underwent an outcome assessment at month 12. Visual acuity improved by -0.3 logMar in 12 (31%) eyes of 38, and worsened by +0.3 logMar in 1 (2.6%) eye. All patients had an active intraocular inflammation at baseline, and 12 patients (63%) achieved control of their inflammation with adalimumab at the end of follow-up. After optic coherence tomography, 33 eyes (86%) had cystoid macular edema (CME) at baseline, and at the end of follow-up there was a complete resolution of CME in 18 of these 33 eyes (54.54%). All patients were able to reduce at least 50% of the dose of the concomitant immunosuppressive drugs at the end of follow-up. Adalimumab was well tolerated in all patients, and only local minor side effects at the s.c. injection site were observed. Nevertheless, 8 patients (42.10%) had relapses during the follow-up period that were controlled with 1 periocular steroid injection. CONCLUSIONS: Adalimumab seems to be an effective, safe therapy for the management of refractory uveitis and may provide the possibility to reduce the concomitant immunosuppressive drugs in these patients. Further long-term studies are warranted to determine the safety and efficacy of adalimumab in treating intraocular inflammation.