Conjunctivitis as a sign of persistent SARS-COV-2 infection? An observational study and report of late symptoms.

PURPOSE: To investigate if symptomatic conjunctivitis during the recovery phase of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. METHODS: An observational study including consecutive COVID19 patients treated at Humanitas Clinical and Research Hospital who were attending for nasopharyngeal swab to confirm the resolution of SARS-CoV-2 infection and end of isolation. We examined 129 consecutive patients from May to June 2020. The primary end point was to determine if symptomatic conjunctivitis at this point of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. RESULTS: One hundred twenty eight patients were included, 9.38% had conjunctivitis, none resulted positive to conjunctival PCR swab test, while two of them had positive nasopharyngeal result. Mean time elapsed since the first COVID-19 positive swab to the time of examination was 6 weeks ( ± 3). The only significant association was the presence of conjunctivitis with older age (65.3 ± 12.7 vs 56.7 + 13.5. p = 0.046). Nasopharyngeal swab resulted positive in 22 patients (17.19%). While 88 patients (68.2%) did not have any ocular complain during their COVID19 disease. The 40 patients (31.8%) reporting ocular disturbances complained about: redness (25.43%), tearing (19.53%), burning (18.35%), foreign body sensation (17.18%), itching (15.62%), and discharge (12.5%). CONCLUSION: This study showed that late conjunctivitis cannot be considered as a marker of persistent infection when patients are sent to confirm the resolution of SARS-CoV-2 infection.

Control of inflammation and prophylaxis of endophthalmitis after cataract surgery: a multicenter study.

PURPOSE: To compare two different postcataract surgery antibiotic/steroid therapeutic combinations, for clinical results as well as patient satisfaction. METHODS: Prospective randomized clinical trial of patients with bilateral operative cataract. Postoperatively, for 15 days one eye was randomly assigned to therapy with the combination chloramphenicol 0.25%-betamethasone 0.13% gel three times a day (Group 1) and the other to the combination tobramycin 0.3%-dexamethasone 0.1% eyedrops four times a day (Group 2). RESULTS: A total of 142 patients (284 eyes) completed the study. The authors could not detect any significant difference between Group 1 and Group 2 concerning preoperative evaluation, surgical procedure, and complications. Pertaining to the two therapeutic regimens, efficacy, side effects, and clinical findings such as uncorrected visual acuity, intraocular pressure, edema or hyperemia of eyelids and/or conjunctiva, conjunctival and/or ciliary vessels congestion, decreased corneal transparency, corneal edema, Descemet folds, anterior chamber Tyndall and depth, and posterior synechiae were also comparable. Postoperative subjective pain and dry eye sensation were comparable between the two groups, while the gel preparation elicited a significantly more pleasant sensation in the patients (p=0.04). CONCLUSIONS: The motivation for use of a gel is to prolong the permanence of associated drugs on the ocular surface, increasing potency and decreasing concentration of the drug and rate of administration. This in order to improve compliance and decrease potential side effects. Chloramphenicol 0.25%-betamethasone 0.13% gel combination proved to have comparable efficacy, tolerance, and better acceptance by the patients than an aqueous tobramycin 0.3%-dexamethasone 0.1% preparation.

Postoperative endophthalmitis resulting from prosthesis contamination in a monocular patient.

Monocular patients who wear an ocular prosthesis may harbor pathogenic conjunctival flora both in the socket and in the contralateral eye. They may therefore be at increased risk of developing endophthalmitis after intraocular procedures. We studied a monocular, prosthesis-wearing, 86-year-old man who underwent cataract extraction, subtotal transpupillary vitrectomy, and intraocular lens insertion. Fulminant endophthalmitis ensued postoperatively, and despite complete vitrectomy and administration of intraocular antibiotics, the eye lost light perception. Intravitreal as well as conjunctival cultures bilaterally grew Proteus mirabilis. The patient disclosed that he cleaned the prosthesis frequently because of discharge. We considered an association between this bacterial colonization and the risk of developing postoperative endophthalmitis and suggest prophylactic measures for treatment of monocular patients undergoing intraocular procedures.

Prevention of corneal ectasia in laser in situ keratomileusis.

PURPOSE: Ectasia after laser in situ keratomileusis (LASIK) is a rare but serious complication. Prevention includes proper patient selection with detection of those at particular risk. Causes of ectasia include predisposition, excessive ablation with less than 250 microm of residual stromal bed, thicker than normal flap, irregular corneal thickness, and different ablation rates. METHODS: We evaluated corneal curvature patterns and their relationship to corneal topography and pachymetry maps. RESULTS: Corneal topography (axial, tangential, and altimetric) and pachymetry map characteristics of normally astigmatic corneas, keratoconus, false-positive and false-negative cases, as well as contact lens-induced warpage are discussed. CONCLUSIONS: Preoperative pachymetry maps for LASIK surgery allow accurate case selection through detection of borderline cases, and provide important documentation of preoperative status, as well as useful information for improving surgical strategy. Another important parameter is the asphericity index.

Decentration after refractive surgery.

PURPOSE: To examine factors useful in evaluation of suspect decentration after refractive surgery. METHODS: We evaluated 148 cases (eyes) referred to us for recentering procedures by review of information obtainable by evaluation of pupil position, corneal topography, and corneal curvature gradient. RESULTS: Only a minority of eyes (n=5, 3.4%) were truly decentered; in the remaining majority a high dioptric gradient with consequent focal scarring was present (n=107, 72.3%). In 28 eyes (18.9%), a drifting of the eye during treatment was responsible, and in eight eyes (5.4%), a central island was observed. CONCLUSIONS: Proper corneal topographical diagnosis reduces the risk of improperly suspecting decentration, and for most cases, smoothing of the central cornea is a simple and efficacious solution. Recommendations for the prevention of decentration include proper patient positioning, special care in treating high myopes, preoperative check of pupil displacement nasally, evaluation of preoperative map with detection of high temporal curvature gradient, and use of the cross-cylinder technique in the treatment of astigmatism.

Cystoid macular oedema after extracapsular cataract extraction and intraocular lens implantation in diabetic patients without retinopathy.

Postoperative onset or aggravation of cystoid macular oedema (CMO) in diabetic patients after extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation is a frequent problem. At present little is known about the occurrence and prognosis of this complication in diabetics with no clinically detectable diabetic retinopathy (DR). Twenty five diabetic eyes (24 subjects) without DR and 45 normal eyes (44 subjects) were studied before surgery and 30, 90, 180, 360 days after ECCE and posterior chamber IOL implantation. Fluorescein angiography was performed at each examination. The frequency of angiographic CMO in the two groups was comparable 30 days after surgery but was significantly higher in diabetic eyes at 90, 180, and 360 days. This finding is probably related to an impairment of the blood-retinal barrier in diabetics. Final visual acuity, however, was similar in the two groups.

Age-related macular degeneration and vitreous hemorrhage.

Age-related macular degeneration led to vitreous hemorrhage (VH) in six eyes of four patients. Macular involvement was bilateral in three patients and fluorescein angiography performed before VH showed extensive subretinal hemorrhage in the macular region in all eyes. We examine the possible causal mechanisms of VH resulting from age-related macular degeneration. Local risk factors, as outlined in our series by fluorescein angiography, are discussed and systemic risk factors are considered. Three out of the six eyes underwent pars plana vitrectomy for removal of intravitreal blood, and had severe inflammatory reactions in the postoperative period. In the three non-operated eyes spontaneous reabsorption of VH was observed at the end of follow-up.

[Laser treatment of subretinal macular neovascularization in pathologic myopia]. / Traitement laser de la néovascularisation sous-rétinienne maculaire dans la myopie forte.

The authors evaluated retrospectively 100 eyes with pathological myopia and a macular subretinal neovascular membranes (SRNV) which was treated with direct laser photocoagulation. Argon green, krypton red and orange dye (590 nm) laser were used to treat, respectively, 19, 63 and 18 eyes. The follow-up period was of 12 months. Mean initial visual acuity was 0.33 and mean final visual acuity was 0.31, with no statistically significative difference between them. One or more recurrence was observed in 44% of the eyes. Recurrences could be treated in 80% of cases. At the end of the follow-up period SRNV had disappeared in 83 eyes and extended into the foveola in the remaining 17.

[Laser treatment of macular subretinal neovascularization in angioid streaks]. / Photocoagulation au laser des néovaisseaux sous-rétiniens maculaires survenant au cours des stries angioïdes.

The authors examined 17 eyes with macular subretinal neovascularization in angioid streaks treated by direct laser photocoagulation. Two eyes were treated with dye laser (590 nm), two with blue-green argon, three with green argon and ten with red krypton laser. At twelve-month follow-up, the visual acuity was of 0.21, a statistically significant decrease respect to the presenting vision. Poor functional results are due to the frequent recurrences of neovascularization.

Vitreo-papillary adhesion as a prognostic factor in pseudo- and lamellar macular holes.

PURPOSE: To determine the incidence of vitreopapillary adhesion (VPA) and to investigate its value as a prognostic factor in the surgical outcome of pseudo- (PMH) and lamellar macular holes (LMH). METHODS: A total of 76 consecutive patients, diagnosed with PMH (41 eyes) or LMH (35 eyes) were included. Eyes with VPA were alternatively assigned to the surgical or control group. Surgery consisted of a 25G vitrectomy and internal limiting membrane peeling with blue dye staining. There were six visits: baseline, the day of surgery, and 1, 3, 6, and 9 post-operative months. Main outcome measures were the incidence of VPA and changes in the outer retinal layers and visual acuity. RESULTS: VPA was found in 27% (11/41) of patients with PMH and 37% (13/35) with LMH (P=0.03). In presence of VPA, the best-corrected visual acuity (BCVA) improved in the surgery group from 32 ± 8 to 47 ± 8 letters, whereas the control group went from 34 ± 7 to 31 ± 8 letters. The difference in letters between the surgery and control groups was statistically significant for both distance (P=0.032) and near (P=0.04) vision. Intra-retinal cysts were significantly correlated with a poor functional prognosis (P=0.01). We found the presence of focal damage to the outer retinal layers in LMH and PMH. CONCLUSION: VPA is more frequent in the presence of LMH vsPMH. It significantly influences the tangential forces at the vitreoretinal interface, exacerbating anatomical changes, and worsening the functional prognosis. Functional difference between the surgical and control groups was statistically significant for distant and near vision in presence of VPA.

Interferon ß-1b and glatiramer acetate effects on permanent black hole evolution.

OBJECTIVE: To compare interferon ß-1b (IFNß-1b) and glatiramer acetate (GA) on new lesion (NL) (gadolinium-enhancing, new T2) evolution into permanent black holes (PBH)--a marker of irreversible tissue damage--in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: BEYOND was a large, phase III, clinical trial comparing IFNß-1b 250 µg, IFNß-1b 500 µg, and GA (2:2:1). Patient scans were reexamined post hoc for PBH in a rater-blinded manner. Two predefined coprimary endpoints compared IFNß-1b 250 µg with GA: first, number of PBH per patient at year 2 evolving from year 1 NL, then proportion of year 1 NL evolving into PBH at year 2. IFNß-1b 500 µg and GA were compared in an exploratory fashion. RESULTS: Approximately 90% (1,957/2,244) of patients had NL at year 1 with follow-up at year 2. Mean numbers of PBH per patient at year 2 evolving from year 1 NL were lower for IFNß-1b 250 µg than GA (0.30 vs 0.43; p = 0.0451). The proportion of NL evolving into PBH was similar (IFNß-1b 250 µg vs GA: 21.6% vs 23.5%; p > 0.20). For IFNß-1b 500 µg, both the mean PBH number per patient at year 2 evolving from year 1 NL (0.26 vs 0.43; p = 0.0037) and proportion of NL evolving into PBH (16.3% vs 23.5%; p = 0.0409) were lower relative to GA. CONCLUSION: IFNß-1b affected PBH development to a similar or better extent than GA. IFNß-1b favorably influences an MRI outcome indicative of permanent tissue destruction in the brains of patients with multiple sclerosis. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that IFNß-1b is associated with a reduction in MRI PBH formation and evolution compared with GA between years 1 and 2 of treatment.

Combined vitrectomy, cataract extraction, and posterior chamber intraocular lens implantation in diabetic patients.

Combined extracapsular cataract extraction, pars plana vitrectomy, and posterior chamber intraocular lens implantation was performed in six eyes with proliferative diabetic retinopathy. These eyes all had minimal iris vascular changes and were at reasonably low risk for developing intraoperative and postoperative complications. The surgery must be relatively brief and the endophotocoagulation accurate. Initial visual acuities ranged from light perception to 4/200. With an average follow-up of 9.7 months, final acuities ranged from 4/200 to 20/40.

Hypertensive choroidopathy: a case report.

The authors report a case of exudative retinal detachment of the posterior pole and peripheral choroidal detachment in a patient with renovascular accelerated hypertension. The peculiar clinical situation of this patient was comparable with experimental models of hypertension recently reported in the literature. Both the retinal and the choroidal detachment regressed after blood pressure stabilization with systemic antihypertensive therapy, supporting a choroidal pathogenesis for the chorioretinal lesions.

Excimer laser photorefractive keratectomy for high myopia: four-year experience with a multiple zone technique.

PURPOSE: The purpose of the study is to evaluate the results of the authors' 4-year experience with excimer laser photorefractive keratectomy (PRK) and multiple optical zone corneal ablation in highly myopic eyes. METHODS: The authors retrospectively evaluated 56 eyes of 44 patients (mean refraction, -11.3 diopters [D]; range, -5.75 to -24.5 D) who underwent PRK with a Visx Model 20/20 laser (Visx, Santa Clara, CA). Preoperative visual acuity of 20/40 or better was present in 46 eyes. Corneal ablation was divided into concentric optical zones (4, 5, and 6 mm), allowing corrections of up to 18 D, with a refractive goal of within -1 D from emmetropia in 49 eyes. A hand-held fixation system was always used, and a nitrogen-blowing system (NBS) was used in the first 21 eyes only. RESULTS: Before retreatment, the range of final cycloplegic refraction from emmetropia in eyes treated with NBS versus not was within +/-1 D in 6 (28.6%) and 15 eyes (44.1%), between -1.25 and -3 D in 5 (23.8%) and 14 eyes (41.1%), and more than -3 D in 10 (47.6%) and 5 eyes (14.7%), respectively. No lines of visual acuity were lost in 37 eyes (80.4%) with 20/40 or better visual acuity before surgery. Three eyes showed vision loss due to worsening of myopic maculopathy and one due to corneal haze. Correction stabilized within 9 months, and at a mean time of 25.6 months, the correction attained was of -8.5 +/- 3.6 D, achieving 90.3% of attempted correction. Eyes with preoperative myopia less than -10 D (n = 27) showed regression less than -1 D in 8 eyes (29.6%), between -1.25 and -3.00 D in 5 eyes (18.5%), and greater than -3.00 D in 1 eye (3.7%); eyes with more than -10 D (n = 29) regressed in 3 (10.3%), 6 (20.7%), and 1 eye (3.4%), respectively. Severe haze was observed in 11 eyes (19.6%) 3 months after surgery. Two eyes showed decentration greater than 1.5 mm. At last examination, night driving problems were reported by 12 (41.4%) of 29 patients evaluated who drive. CONCLUSIONS: After the NBS was eliminated, the multiple-zone technique achieved a long-term, stable 83.1% reduction of preoperative myopia. Patients with severe myopia appreciated reduction of most of the refractive defect, although perception of halos was noted by 16 patients.

Influence of silicone oil on iris microangiopathy in diabetic vitrectomized eyes.

PURPOSE: This study evaluates the influence of intraocular silicone oil on iris diabetic microangiopathy in diabetic vitrectomized eyes. METHODS: The authors examined 20 eyes of 20 patients with diabetes undergoing primary vitrectomy for fractional diabetic retinal detachment, endophotocoagulation, and 1000 centistokes silicone oil tamponade. The vascular status of the iris in these eyes was examined by iris fluorescein angiography once before silicone oil injection and again when it was removed (mean follow-up, 8.3 months). RESULTS: Iris diabetic microangiopathy, including breakdown of the blood-iris barrier and iris neovascularization, improved or remained stable in 40% of eyes. It worsened in 60% of eyes, including all aphakic eyes. Neovascular glaucoma developed in one of them. A significant correlation was found between worsening of iris diabetic microangiopathy and both aphakia (P = 0.01) and severe immediate postvitrectomy inflammation (P = 0.02). Eyes with recurrent retinal detachment (n = 4) showed worsening of iris diabetic microangiopathy, but this was not significantly correlated. CONCLUSION: Aphakic vitrectomized eyes have a higher risk of iris diabetic microangiopathy developing, even after silicone oil tamponade. Immediate postoperative intraocular inflammation also is a risk factor for worsening of iris diabetic microangiopathy in phakic eyes. Recurrence of retinal detachment was not significantly correlated with worsening of iris status.

Peripheral retinal changes and axial myopia.

The relationship between the presence of peripheral chorioretinal changes and axial myopia in 513 eyes (513 patients) 24 mm or more in length, or beyond the upper range of normal axial length, is studied. Axial length was measured with A-scan ultrasonography (immersion technique) and retinal periphery was studied by biomicroscopic examination and scleral indentation. The presence of lattice degeneration, pavingstone degeneration, pigmentary degeneration, white with or without pressure (WWP), retinal holes, tears, or both (RHT), retinal detachment, and posterior vitreous detachment was reported. The correlation between presence of a lesion and a longer axial length was always significant, except with retinal detachment, pigmentary degeneration, and RHT. Pavingstone degeneration was significantly related to older age and WWP and RHT to younger age. Posterior vitreous detachment was frequent in almost all axial length groups and age classes. No significant relationship was found between any kind of lesion and gender of the patient, or between axial length and patient age.

Laser photocoagulation of choroidal neovascularization in pathologic myopia: long-term results.

Direct laser photocoagulation of macular choroidal neovascularization (CNV) in pathologic myopia is still controversial. However, previous studies have reported encouraging results. One-hundred and thirty-three consecutively treated eyes were followed, in a prospective manner, for at least 12 months (108 of these were followed for 24 months, 84 for 36 months, 63 for 48 months, and 47 for 60 months) to evaluate the potential benefits and complications of laser treatment of extra-foveal macular CNV in pathologically myopic eyes. Pre-treatment mean visual acuity was 0.36. Post-treatment mean visual acuity was 0.33 at 1-year examination, 0.31 at 2 years, 0.32 at 3 years, 0.34 at 4 years, and 0.33 at 5 years. During the total follow-up period mean visual acuity did not change. Neovascular recurrences occurred in 58% of treated eyes by the end of the five-year follow-up. At final examination, complete destruction of CNV was achieved in 100 eyes (75%). These findings suggest that laser photocoagulation of macular choroidal neovascularization in pathologic myopia may be effective in preventing or limiting severe and irreversible loss of vision.

Endophotocoagulation through perfluorodecalin in rabbit eyes.

Retinal laser endophotocoagulation through perfluorodecalin was studied in six eyes of three Dutch-belted rabbits after vitrectomy. Both the energy density threshold (EDT/50) and the energy threshold necessary to obtain a therapeutic lesion were evaluated. Both argon and semiconductor diode laser endophotocoagulators were used. The amount of laser power energy and the histology of chorioretinal lesions were similar when photocoagulating through perfluorodecalin, compared to photocoagulation through balanced salt citrate-buffered solution. This experimental study indicates that no extra care is necessary when retinal endophotocoagulation is performed through perfluorodecalin, as long as circular spots are obtained and energy is delivered symmetrically to the target site.