A rare presentation of Nocardia Choroidal Abscess after Glioblastoma surgery.

PURPOSE: to report the natural history of a rare ocular manifestation of endogenous Nocardia farcinica infection in an immunocompromised patient, with involvement observed in both the anterior and posterior segments of the eye. METHODS AND RESULTS: Given the patient's limited mobility, a handheld fundus camera was utilized for bedside anterior segment and ocular fundus examinations. The findings included visual acuity of hand motion, posterior synechiae, vitreal opacity, and a large choroidal abscess. We monitored the lesion's progression through a series of follow-ups. Despite not employing intravitreal drug therapy, we noted a significant reduction in the lesion's size until the patient's overall health deteriorated. CONCLUSIONS: This case contributes valuable information to our understanding of the natural history of a rare condition like Nocardia endophthalmitis. We highlighted the usefulness of a handheld fundus camera in aiding infectious disease specialists in assessing the immediate response to systemic treatment.

OCT biomarkers as predictors of visual improvement in diabetic macular edema eyes receiving dexamethasone implants.

BACKGROUND: Several optical coherence tomography (OCT) biomarkers have been proposed as predictors for functional and anatomical outcomes in Diabetic Macular Edema (DME). This study aims to examine the impact of these OCT features on the visual acuity improvement of patients with DME after long-acting Dexamethasone intravitreal implants (DEX-I) injection. Furthermore, the safety and impact of DEX-I on clinical parameters, including intraocular pressure (IOP) were assessed. METHODS: In this retrospective observational study, we reviewed the medical records of naïve and non-naïve eyes with DME who received at least one DEX-I. The primary endpoint was visual acuity improvement of ≥ 5 ETDRS letters at 1 month and 4 months after treatment. Secondary outcomes were the changes in OCT biomarkers and the impact of DEX-I on IOP at 1 and 4 months of follow-up. Linear panel regression analysis was used to test for differences in central subfield thickness (CST) over time and it was stratified according to biomarkers at baseline. Finally, a logistic regression analysis was used to identify factors predicting visual improvement at 1 and 4 months. RESULTS: We included 33 eyes of which 63.6% were at an advanced stage of DME. Overall, CST, cube average thickness (CAT), cube volume (CV), and intraretinal cystoid spaces > 200 µm (ICS) decreased following DEX-I injection (p < 0.001). Additionally, a thicker CST at baseline was observed in eyes with better visual improvement at one month (p = 0.048). After logistic regression analysis, CST was retained as the only predictor for visual improvement at one month (p = 0.044). Furthermore, panel regression analysis identified a relation between subfoveal neuroretinal detachment (SND) at baseline and CST increase at four months. Lastly, only 15.2% of the eyes necessitated topical medication for IOP reduction, with no differences observed when stratifying between naïve and non-naïve eyes. CONCLUSION: Our analyses suggest that a ticker baseline CST may serve as a positive predictor of early visual improvement and SND presence at baseline may be a negative prognostic factor for CST increase 4 months after DEX-I injection. Other well-known biomarkers, such as disorganization of the inner retinal layers (DRIL) and hyperreflective foci (HF), did not demonstrate prognostic value on visual outcomes, at least within the first four months following the injection.

Osteo-odonto-keratoprosthesis According to Strampelli Original Technique: A Retrospective Study With Up to 30 Years of Follow-up.

PURPOSE: To describe clinical, anatomical, and visual outcomes obtained from a long-term follow-up of 59 patients who underwent osteo-odonto-keratoprosthesis (OOKP) using the Strampelli original technique. DESIGN: Retrospective clinical cohort study. METHODS: The study included 82 eyes of 59 patients who underwent OOKP surgery between 1969 and 2011. Patients' clinical characteristics before surgery as well as complications and further surgeries until the end of follow-up were recorded. Best-corrected visual acuity (BCVA) was revised before surgery and at 1 month, 1 year, and every 5 years until the 30th year of follow-up. RESULTS: Mean follow-up post-OOKP was 27.4 ± 11.2 years (range, 2.4-52). The most frequent cause of blindness was chemical injuries (71%). OOKP integrity was maintained in 77 of 82 eyes (94%) until the end of follow-up. Excluding cataract, acquired glaucoma was the most frequent complication, with a prevalence at 10 years of 36%. Mean BCVA improved from 2.60 ± 0.32 at presentation to 0.40 ± 0.65 at 1 year and 1.21 ± 1.19 logMAR at 30 years. Overall, 51% of the included eyes attained a BCVA better than 0.05 logMAR, and stabilization of BCVA was observed for the first 10 years of follow-up post-OOKP. Better BCVA outcomes were observed in the Stevens-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN) group, whereas glaucoma was found not to significantly affect visual acuity. CONCLUSIONS: The original OOKP still represents a valid surgical choice, which is durable over time, for restoring vision in end-stage corneal blindness patients who are not eligible for a corneal transplant.

COMPARISON BETWEEN SCLERAL BUCKLING AND VITRECTOMY IN THE ONSET OF CYSTOID MACULAR EDEMA AND EPIRETINAL MEMBRANE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

PURPOSE: To investigate the incidence and risk factors for the main complications in patients with rhegmatogenous retinal detachment treated with scleral buckling (SB) or pars plana vitrectomy (PPV). METHODS: A retrospective, comparative, observational study was conducted. The medical records of 107 patients with primary rhegmatogenous retinal detachment who were managed with SB (n = 57) or PPV (n = 50) were reviewed. Scleral buckling was performed using scleral encircling solid silicone band and circumferential solid silicone exoplant to support the break. Pars plana vitrectomy was combined with phacoemulsification in phakic eyes and with scleral encircling in inferior detachments. Follow-ups, including spectral-domain optical coherence tomography examination, were scheduled at 1, 3, and 12 months after surgery. Propensity score matching was used to adjust for potential preoperative selection bias. RESULTS: The overall incidence of postoperative cystoid macular edema (CME) and epiretinal membrane was 14.95% and 30.84%, respectively. Compared with SB, CME was more frequent in the PPV (P = 0.021) and in the PPV pseudophakic eyes (P = 0.027). Postoperative CME was an early, predominantly transient complication and regressed in 67% of SB and in 77% of PPV eyes within 12 months after surgery. No differences were observed regarding epiretinal membrane development. Except for the surgical technique, no preoperative factors associated with CME were identified. A correlation between epiretinal membrane and patients' age was found (P = 0.028). CONCLUSION: The incidence of CME after rhegmatogenous retinal detachment repair was higher in patients who underwent PPV, either alone or combined with phacoemulsification, than in those treated with SB. Epiretinal membrane development was correlated to older age, regardless of the surgical procedure.

Topography-Guided Trans-Epithelial No-Touch Photorefractive Keratectomy for High Irregular Astigmatism After Penetrating Keratoplasty: A Prospective 12-Months Follow-Up.

PURPOSE: To describe the efficacy and safety of topography-guided trans-epithelial no-touch photorefractive keratectomy (PRK) for the correction of highly irregular astigmatism after penetrating keratoplasty (PK). PATIENTS AND METHODS: A prospective study was conducted on 12 eyes of 12 patients affected by highly irregular astigmatism after PK for keratoconus. Each patient underwent a single-step topography-guided trans-epithelial ablation (CIPTA®2 software, iVis Technologies). Corneal topography data as well as uncorrected (UDVA) and corrected distance visual acuity (CDVA) and spherical equivalent (SEQ) were collected preoperatively (T0) and at 1 (T1), 3 (T2) and 12 (T3) months after surgery. RESULTS: Mean UDVA and CDVA significantly improved, respectively, from 1.22±0.17 and 0.18±0.03LogMAR at T0 to 0.63±0.17 (CI 95%, P<0.001) and 0.04±0.03LogMAR at T3 (CI 95%, P<0.001). Mean SEQ significantly decreased from -3.75±1.32 to -1.60±1.32D (CI 95%, P<0.02). Mean subjective refractive astigmatism (SRAST) and mean keratometry astigmatism (SimK) significantly decreased, respectively, from 7.83±0.98 and 8.10±1.48D to 2.83±0.98 and 5.29±1.48D (CI 95%, P<0.001). Corneal Morphological Irregularity index (CMI) significantly decreased from 62.76±7.26 µm to 23.24±7.26 µm (CI 95%, P<0.001). Apart from a single episode of graft rejection 5 days after ablation, successfully reverted with topical steroids, no other complications were noted. A mild corneal haze was observed in two eyes (16.7%) at 3 months post-PRK, and no regression was observed at 12 months. CONCLUSION: Our study demonstrates the safety and long-term effectiveness of a trans-epithelial topography-guided ablation in the treatment of post-PK highly irregular astigmatism.

Long-term ocular biometric variations after scleral buckling surgery in macula-on rhegmatogenous retinal detachment.

BACKGROUND: Myopic shift and biometric ocular changes have been previously observed after scleral buckling (SB) surgery in rhegmatogenous retinal detachment (RRD), but long term-term outcomes had not yet been explored. The purpose of present study is to evaluate long term ocular biometric changes in patients with primary macula-on RRD treated with SB. METHODS: In this retrospective, observational study, we reviewed the medical records of patients undergoing SB surgery for macula-on RRD. Ocular biometry was performed before and at the most recent visit after surgery. Axial length (AXL), anterior chamber depth (ACD), anterior corneal astigmatism and spherical equivalent in treated eyes were compared before and after surgery as well as with those of fellow eyes. RESULTS: Thirty-four eyes of 17 patients with a mean age of 57.0 ± 8.9 years were included. The mean follow-up duration was 50.9 ± 21.9 months (median 53.0; range 12 to 82 months). A significant postoperative AXL increase of 0.83 mm and a concomitant myopic shift of 1.35 diopters was observed in the operated eyes (p <  0.0001). The preoperative AXL was the only predictive factor of AXL change after surgery (B = 0.152, 95% CI 0.059 to 0.245, ß = 0.668, P = 0.003). Compared to fellow eyes, a postoperative ACD shallowing of 0.1 mm was found in operated eyes (p <  0.05), while there were no long-term changes of anterior corneal astigmatism. CONCLUSIONS: We show that the preoperative AXL is the only predictive factor of AXL increase after SB surgery. Scleral encircling induces a concomitant long-term shallowing of the AC, therefore fourth generation intraocular lens (IOL) power calculation formulae should be used for patients requiring cataract surgery after SB.