Corneal Findings Associated to Belantamab-Mafodotin (Belamaf) Use in a Series of Patients Examined Longitudinally by Means of Advanced Corneal Imaging.

Belantamab mafodotin (belamaf) is a novel antibody-drug conjugate developed for the treatment of patients with relapsed or refractory multiple myeloma (RRMM). Although the drug has demonstrated a good efficacy, corneal adverse events have been reported. In this prospective study, consecutive patients with RRMM who received belamaf infusions were included. The standard ophthalmological visit was implemented with anterior segment (AS)-optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). Five patients (three males, two females; mean age 66 ± 6.0 years) with MMRR and unremarkable ocular findings at baseline who received belamaf infusion were included. After a median time of 28 days from the first infusion, four of them developed corneal alterations with transient vision reduction to a variable extent. In particular, corneal deposits of microcyst-like epithelial changes (MECs) were detected centrally in one patient and peripherally in three patients. AS-OCT scans showed a bilateral heterogeneous increase in signal intensity, together with hyper-reflective lesions confined within the epithelium in all cases, except for one case in which they also involved the stroma. Corneal maps showed a transient increase in epithelial thickness in the first phase that was followed by a diffuse decrease in the subsequent phase. IVCM scans showed MECs as hyper-reflective opacities located at the level of corneal epithelium, largely intracellular. Multimodal corneal imaging may implement the current clinical scale, helping us to detect corneal abnormalities in patients under belamaf therapy. This workup provides useful data for monitoring over time corneal findings and for optimizing systemic therapy.

Long-Term Visual Outcomes and Morphologic Biomarkers of Vision Loss in Eyes With Diabetic Macular Edema Treated With Anti-VEGF Therapy.

PURPOSE: To analyze the morphological characteristics and long-term visual outcomes in eyes with diabetic retinopathy (DR) and diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF) therapy. DESIGN: Retrospective clinical cohort study. METHODS: Patients with a long-term follow-up and evidence of resolved DME in at least 1 visit (study visit) after 5 years of follow-up after the initiation of anti-VEGF therapy were included. At the study visit, structural optical coherence tomography (OCT) scans were reviewed for qualitative features reflecting a distress of the neuroretina or retinal pigment epithelium (RPE). A quantitative topographical assessment of the inner and outer retinal thicknesses was also provided. RESULTS: A total of 61 eyes (50 patients) were included and were divided into 2 subgroups according to visual acuity (VA) at the study visit, yielding a group of 24 eyes with a VA <20/40 ("poor/intermediate vision" group), and 37 eyes with a VA ≥20/40 ("good vision" group). The external limiting membrane (ELM) and RPE bands were more frequently disrupted or absent in the poor/intermediate vision group (P = .003 and P = .019). Similarly, disorganization of retinal inner layers was more prevalent in the poor/intermediate vision group (P = .013). The foveal and parafoveal outer retinal thicknesses were reduced in eyes with poor/intermediate vision (P = .022 and P = .044). Multivariate stepwise linear regression analysis demonstrated that VA was associated with appearances of the RPE and ELM (P < .0001 and P = .048), foveal and parafoveal outer retinal thicknesses (P = .046 and P = .035). CONCLUSIONS: Modifications in the outer retina and RPE represent OCT biomarkers of long-term visual outcomes in eyes with DME treated with anti-VEGF.

Bilateral morphometric analysis of corneal sub-basal nerve plexus in patients undergoing unilateral cataract surgery: a preliminary in vivo confocal microscopy study.

AIMS: To evaluate bilateral morphometric changes of corneal sub-basal nerve plexus (CSNP) occurring after unilateral cataract surgery by in vivo confocal microscopy (IVCM) images analysed with automated software. METHODS: IVCM was performed before (V0) and 1 month after surgery (V1) in both operated eyes (OEs) and unoperated eyes (UEs) of 30 patients. Thirty age and sex-matched subjects acted as controls. Corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve total branch density (CTBD), corneal nerve fibre area (CNFA), corneal nerve fibre width, corneal nerve fractal dimension (CNFrD) and dendritic cells density were calculated. RESULTS: Mean CNFD, CNBD, CNFL, CTBD, CNFA and CNFrD significantly decreased at V1 versus V0 in both eyes (respectively, 15.35±7.00 vs 21.21±6.56 n/mm2 in OEs and 20.11±6.69 vs 23.20±7.26 in UEs; 13.57±12.16 vs 26.79±16.91 n/mm2 in OEs and 24.28±14.88 vs 29.76±15.25 in UEs; 9.67±3.44 mm/mm2 vs 13.49±3.42 in OEs and 12.53±3.60 vs 14.02±3.82 in UEs; 22.81±18.77 vs 42.25±24.64 n/mm2 in OEs and 38.06±20.52 vs 43.93±22.27 in UEs; 0.0040±0.0021 vs 0.0058±0.0020 mm2/mm2 in OEs and 0.0049±0.0016 vs 0.0057±0.0019 in UEs; 1.418±0.058 vs 1.470±0.037 in OEs and 1.466±0.040 vs 1.477±0.036 in UEs; always p<0.049). CONCLUSION: Patients undergoing cataract surgery exhibit bilateral alterations of CSNP. This finding could have broad implications in the setting of sequential cataract surgery.

Anti-VEGF Treatment in Corneal Diseases.

BACKGROUND: Corneal neovascularization (CN) is a clue feature of different ocular pathological conditions and can lead to corneal edema and opacification with subsequent vision loss. Vascular endothelial growth factor (VEGF), which plays a key role in new vessels formation, proliferation and migration, was found to be up-regulated in these conditions. Nowadays, it is possible to downregulate the angiogenic process by using anti-VEGF agents administered by different routes. OBJECTIVE: To evaluate the efficacy, safety and possible future directions of anti-VEGF agents used for the treatment of CNV owing to different aetiologies. METHODS: A computerized search of articles dealing with the topic of anti-VEGF therapy in CN was conducted in PubMed, Scopus and Medline electronic databases. The following key phrases were used: anti-VEGF agents, corneal neovascularization, bevacizumab, ranibizumab, vascular endothelial growth factor, angiogenesis. RESULTS: The use of anti-VEGF therapy in the treatment of CN reduced pathological vessel density without causing significant side effects. Various administration routes such as topical, subconjunctival and intrastromal ones are available, and the choice depends on patient and disease characteristics. Much more effectiveness is achieved in case of early administration before mature and wellestablished vessels take place. A combined approach between various drugs including anti-VEGF agents should be adopted in those cases at higher risk of neovascularization recurrence such as chronic long-standing diseases where ischemic and inflammatory stimuli are not definitively reversed. CONCLUSION: The efficacy and safety of anti-VEGF agents support their adoption into the daily clinical practice for the management of CN.

Foreskin reconstruction at the time of single-stage hypospadias repair: is it a safe procedure?

INTRODUCTION: Foreskin reconstruction (FR) is a recognised, yet debated, option for patients undergoing single-stage hypospadias repair (HR). METHODS: We evaluated the incidence of complications after single-stage HR in our institution. This is a retrospective review of all single-stage HR. Patients were classified into group 1 (circumcision) and group 2 foreskin reconstruction (FR). Urethroplasty and foreskin complications were recorded. Statistics used are as follows: Mann-Whitney test to compare age at operation and length of follow-up (FU); Chi-Square test to analyse the incidence of urethral complications and need for reoperation; Log rank test to compare the survival curves; p statistically significant < 0.05. Data are presented as median (range). RESULTS: 304 patients were identified, operated between January 2010 and December 2016, and 20 were excluded: 6 already circumcised at the time of the surgery, 3 with megameatus intact prepuce, 11 lost at FU. 284 patients were included: 161 circumcised and 123 FR. Median age at the operation was 17 months (8-179) (group 1) and 17 months (8-148) (group 2) (p = 0.71). Length of FU was 19 months (8-91) (group 1) and 17 months (4-87) (group 2) (p = 0.45). The survival curve was homogeneous (p = 0.28). Urethroplasty complications occurred in 32/161 (20%) (group 1) and in 21/123 (17%) (group 2) (p = 0.55). Foreskin complications occurred in 18/123 (15%). A second operation was required in 33 boys in each group, (20% group 1 and 27% group 2) (p = 0.21). CONCLUSION: FR does not increase the complication rate or the need for a reoperation after single-stage HR. Parents should be offered the option between the two procedures according to their personal preference.