Feasibility and Safety of Intraoperative Optical Coherence Tomography-Guided Short-Term Posturing Prescription after Macular Hole Surgery.

PURPOSE: To assess closure rate and visual outcome of a court of patients with macular hole (MH) who underwent surgical repair with intraoperative optical coherence tomography (iOCT)-confirmed MH closure and short-term postoperative face-down posturing (FDP). Secondary aim was to assess the correlation between iOCT and postoperative OCT at day 1. METHODS: Retrospective clinical study conducted in the Miulli Hospital Acquaviva delle Fonti (Italy), enrolling patients with idiopathic MH who underwent 25-G pars plana vitrectomy plus internal limiting membrane peeling. During surgery, closure of MH was confirmed by iOCT and short-term FDP (12-24 h, until day-1 visit) was prescribed. All patients had measurement of best-corrected visual acuity (BCVA) and spectral domain-OCT before the surgery and during follow-up (at 1 day, 1 month, 3 months). RESULTS: Twenty-nine eyes of 29 patients (14 males, 62.1%) were enrolled in the study. MH mean size was 451.7 ± 139.7 µm and baseline BCVA was 0.77 ± 0.26 logarithm of the minimum angle of resolution (LogMAR). MH was confirmed to be closed in 100% of patients intraoperatively (iOCT) and at OCT during early follow-up (1-3 days). Mean time of FDP was 18 ± 2.6 h. At 3 months, MH closure rate was 93%; 2 eyes -underwent secondary MH repair surgery. Final BCVA was 0.39 ± 0.22 LogMAR (p < 0.0001). CONCLUSION: iOCT-based confirmation of MH closure could be a safe and useful tool for prescribing short-term FDP after surgery, with high closure rate and no additional complication. The execution of an OCT in the immediate postoperative days could be potentially unnecessary.

Spanish flu in Turin as told by historical autopsy reports.

Spanish flu spread worldwide between 1918 and 1920 causing over 20 million deaths, exceeding even the number of deaths registered during the First World War (WWI). The main symptom of the disease was hemorrhagic tracheobronchitis, the onset of which was typically sudden and fatal. Young, healthy people died quickly. Despite the tragic impact of the disease on populations, already exhausted by the First World War, there is very little documentation. This was likely due to the severe censorship of the time. For this reason, autopsy reports can be a relevant source of information on the disease. Historical catalogues kept in Turin, where all autopsies were detailed, can be consulted. According to the "Regolamento di Polizia Mortuaria" dating back to 1892, autopsies were to be performed on all patients that died at home or in hospital. Therefore, autopsy reports showing the spread of diseases among the population can also help us obtain information about the spread of Spanish flu in Turin. While not documented, almost certainly the "Regolamento" was improperly implemented since just 45 cases of Spanish flu were reported, while deaths were most certainly daily and in their hundreds. According to autopsy reports, the first case occurred on 8th October 1918, although, the first official diagnosis is dated as being 24th November 1918. The records show that 18 people died during the first Italian pandemic wave. The second Italian pandemic wave seems to have been even more aggressive in Turin with 27 people having died between 8th January 1920 and 7th February 1920.

Features, reason for testing, and changes with time of 583 paroxysmal nocturnal hemoglobinuria clones from 529 patients: a multicenter Italian study.

In this study, we aimed at disclosing the main features of paroxysmal nocturnal hemoglobinuria (PNH) clones, their association with presentation syndromes, and their changes during follow-up. A large-scale, cooperative collection (583 clones from 529 patients) of flow cytometric and clinical data was entered into a national repository. Reason for testing guidelines were provided to the 41 participating laboratories, which followed the 2010 technical recommendations for PNH testing by Borowitz. Subsequently, the 30 second-level laboratories adopted the 2012 guidelines for high-resolution PNH testing, both upon order by the local clinicians and as an independent laboratory initiative in selected cases. Type3 and Type2 PNH clones (total and partial absence of glycosyl-phosphatidyl-inositol-anchor, respectively) were simultaneously present in 54 patients. In these patients, Type3 component was sevenfold larger than Type2 (p < 0.001). Frequency distribution analysis of solitary Type3 clone size (N = 442) evidenced two discrete patterns: small (20% of peripheral neutrophils) and large (> 70%) clones. The first pattern was significantly associated with bone marrow failure and myelodysplastic syndromes, the second one with hemolysis, hemoglobinuria, and thrombosis. Pediatric patients (N = 34) showed significant preponderance of small clones and bone marrow failure. The majority of PNH clones involved neutrophils, monocytes, and erythrocytes. Nevertheless, we found clones made exclusively by white cells (N = 13) or erythrocytes (N = 3). Rare cases showed clonal white cells restricted only to monocytes (6 cases) or neutrophils (3 cases). Retesting over 1-year follow-up in 151 cases showed a marked clone size increase in 4 cases and a decrease in 13, demonstrating that early breaking-down of PNH clones is not a rare event (8.6% of cases). This collaborative nationwide study demonstrates a clear-cut difference in size between Type2 and Type3 clones, emphasizes the existence of just two classes of PNH presentations based on Type3 clone size, depicts an asymmetric cellular composition of PNH clones, and documents the possible occurrence of changes in clone size during the follow-up.

COMPARATIVE ANALYSIS OF RETINAL REATTACHMENT SURGERY WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING TO PREVENT POSTOPERATIVE MACULAR PUCKER.

PURPOSE: To determine whether internal limiting membrane (ILM) peeling during pars plana vitrectomy for rhegmatogenous retinal detachment reduces the incidence of epiretinal membrane (ERM) formation. METHODS: In this retrospective study, preoperative, intraoperative, and postoperative data from all eyes undergoing pars plana vitrectomy for rhegmatogenous retinal detachment between January 2007 and December 2013 was analyzed. All cases with at least 1-year of follow-up were included. Data collection included vision, intraoperative complications, occurrence of ERM, and spectral domain optical coherence tomography characteristics. The OCTs were retrieved for all eyes and were graded by a single masked grader. RESULTS: Out of 159 eyes recruited, ILM peeling was done in 78 eyes (49%). Overall occurrence of ERM was 20%. Seven eyes (9%) in ILM peeling group and 25 eyes in the non-ILM peeling group (31%) showed ERM (P = 0.001). Postoperative vision was significantly better in eyes that had ILM peeling (0.48 ± 0.4 logarithm of the minimum angle of resolution [20/63] vs. 0.77 ± 0.6 logarithm of the minimum angle of resolution [20/125], P = 0.003). In multivariable models adjusting for type of tamponade, ILM peeling reduced the likelihood of ERM formation by 75% (P = 0.01). CONCLUSION: Internal limiting membrane peeling during pars plana vitrectomy for rhegmatogenous retinal detachment significantly reduces ERM formation in the postoperative period and is associated with better visual and anatomical outcomes.

Treatment of simple and complex endometrial non-atypical hyperplasia with natural progesterone: response rate to different doses.

The aim of this study is to evaluate the response rate to natural progesterone in non-atypical endometrial hyperplasia and to identify the lowest effective dose. A total of 197 patients of childbearing age with simple or complex hyperplasia were retrospectively identified. The women were treated with a cyclic administration of progesterone at different dosages (100 versus 200 versus 300 mg daily). Endometrial biopsies were performed at 6, 12, 18 months. In comparing progesterone to a regimen of no therapy, a significantly higher remission rate was observed in the progesterone group than in the latter (95 versus 75%, p = 0.05 for simple hyperplasia; 89 versus 35%, p < 0.001 for complex hyperplasia). Out of 60 women with simple hyperplasia, remission was observed in 9/11 (81.8%), 40/41 (97.5%) and 8/8 (100%) patients treated, respectively, with progesterone 100, 200 and 300 mg daily. Out of 72 women with complex hyperplasia, remission was observed in 3/5 (60%), 49/53 (92.4%) and 12/14 (85.7%) patients treated with progesterone 100, 200 and 300 mg daily, respectively. There was no statistically significant difference in the response rate in the two groups, neither with simple nor with complex hyperplasia. In conclusion, progesterone increased the regression rate of both simple and complex hyperplasia.

Short-Term Morpho-Functional Changes before and after Strabismus Surgery in Children Using Structural Optical Coherence Tomography: A Pilot Study.

PURPOSE: To evaluate the immediate alterations in the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL), peripapillary retinal nerve fiber layer (RNFL), inner retinal layer (IRL), and outer retinal layer (ORL) using spectral domain optical coherence tomography (SD-OCT) subsequent to strabismus surgery in pediatric patients diagnosed with horizontal esotropia. METHODS: Twenty-eight eyes from twenty-one child patients who had undergone uncomplicated horizontal rectus muscle surgery due to strabismus were included. Measurements of RNFL, mGCL-IPL, IRL, and ORL using structural OCT were conducted both before the surgery and one month after the surgical procedure. Importantly, a control group comprising 14 healthy eyes, matched for age and significant refractive error (<3.00 diopters), was included in the current analysis. RESULTS: Our analysis indicated no significant disparity before and after surgery in terms of best-corrected visual acuity (BCVA), RNFL, IRL, and ORL. Conversely, concerning the macular ganglion cell layer-inner plexiform layer analysis, a substantial increase in mGCL-IPL was observed following the surgical intervention. The mean mGCL-IPL measured 60.8 ± 9.2 µm at baseline and 66.1 ± 13.2 µm one month after the surgery (p = 0.026). Notably, comparison between the strabismus group at baseline and the healthy group revealed a significant reduction in mGCL-IPL in the strabismus group (60.8 ± 9.2) compared to the healthy control group (68.3 ± 7.2; p = 0.014). CONCLUSIONS: Following strabismus surgery, our observations pointed towards a thickening of the mGCL-IPL layer, which is likely attributable to transient local inflammation. Additionally, we identified a significant differentiation in the mGCL-IPL complex between the pediatric patient group with strabismus and the control group.

Improving the antinutritional profiles of common beans (Phaseolus vulgaris L.) moderately impacts carotenoid bioaccessibility but not mineral solubility.

Common beans are a common staple food with valuable nutritional qualities, but their high contents in antinutritional factors (ANFs) can decrease the bioavailability of (i) fat-soluble micronutrients including carotenoids and (ii) minerals. Our objective was to select ANF-poor bean lines that would not interfere with carotenoid and mineral bioavailability. To achieve this objective, seeds of commercial and experimental Phaseolus vulgaris L. bean lines were produced for 2 years and the bean's content in ANFs (saponins, phytates, tannins, total polyphenols) was assessed. We then measured carotenoid bioaccessibility and mineral solubility (i.e. the fraction of carotenoid and mineral that transfer into the aqueous phase of the digesta and is therefore absorbable) from prepared beans using in vitro digestion. All beans contained at least 200 mg/100 g of saponins and 2.44 mg/100 g tannins. The low phytic acid (lpa) lines, lpa1 and lpa12 exhibited lower phytate levels (≈ - 80%, p = 0.007 and p = 0.02) than their control BAT-93. However, this decrease had no significant impact on mineral solubility. HP5/1 (lpa + phaseolin and lectin PHA-E free) bean line, induced an improvement in carotenoid bioaccessibility (i.e., + 38%, p = 0.02, and + 32%, p = 0.005, for phytofluene bioaccessibility in 2021 and 2022, respectively). We conclude that decrease in the phytate bean content should thus likely be associated to decreases in other ANFs such as tannins or polyphenols to lead to significant improvement of micronutrient bioaccessibility.

Living matter observations with a novel hyperspectral supercontinuum confocal microscope for VIS to near-IR reflectance spectroscopy.

A broad range hyper-spectroscopic microscope fed by a supercontinuum laser source and equipped with an almost achromatic optical layout is illustrated with detailed explanations of the design, implementation and data. The real novelty of this instrument, a confocal spectroscopic microscope capable of recording high resolution reflectance data in the VIS-IR spectral range from about 500 nm to 2.5 µm wavelengths, is the possibility of acquiring spectral data at every physical point as defined by lateral coordinates, X and Y, as well as at a depth coordinate, Z, as obtained by the confocal optical sectioning advantage. With this apparatus we collect each single scanning point as a whole spectrum by combining two linear spectral detector arrays, one CCD for the visible range, and one InGaAs infrared array, simultaneously available at the sensor output channel of the home made instrument. This microscope has been developed for biomedical analysis of human skin and other similar applications. Results are shown illustrating the technical performances of the instrument and the capability in extracting information about the composition and the structure of different parts or compartments in biological samples as well as in solid statematter. A complete spectroscopic fingerprinting of samples at microscopic level is shown possible by using statistical analysis on raw data or analytical reflectance models based on Abelés matrix transfer methods.

Acute acquired concomitant esotropia: May COVID-19 lockdowns have changed its presentation?

PURPOSE: To evaluate the effects of COVID-19 lockdown in Italy on the features of Acute Acquired Concomitant Esotropia (AACE). SUBJECTS: Patients of the Polyclinic Hospital of Bari diagnosed with AACE between January 2018 and December 2021, subdivided in pre-lockdown group - diagnosed before March 2020 - and post-lockdown group. METHODS: Medical records were reviewed, and statistical analysis performed. Deviation size was assessed in the 9 cardinal positions of gaze with refractive correction. Wilcoxon test for unpaired samples was used to compare data of age, near maximum deviation and best corrected visual acuity (BCVA) for each eye; Student's t test was used to compare far maximum deviation, difference far/near maximum deviation and spherical equivalent data. Fisher exact test was used to compare subtype cases (Bielschowsky vs Non-Bielschowsky) in the two groups. A p-value lower than 0.05 was considered statistically significant.The primary outcome measure was the difference in AACE subtypes between the two groups. RESULTS: Nineteen patients were included, of which 12 males (63.2%); 7 belong to the pre-lockdown group and 12 to the post-lockdown group. The difference in types between the two groups proved to be statistically significant (p = 0.01977).The differences in the mean of age, right BCVA, right spherical equivalent and mean spherical equivalent between the two groups proved to be statistically significant (p < 0.05). CONCLUSIONS: After the COVID-19 pandemic, the profile of the typical patient with AACE has probably changed, and now it is more probably myopic and elderly than before. Thus, we observed an increase in the Bielschowsky subtype.

Genome-wide analysis of genetic diversity in a germplasm collection including wild relatives and interspecific clones of garden asparagus.

The Asparagus genus includes approximately 240 species, the most important of which is garden asparagus (Asparagus officinalis L.), as this is a vegetable crop cultivated worldwide for its edible spear. Along with garden asparagus, other species are also cultivated (e.g., Asparagus maritimus L.) or have been proposed as untapped sources of variability in breeding programs (e.g., Asparagus acutifolius L.). In the present work, we applied reduced-representation sequencing to examine a panel of 378 diverse asparagus genotypes, including commercial hybrids, interspecific lines, wild relatives of garden asparagus, and doubled haploids currently used in breeding programs, which enabled the identification of more than 200K single-nucleotide polymorphisms (SNPs). These SNPs were used to assess the extent of linkage disequilibrium in the diploid gene pool of asparagus and combined with preliminary phenotypic information to conduct genome-wide association studies for sex and traits tied to spear quality and production. Moreover, using the same phenotypic and genotypic information, we fitted and cross-validated genome-enabled prediction models for the same set of traits. Overall, our analyses demonstrated that, unlike the diversity detected in wild species related to garden asparagus and in interspecific crosses, cultivated and wild genotypes of A. officinalis L. show a narrow genetic basis, which is a contributing factor hampering the genetic improvement of this crop. Estimating the extent of linkage disequilibrium and providing the first example of genome-wide association study and genome-enabled prediction in this species, we concluded that the asparagus panel examined in the present study can lay the foundation for determination of the genetic bases of agronomically important traits and for the implementation of predictive breeding tools to sustain breeding.

Study of vitamin D penetration in the human aqueous after topical administration.

PURPOSE: this study was designed to measure the concentration of Vitamin D in the aqueous and to investigate if its topical application can increase quantities in aqueous humor. METHODS: 29 patients scheduled for cataract surgery were divided into two groups. Group 1 was used as a control group, in group 2 patients were instructed to instill one drop of vitamin D eye drops three times daily 10 days before surgery .Aqueous humor was collected with a 30-gauge needle immediately before surgery. Vitamin D concentrations were analyzed by liquid chromatography tandem mass spectrometry. RESULTS: Aqueous humor (AH) samples in both groups had small but detectable vitamin D levels. In the AH concentrations of vitamin D were, respectively, 2.1ng/mL 0.4 in group 1 and 2.1ng/mL0.3 in group 2(P = 0.9). CONCLUSION: Our study confirmed the presence of vitamin D in AH. No significant difference of vitamin D concentration in AH was observed between the treatment and control group.

Effect of intravitreal dexamethasone implant in treatment-naive and previously-treated patients with diabetic macular edema.

PURPOSE: To document the effects of intravitreal dexamethasone implant on retinal microvasculature in patients with diabetic retinopathy complicated by center-involving macular edema. METHODS: 35 eyes of 35 patients affected by retinopathy due to type 2 diabetes (15 treatment-naïve and 20 previously treated) were included in this retrospective study with a follow-up of 4 months. Foveal avascular zone (FAZ) area and superficial capillary plexus (SCP) and deep capillary plexus (DCP) densities in the foveal and parafoveal areas were measured by optical coherence tomography angiography (OCTA) at baseline and 2 and 4 months post-injection. Intraocular pressure, morphological and functional parameters were evaluated. RESULTS: a significant difference was found in both groups at 2 months after injection in terms of functional (BCVA, p < 0.05) and morphological (CMT, p < 0.05) parameters. During follow-up, FAZ area, SCP, and DCP in the foveal and parafoveal areas did not change significantly. CONCLUSIONS: intravitreal dexamethasone implant is effective in the treatment of diabetic center-involving macular edema and was associated with significant improvements in BCVA and CMT at 2 months after injection. After a single dexamethasone implant injection, FAZ area and retinal vascular density does not show significant variations in both naive and non-naive DME patients subgroups.

Success of iOCT in surgical management of ERM peeling.

PURPOSE: Epiretinal membranes (ERM) are a disorder leading to progressive vision loss and metamorphopsia. The ERM is treated through a pars-plana vitrectomy (PPV) with membrane peeling. The aim of this study was to define the success of intraoperative optical coherence tomography (iOCT) in ERM surgery to standard surgical visualization techniques and enhance our current approach to clinical practice. METHODS: This study included 56 eyes of 54 patients who underwent surgical intervention for management of idiopathic ERM. Patients were recruited between February 2018 and March 2020 at "Francesco Miulli" Hospital ophthalmology department in Acquaviva delle Fonti, Bari, Italy. RESULTS: in 28 eyes, ERM peeling was performed without staining and without iOCT; 25% of these eyes peeling ERM (n = 7) was performed easily, while 75% of eyes peeling ERM (n = 21) was not possible without staining and was necessary staining with Brillant Blu G.In 28 eyes ERM peeling were performed with iOCT; in 92.5% of these eyes (n = 26) ERM peeling was easily done without staining, while in 7.5% of this group of eyes (n = 2) ERM peeling was not possible without staining. CONCLUSIONS: Our study shows how iOCT has successfully assisted the surgeon to complete peeling in most of the cases treated without the use of a chromovitrectomy dye; in flat ERM was more difficult and iOCT failed to visualize the inner limiting membrane (ILM).

Granulomatous uveitis and choroidal detachment in a patient after topical treatment with Bimatoprost: A case report.

BACKGROUND: Bimatoprost 0.03% is an intraocular pressure (IOP) lowering prostaglandin analog with different adverse side effects such as potential ocular inflammatory effect and ocular hyperemia. CASE PRESENTATION: We report a case of 80-year-old woman diagnosed with bilateral glaucomatous uveitis, and choroidal detachment in the left eye after topical bimatoprost administration. During the patient's hospitalization, Bimatoprost treatment was discontinued and local steroid therapy was administrated. After 1 week we reported a marked improvement of visual acuity, IOP measurement was 12 mmHg in both eyes. Anterior segment examination showed complete resolution of conjunctival and pericheratic hyperemia with significant reduction of endothelial precipitates in both eyes. CONCLUSIONS: In our case, the anterior granulomatous uveitis occurred in both pseudophakic eyes and the choroidal detachment (CD) in the eye that previously had trabeculectomy. Probably the scar tissue of the trabeculectomy allowed a better penetration of the Bimatoprost or a greater sensitivity due to an altered trabecular tissue. This work confirms that the onset physiopathology mechanism of granulomatous uveitis and CD following instillation of Bimatoprost remains uncertain.

Modeling Provincial Covid-19 Epidemic Data Using an Adjusted Time-Dependent SIRD Model.

In this paper, we develop a forecasting model for the spread of COVID-19 infection at a provincial (i.e., EU NUTS-3) level in Italy by using official data from the Italian Ministry of Health integrated with data extracted from daily official press conferences of regional authorities and local newspaper websites. This data integration is needed as COVID-19 death data are not available at the NUTS-3 level from official open data channels. An adjusted time-dependent SIRD model is used to predict the behavior of the epidemic; specifically, the number of susceptible, infected, deceased, recovered people and epidemiological parameters. Predictive model performance is evaluated using comparison with real data.

Clinical course of choroidal neovascular membrane in West Nile virus chorioretinitis: a case report.

BACKGROUND: This report describes the clinical course of choroidal neovascular membrane (CNV) in West Nile virus-associated chorioretinitis. CASE PRESENTATION: A 28-year-old Italian woman was referred to our institution because of reduced visual acuity in the left eye dating back 4 months. A diagnosis of retinal vasculitis in the right eye and chorioretinitis with CNV in the left eye was made. A complete workup for uveitis revealed positivity only for anti-West Nile virus immunoglobulin M (IgM), while immunoglobulin G (IgG) was negative. Whole-body computed tomography and nuclear magnetic resonance imaging of the brain were also negative. Therefore, the patient was treated with a combination of oral prednisone (starting dose 1 mg/kg per day) and three intravitreal injections of bevacizumab 1.25 mg/0.05 ml, 1 month apart. Fourteen days from starting corticosteroid therapy and after the first intravitreal injection, the patient experienced increased visual acuity to 0.4. Response to therapy was monitored by clinical examination, ocular coherence tomography (OCT), OCT angiography and retinal fluorescein angiography. Three months later, resolution of CNV in the left eye was achieved and no signs of retinal vasculitis were detected in the right eye, while serum IgM for West Nile virus turned negative and IgG positive. CONCLUSION: CNV may be a complication of West Nile virus-associated chorioretinitis, and only subclinical retinal vasculitis may also be found even in non-endemic regions.

Perfluorocarbon liquid-assisted inverted inner limiting membrane-flap for large macular hole after recurrent rhegmatogenous retinal detachment.

A 45-year-old Caucasian myopic woman with a severe vision impairment (20/320) in the left eye due to a macula-off rhegmatogenous retinal detachment (RRD) underwent vitrectomy with silicone oil tamponade followed by an inferior relaxing retinectomy with heavy silicone oil tamponade during the second procedure for recurrence of RRD due to proliferative vitreoretinopathy. Four weeks after the second surgery, visual acuity was 20/200 and the patient complained metamorphopsia in the same eye due to a large full-thickness macular hole. A perfluorocarbon liquid-assisted inverted inner limiting membrane-flap technique was performed. Visual acuity improved to 20/80 after closing of macular hole and partial recovery of outer retinal layers at 3 months from the last surgery.

Spontaneous resolution of optic pit maculopathy: an OCT report.

The separation of the vitreous from the optic nerve head and the macula plays a primary role in the spontaneous resolution of optic disc pit (ODP) maculopathy. Optical coherence tomography (OCT) helps in the non-invasive monitoring of this condition, when treated conservatively. The aim of this report was to describe a pediatric case of spontaneously resolved ODP maculopathy, managed conservatively and monitored by means of spectral domain (SD)-OCT. A 14-year-old girl presented with severe visual loss in the right eye (RE). Fundus examination demonstrated a temporal ODP with altered foveal reflex. The SD-OCT B-scans revealed severe intraretinal schisis-like changes, broad vitreal adhesion in the optic nerve head area, posterior hyaloid thickening, and vitreal entrapment in the premacular space. The patient was managed conservatively. Spontaneous resolution of ODP maculopathy took place over 3 months, with vision improved up to 1.0 (Snellen charts). The macular schisis progressively resolved after posterior vitreous detachment. In conclusion, in our report, a complete restoration of the foveal anatomy was achieved without any surgical intervention. This OCT-based report confirms the role of the vitreomacular abnormalities in the pathogenesis of the disease.

PROGRESSION OF RETINAL ISCHEMIA IN A CASE OF MACULAR TELANGIECTASIA TYPE 1 AFTER RANIBIZUMAB INJECTION: OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS.

PURPOSE: To describe a case of a 68-year-old man with macular telangiectasia (MacTel) Type 1 in the right eye, showing an increase in capillary ischemia after intravitreal ranibizumab. METHODS: The patient underwent complete ophthalmologic evaluation, including best-corrected visual acuity, intraocular pressure, anterior segment and fundus examination, optical coherence tomography (OCT), and OCT angiography at baseline and on each visit. Fluorescein angiography was performed at baseline. The patient was followed up on monthly bases for 22 months. RESULTS: The patient presented a best-corrected visual acuity of 20/80 in the right eye and of 20/25 in the left eye at baseline. In the right eye, the fluorescein angiography images showed perifoveal capillary ectasia, late-frames dye leakage, and enlargement of the foveal avascular zone. The OCT showed intraretinal pseudocysts and microaneurysms, and the OCT angiography showed vascular rarefaction, capillary dropout, and capillary ectasia of the superficial plexus. After 16 months of follow-up and four ranibizumab injections, the best-corrected visual acuity was 20/60, and the OCT angiography disclosed a further enlargement of the foveal avascular zone area and increased capillary obliteration in the perifoveal nasal area. CONCLUSION: Optical coherence tomography angiography may represent an indispensable diagnostic technique, complementary to traditional imaging, in the evaluation of the effects of anti-vascular endothelial growth factor therapy in patients with MacTel Type 1.

Escherichia coli keratitis treated with ultraviolet A/riboflavin corneal cross-linking: a case report.

PURPOSE: To describe a case of keratitis caused by the Gram-negative Escherichia coli, treated with UVA-riboflavin cross linking. METHODS: Case report. RESULTS: A 78-year-old woman with diabetes presented with a 1-week history of pain, photophobia, foreign body sensation, and lacrimation in the right eye. The patient underwent topical and systemic antimicrobial therapy, without improvement. The authors treated the patient with riboflavin and corneal UVA crosslinking, with the aim to promote healing of the ulceration. One day after the procedure, the corneal ulceration was covered by cicatricial tissue, and the patient reported a significant improvement in symptoms. One month after the treatment, corneal edema was almost completely resolved, corneal ulceration was healed, and the painful symptoms of the patient had disappeared. CONCLUSIONS: UVA-riboflavin crosslinking can be useful for the treatment of corneal ulceration unresponsive to medical treatment.