Multimodal imaging of Hypotrichosis with juvenile macular dystrophy: a case report.

BACKGROUND: To report the first Italian case of hypotrichosis with juvenile macular dystrophy complicated by macular neovascularization diagnosed through multimodal imaging. CASE PRESENTATION: An 11-year-old boy was referred to our Institution for bilateral maculopathy of unknown origin. Multimodal imaging helps the diagnosis of Juvenile Macular Dystrophy with Hypotrichosis (HJMD). Fundus examination showed several alterations of the retinal pigment epithelium and circular pigmented area of chorioretinal atrophy. Structural spectral domain optical coherence tomography (OCT) showed some backscattering phenomenon with several alterations of retinal pigment epithelium and photoreceptor layer in both eyes. Moreover, OCT showed hyperreflective lesion beneath the neuroepithelium in left eye. OCT angiography (OCT-A) revealed a pathologic neovascular network in choriocapillaris plexus, probably the result of a fibrovascular membrane. Multifocal electroretinograms (MfERGs) showed functional alterations in 12.22° of the central retina. In order to confirm the suspicion of HJMD, the child and both parents underwent genetic testing. Both parents resulted to be heterozygous healthy carriers of a single variation. CONCLUSION: Multimodal imaging, in particular OCT-A, is a useful aid, along to clinical findings and genetics, for the diagnosis of inherited retinal dystrophies.

Qualitative and quantitative analysis of an explanted opacified hydrophilic IOL after over two years from cataract surgery.

Opacification of hydrophilic intraocular lenses (IOLs) is an uncommon complication, that can appear after uneventful cataract surgery. We report a case of opacified Hydroview® IOL in a 76-year-old woman, with a previous history of pars plana vitrectomy with silicon oil tamponade in her right eye for a proliferative diabetic retinopathy, who developed an opacification of the IOL after over two years from a silicon oil/BSS exchange in combination with an uneventful phacoemulsification. The patient complained about a progressive decrease in her visual acuity. The slit-lamp examination confirmed the opacification of the IOL. Therefore, because of blurred vision, a combined procedure of explant and exchange of the IOL was performed in the same eye. Qualitative (Optic microscope, X-Ray powder Diffraction (XRD), Scanning Electron Microscopy (SEM)) and quantitative (Instrumental Neutron Activation Analysis (INAA)) analysis of the IOL material were performed. Here, our aim is to report the acquired data of the explanted Hydroview® H60M IOL.

Acute Acquired Concomitant Esotropia From Excessive Application of Near Vision During the COVID-19 Lockdown.

The public health measures imposed in many countries to slow the spread of the novel coronavirus (COVID-19) outbreak could have negative effects on children's physical and mental health. The authors describe four cases of acquired concomitant acute esotropia likely caused from excessive application of near vision during the COVID-19 lockdown. [J Pediatr Ophthalmol Strabismus. 2020;57:e88-e91.].

Comparison of corneal densitometry between big-bubble and visco-bubble deep anterior lamellar keratoplasty.

AIMS: To evaluate deep corneal densitometry and visual outcomes after big-bubble (BB-DALK) and visco-bubble (VB-DALK) deep anterior lamellar keratoplasty performed in patients with keratoconus. METHODS: Prospective comparative study of 50 advanced keratoconic patients who underwent DALK surgery; 25 eyes (group I) were completed with BB-DALK and 25 eyes (group II) with VB-DALK after the failure of pneumatic dissection. Best spectacle-corrected visual acuity (BSCVA), corneal tomographic parameters and endothelial cell count were recorded 1, 3, 6, 12 and 24 months after surgery. Densitometric analysis of the deep corneal interface was obtained using Scheimpflug tomography at each visit; values recorded were compared between the two groups and statistically analysed. RESULTS: BSCVA was significantly better in the BB-DALK group than the VB-DALK group (0.39±0.29 vs 0.65±0.23 logarithm of the minimum angle of resolution, respectively) for the first 3 months; and in the same time period, densitometry was significantly higher in the VB-DALK group than those recorded in the BB-DALK group (23.97±5.34 vs 17.13±4.44 grayscale units). However, densitometric values and visual acuity did not differ significantly in the two groups at 1 year. No statistically significant difference for the other variables analysed at any time frame was found. CONCLUSION: The use of viscoelastic substance in the VB-DALK technique may induce modification of interface stromal reflectivity resulting in reduced visual acuity up to 3 months postoperatively. However, this initial negative effect on the interface quality does not affect the long-term visual outcome, with densitometric values and visual outcomes similar in the two groups from 6 months postoperatively.

Efficacy and Safety of Wet Wipes Containing Hy-Ter® Solution Compared with Standard Care for Bilateral Posterior Blepharitis: A Preliminary Randomized Controlled Study.

INTRODUCTION: A novel treatment for posterior blepharitis which involves the use of disposable wet wipes imbibed with a solution of terpinen-4-ol and hyaluronic acid (Hy-Ter®) as well as aloe, natural anti-inflammatories and antiseptics (Blephapad Combo; Novelty Technology Care, Milan, Italy) has been proposed. The aim of this study was to compare the efficacy and safety of treatment with Blephapad Combo with standard treatment. METHODS: We conducted 4-week, open-label, randomized controlled study with a closed sequential design at the Magna Graecia University of Catanzaro, Italy in which patients aged > 40 years with symmetrical bilateral posterior blepharitis were enrolled. Each eye represented a single experimental unit. Patients were randomly assigned using a computer-generated randomization list to apply a reusable heated compress to the eyelid of one eye before cleansing the eyelid with the Blephapad Combo wet wipe (Blephapad Combo treatment arm) or to use the standard treatment of applying a wet and warm gauze to the other eye (standard treatment arm), twice daily for 4 weeks. The primary endpoint was the percentage change from baseline to week 4 in meibomian gland dysfunction (MGD) grading scale scores. RESULTS: Eighteen patients (9 men; 9 women) with a mean (± standard deviation) age of 66.9 ± 9.03 years were included in the study. Compared with the eye receiving the standard treatment, treatment with Blephapad Combo appeared to improve the MGD total score after 4 weeks of treatment (mean change from baseline - 29.9 vs. - 38.5%). The assessment of the investigators was that in 11 patients the eye treated with Blephapad Combo showed greater benefit, in two patients the eye treated with the standard treatment showed greater benefit and in four patients there was no difference between treatments. Blephapad Combo was well tolerated, with no serious adverse events (AEs) reported. Minor ocular AEs were reported in 44.4 and 38.9% of patients in the Blephard Combo and standard treatment arms, respectively. CONCLUSIONS: Treatment with Blephapad Combo was more effective than the standard treatment in ameliorating MGD in patients with posterior blepharitis. Minor ocular AEs events were equally distributed between the two treatments arms. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03301844.

Maxillary sinus mucocele with orbital complications.

INTRODUCTION: Maxillary sinus mucocele is an unusual clinic entity (incidence of 3-10%), represented by mucous secretion lined by respiratory stratified pavemented epithelium and its origin is mainly secondary to infections, inflammations, surgery, trauma or neoplasia. CASE REPORT: We present a case of maxillary sinus mucocele. Subject of the study is a 74 aged patient referring positive anamnesis for nasal cavity surgery. His symptoms appeared six months ago and he complainted vertical ocular diplopia and ocular tension sensation, without rhinologic complaints. Oculistic examination confirmed an isolated left inferior rectus palsy, and CT showed mucous secretion occupying left maxillary sinus, with bone erosion to the orbital floor until orbital muscles. MRI is the gold standard for differential diagnosis with neoplastic lesions but the patient refused to perform this radio-diagnostic exam. He underwent to Endoscopic sinus surgery, consisting in middle meatal antrostomy and removal of the mucocele. Four months later the endoscopic follow-up showed regular maxillary cavity and regular ocular motility. CONCLUSION: In our opinion the rebuilding of the eroded bone is not mandatory if the integrity of the maxillary upper wall mucosa is respected, and antrostomy with drainage allows to recover ocular and paranasal sinus function. KEY WORDS:, Diplopia, Endoscopic sinus surgery.

Novel Mutation in the CHRDL1 Gene Detected in Patients With Megalocornea.

PURPOSE: The aim of this study was to determine the mutation associated with X-linked megalocornea (MGC1) found in 2 patients from the same area in southern Italy. METHODS: Diagnosis of megalocornea was confirmed by detailed ophthalmic examination in 2 probands from independent families and in another 3 affected family members. Genomic DNA of the probands was used to amplify and sequence all the coding regions of CHRDL1. RESULTS: Megalocornea diagnosis was associated with a novel mutation found in the probands and affected kindreds (5 subjects). The mutation is an 11-base pair deletion that leads to a stop codon in the second coding exon of the CHRDL1 gene. Research on the CHRDL1 mutation was also performed on other family members (11 subjects) not affected by MGC1, and the mutation was not detected in unaffected male family members. CONCLUSIONS: The detection of mutations in the CHRDL1 gene is useful for differential diagnosis with different forms of megalocornea.