Intravitreal Injections during the COVID-19 Outbreak in Northern Italy: An Innovative Approach for a High Quality and Safe Treatment.

BACKGROUND: Intravitreal injection (IVI) is a standard procedure performed in ophthalmology to treat several conditions, and is performed in different settings across countries. The Italian guidelines recommend this intervention is performed in an operating room to minimize the risk of infections, while in other countries, including Canada, USA and the UK, IVIs are performed in the ophthalmologist's office. The 2020 COVID-19 outbreak caused a dramatic modification in outpatient care. Consequently, non-urgent surgical activities, like IVIs, were subjected to a drastic reduction. METHODS: We conducted observational study which investigated the outcomes of IVIs performed in an ophthalmologist's office using a mobile laminar flow unit, the Operio mobile (Toul Meditech, Operio®) versus an operating room setting. RESULTS: Use of the Operio mobile allowed the safety performance of 3838 IVIs during COVID-19 and significantly reduced the waiting time of the first visit. This results in a faster intervention without affecting the technical IVI procedure that remained unchanged comparing the two settings. Specifically, we observed a 26% reduction in operation costs for each IVI performed in the office, which can be translated to a higher impact when considering the total number of IVIs performed over one year. CONCLUSION: The use of the Operio mobile in an ophthalmologist's office provides flexibility to perform IVIs, assuring patient safety, reducing healthcare personnel employment times, and the waiting lists for the patients, increasing the number of surgeries and improving the cost-effectiveness of the procedure.

COMPARISON OF RETROBULBAR, SUB-TENON ANESTHESIA AND MEDIAL CANTHUS EPISCLERAL ANESTHESIA FOR 25-GAUGE POSTERIOR VITRECTOMY.

PURPOSE: The aim of the study is to compare the efficacy, safety, and globe akinesia between retrobulbar anesthesia, sub-Tenon anesthesia, and medial canthus episcleral anesthesia for 25-gauge posterior vitrectomy. METHODS: A total of 340 25-gauge vitrectomy data sheets were retrospectively collected between November 2017 and June 2019. Ninety patients were included in the study. These patients were matched by sex and age to receive retrobulbar anesthesia (group 1, n = 30), sub-Tenon anesthesia (group 2, n = 30), and medial canthus episcleral anesthesia (group 3, n = 30). Globe akinesia was recorded after the injection of anesthetic at 2, 5, and 10 minute time intervals. Patients were asked to rate the pain during administration of anesthesia, during surgery, and postoperatively using the visual analog pain scale. RESULTS: For a perfect block, at 10 minutes, retrobulbar outperformed both sub-Tenon and medial canthus episcleral anesthesia which seemed quite similar. During administration, the three techniques did not show statistically different effects on pain. Regarding perioperative pain, retrobulbar outperformed medial canthus episcleral anesthesia. CONCLUSION: All three techniques allowed for safe surgery. Retrobulbar obtained the best results, although sub-Tenon proved to be a valid alternative. Medial canthus episcleral anesthesia obtained mostly good and fair blocks and acceptable pain levels during surgery. Further studies should investigate whether optimal anesthetic efficacy can be obtained with sub-Tenon and medial canthus episcleral techniques when higher volumes are used.

Carcass Composition, Meat Quality and Sensory Quality of Gentile di Puglia Light Lambs: Effects of Dietary Supplementation with Oregano and Linseed.

There is a growing demand by the modern consumer for meat containing less fat and lower levels of saturated fatty acids, which are considered to increase the risk of coronary heart disease. In southern Italy, the Gentile di Puglia breed is one of the most common on farms, and the light lambs are often consumed. The study evaluates the effect of a diet containing extruded linseed (Linum usitatissimum) on growth performances, carcass traits, and meat quality in Gentile di Puglia light lambs. Thirty-six male lambs are weaned at about 20 days of age, and divided into three groups-each group is either fed a control diet (C), a diet containing 3% extruded linseed (L), or a diet containing 3% extruded linseed and 0.6% oregano (Origanum vulgare) (L + O). The lambs' growth performances and the slaughtering and dissection data did not differ between groups. Dietary treatments have no significant effect on the quality and chemical composition of Longissimus lumborum (Ll). The mount of linoleic acid in Ll meat is significantly higher in the L group, and this positively affected the total content of n-3 Polyunsaturated Fatty Acid, as well as the n-6/n-3 ratio. The good results obtained concerning the sensory traits meet the requirements of the market's consumer.

Suppression of Covid-19 outbreak among healthcare workers at the Treviso Regional Hospital, Italy and lessons for ophthalmologists.

PURPOSE: To describe a strategy to reduce Covid-19 spread among healthcare workers and provide ophthalmologists with recommendations useful for a possible second wave of Covid-19 in Autumn. METHODS: Epidemiological surveillance at the Cà Foncello Hospital (Veneto, Italy) since 24 February 2020 to 24 April 2020 when the municipality of Treviso was hit by the Covid-19 outbreak. The number of naso-pharigeal (NP) swabs performed was 7010. RESULTS: The number of infected among healthcare workers was 209/ 3924 (5.32%): medical doctors: 28 cases / 498 (5.6%). None among ophthalmologists; specialized nurses: 86/1294 (6.4%) None in the ophthalmic unit; intermediate care technicians: 68/463 (14.7%). The 46% of the positive tested were asymptomatic. We share key suggested actions for the reorganization in ophthalmological services: be part of a global epidemiological local strategy of containment (Testing, Tracing, Treating); protect your department: Keep on screening patients by telephone interview before entering the hospital; promote continuous and appropriate use of PPE both for doctors and for patients; make any effort to obtain a continuous flow of patients in every line of the ophthalmic service; treat appropriately any single patient with vision threatening condition; avoid unnecessary or futile testings and examinations. CONCLUSION: The Treviso model shows that it is possible and safe to keep on performing high risk hospital activities like ophthalmology, even in the epicenter of covid outbreak, if adequate actions are performed. We discuss about the value of NP swabs and serological tests as a strategy in case of a second wave of infections.

Choosing wisely and the use of antibiotics in ophthalmic surgery: There is more than meets the eye.

BACKGROUND:: One of the directions of modern ophthalmology is toward an odontoiatric model, and new settings of eye care are becoming the standard of care: one day surgery and also office-based therapies. METHODS:: Retrospective analysis of three tertiary-care centers in Italy and analysis of the literature. RESULTS:: We provide readers with state-of-the-art measures of prophylaxis in ophthalmic surgery. DISCUSSION AND CONCLUSION:: Role of antibiotics is criticized in the light of stewardship antimicrobial paradigm.

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article.

Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.

The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application.

Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The "no prevention strategy" with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (-13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes.

Large Area Nano-transfer Printing of Sub-50-nm Metal Nanostructures Using Low-cost Semi-flexible Hybrid Templates.

In this work, we present a method for printing metal micro- and nanopatterns down to sub-50-nm feature sizes using replicated, defect-tolerant stamps made out of OrmoStamp®; material. The relevant parameters for a successful transfer over large areas were investigated and yields above 99 % have been achieved. Comparing our results to conventional nano-transfer printing using PDMS stamps, we find that the more rigid hybrid polymer used here prevents unintended transfer from interspaces between structures of large distance due to roof collapse and deformation of nano-sized structures due to lateral collapse. Yet, our stamps are flexible enough to ensure intimate contact with the underlying substrate over large areas even in the presence of defect particles. Additionally, the presented patterning technique is resist-, solvent-, and chemical-free and is therefore ideally suited for applications in organic nanoelectronics where standard nanostructuring methods can harm or destroy the organic material.

Adherence to European Society for Cataract and Refractive Surgery recommendations among Italian cataract surgeons: a survey.

PURPOSE: To survey the surgical routines with regards to prophylactic strategies in a sample of Italian hospitals and compare these with European Society for Cataract and Refractive Surgery (ESCRS) guidelines. METHODS: Six private and 18 public hospitals were included in this clinical-based retrospective study. The overall volume of cataract operations in the 24 centers in 2013 was 43,553. Main outcome measure was incidence of endophthalmitis per 1,000. An incidence of less than 0.13% was considered acceptable. RESULTS: Our study provides the first Italian data on the use of intracameral antibiotics in cataract surgery as recommended by the ESCRS. Thirteen centers (54%) used intracameral cefuroxime at the end of surgery. Of the 13 centers that used cefuroxime, 8 (62%) had an incidence of endophthalmitis less than 0.13%. Of the 7 (29%) centers that did not use intracameral cefuroxime, all had an endophthalmitis rate of greater than 0.13%. This difference was statistically significant (p<0.05). Among the 4 centers not included, 2 used vancomycin in the infusion bottle, 1 a fluoroquinolone, and the last a combination of antibiotics. The majority of surgeons (71%) used preoperative antibiotic eyedrops, but this measure was not shown to be significantly protective. CONCLUSIONS: Slightly more than half of the centers surveyed in this study adhered to the recommendations of the ESCRS and routinely employed prophylactic intracameral cefuroxime. An incidence of endophthalmitis greater than 0.13% was encountered significantly more frequently among centers that did not employ intracameral cefuroxime.

Transfer Printed P3HT/PCBM Photoactive Layers: From Material Intermixing to Device Characteristics.

The fabrication of organic electronic devices involving complex stacks of solution-processable functional materials has proven challenging. Significant material intermixing often occurs as a result of cross-solubility and postdeposition treatments, rendering the realization of even the simplest bilayer architectures rather cumbersome. In this study we investigate the feasibility of a dry transfer printing process for producing abrupt bilayer organic photodiodes (OPDs) and the effect of thermal annealing on the integrity of the bilayer. The process involves the transfer of readily deposited thin films of poly(3-hexylthiophene-2,5-diyl) (P3HT) and [6,6]-phenyl C61 butyric acid methyl ester (PCBM) using a polydimethylsiloxane (PDMS) stamp. Fabricated structures are characterized by means of cross-sectional scanning electron microscopy (SEM), UV/vis absorption spectroscopy, and time-of-flight secondary ion mass spectrometry (TOF-SIMS). Joint consideration of all results unveils abrupt interfaces with no thermal treatment applied and significant material intermixing for samples annealed above 100 °C. The role of the thermally assisted intermixing in determining the performance of complete devices is evaluated through the comparison of J-V characteristics and external quantum efficiencies (EQEs) of identical photodiodes subject to different annealing conditions. It is shown that the performance of such devices approaches the one of bulk heterojunction photodiodes upon thermal annealing at 140 °C for 5 min. Our results demonstrate that transfer printing is a reliable and simple process for the realization of functional multilayers, paving the way for organic electronic devices incorporating complex stacks. It further contributes to a fundamental understanding of material composition within photoactive layers by elucidating the process of thermally assisted intermixing.

Epithelial downgrowth after cataract surgery: an atypical presentation with scleral thinning and massive seeding in anterior chamber.

PURPOSE: To report an atypical presentation of epithelial downgrowth (ED) after clear cornea cataract extraction, characterized by mixed clinical expression of both cystic and diffuse form and massive epithelial debris seeding in anterior chamber, associated with scleral involvement. METHODS: In this case report, fine needle anterior chamber aspiration cytology was performed to identify pathologic tissue invading iris, cornea, and angular structures. The patient was treated with anterior chamber membrane surgical excision. RESULTS: Epithelial downgrowth was identified by cytologic assessment. The patient was treated with epithelial membrane peeling and scleral defect conjunctival covering. This conservative surgical approach led to a significant reduction of ocular pain. During follow-up, residual epithelial tissue was present in anterior chamber without tendency to regrowth. CONCLUSIONS: In doubtful cases of ED, histocytopathologic analysis should be performed without hesitation. Avoiding more invasive procedures, early detection and prompt surgical approach can result in improved outcome even in case of extensive intraocular involvement.

Spray-coated all-solid-state potentiometric sensors.

A novel fully spray coating-based method of the preparation of all-solid-state ion-selective electrodes of simplified construction is proposed. This method is an alternative for screen-printed electrodes used sometimes in potentiometric applications. The benefits of the herein-proposed approach include fully automatic sensor preparation and minimized use of chemicals allowing for the production of low-cost sensors that can be applied as disposables. A layer of spray-coated carbon nanotubes on an inert support was used both as an electrical lead and as a transducer, to simplify sensor layout and to avoid the possible problems of changing in-time composition of this layer, as previously observed in the case of screen-printed supporting electrodes in potentiometric applications. The ion-selective poly(vinyl chloride)-based membrane and the insulator layer were also spray-coated. The obtained sensors, as the model system potassium-selective sensors were prepared and characterized with analytical parameters well comparable with that of conventional, all-solid-state, ion-selective electrodes. In addition, the applicability of the herein-proposed approach to prepare other ion-selective electrodes was tested on examples of H(+) and Cl(-) sensors.

Characterization and simulation of electrolyte-gated organic field-effect transistors.

In this work we fabricate and characterize field-effect transistors based on the solution-processable semiconducting polymer poly(3-hexylthiophene) (P3HT). Applying two independent gate potentials to the electrolyte-gated organic field-effect transistor (EGOFET), by using a conventional SiO(2) layer as the back-gate dielectric and the electrolyte-gate as the top-gate, allows the measurement of the electrical double layer (EDL) capacitance at the semiconductor-electrolyte interface. We record the transfer curves of the transistor in salt solutions of different concentration by sweeping the bottom gate potential for various constant electrolyte-gate potentials. A change of the electrolyte-gate potential towards more negative voltages shifts the threshold voltage of the bottom-gate channel towards more positive back-gate potentials, which is directly proportional to the capacitive coupling factor. By operating the EGOFET in the dual-gate mode, we can prove the dependency of the EDL capacitance on the molarity of the electrolyte according to the Debye-Hückel theory, and additionally show the difference between a polarizable and non-polarizable electrolyte-gate electrode. With the experimentally obtained values for the EDL capacitance at the semiconductor-electrolyte interface we can model the electrolyte-gate transfer characteristics of the P3HT OTFT.

Sensing Reversible Protein-Ligand Interactions with Single-Walled Carbon Nanotube Field-Effect Transistors.

We report on the reversible detection of CaptAvidin, a tyrosine modified avidin, with single-walled carbon nanotube (SWNT) field-effect transistors (FETs) noncovalently functionalized with biotin moieties using 1-pyrenebutyric acid as a linker. Binding affinities at different pH values were quantified, and the sensor's response at various ionic strengths was analyzed. Furthermore, protein "fingerprints" of NeutrAvidin and streptavidin were obtained by monitoring their adsorption at several pH values. Moreover, gold nanoparticle decorated SWNT FETs were functionalized with biotin using 1-pyrenebutyric acid as a linker for the CNT surface and (±)-α-lipoic acid linkers for the gold surface, and reversible CaptAvidin binding is shown, paving the way for potential dual mode measurements with the addition of surface enhanced Raman spectroscopy (SERS).

Fully-sprayed and flexible organic photodiodes with transparent carbon nanotube electrodes.

In this study, we demonstrate the feasibility of TCO-free, fully sprayed organic photodiodes on flexible polyethylene terephthalate (PET) substrates. Transparent conducting films of single-wall carbon nanotubes are spray deposited from aqueous solutions. Low roughness is achieved, and films with sheet resistance values of 160 Ω/sq at 84% in transmittance are fabricated. Process issues related to the wetting of CNTs are then examined and solved, enabling successive spray depositions of a poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) layer and a blend of regioregular poly(3-hexylthiophene-2,5-diyl) and [6,6]-phenyl C61 butyric acid methyl ester (PCBM). The active layer is then optimized, achieving a process yield above 90% and dark currents as low as 10(-4) mA/cm(2). An external quantum efficiency of 65% and high reproducibility in the performance of the devices are obtained. Finally, the impact of the characteristics of the transparent electrode (transmittance and sheet resistance) on the performances of the device are investigated and validated through a theoretical model and experimental data.

Watch the screw. An unusual complication of orbital reconstruction.

Traumatic intraocular foreign bodies are a particular subset of open globe injuries usually caused by metal processing, blasts, or yard work. This case report presents a retained intraocular screw as a complication of mesh positioning during lateral orbit reconstruction after resection of a left spheno-orbital infiltrating meningioma.

Metallic nanoparticles functionalizing carbon nanotube networks for gas sensing applications.

We report the fabrication of carbon nanotube (CNT) based gas sensors functionalized with different metallic nanoparticles (NPs) (Au, Pd, Ag) with exceptionally high responses towards four test gases (NH3, CO2, CO and ethanol). The CNT networks were fabricated through a low cost spray deposition process while the NPs were deposited by a thermal evaporation process. CNT based gas sensors functionalized with Au with a nominal thickness of 1.0 nm showed superior response towards NH3, CO and ethanol. The sensors' normalized responses reached 92%, 22% and 32% with concentrations of 100 ppm, 50 ppm and 100 ppm for NH3, CO and ethanol respectively. CNT based gas sensors functionalized with Pd with a nominal thickness of 1.5 nm showed the best performance with CO2. The normalized response reached 3%, 6%, 12% and 17% with concentrations of 500 ppm, 1000 ppm, 2500 ppm and 5000 ppm of CO2 respectively. We also investigated the morphological and optical changes that occur to the NPs upon thermal treatment. Functionalization of CNT films deposited on glass with Au and Ag showed surface plasmon resonance effects that are dependent on the nominal thickness of the functionalization layer.

Late vitreomacular traction in toxoplasma retinochoroiditis resolved by vitrectomy.

This paper reports a case of late vitreomacular traction in a young patient secondary to toxoplasma retinochoroiditis resolved by vitrectomy. A 17-year-old female with chronic inflammatory bowel disease developed severe vitreomacular traction 8 months after resolution of ocular toxoplasmosis with medical therapy. Best-corrected visual acuity, full ophthalmic slit-lamp examination, colour fundus photography, spectral domain optical coherence tomography, and fluorescein angiography were performed. The patient underwent vitrectomy with removal of the clinically evident posterior hyaloid. Vitrectomy was rapidly successful in resolving the vitreomacular traction, with full recovery in best-corrected visual acuity of 20/20. Vitreoretinal traction in patients with previous toxoplasma retinochoroiditis may appear several months after resolution of the inflammatory condition. We suggest observing carefully for possible development of late vitreoretinal traction during follow-up of such patients.

Low-cost thermo-optic imaging sensors: a detection principle based on tunable one-dimensional photonic crystals.

Infrared (IR) sensors employing optical readout represent a promising class of devices for the development of thermographic imagers. We demonstrate an infrared radiation detection principle based on thermally tunable one-dimensional (1D) photonic crystals acting as optical filters, integrated with organic and inorganic light emitting diodes (OLEDs and LEDs, respectively). The optical filters are composed of periodically assembled mesoporous TiO2 and SiO2 layers. Due to the thermal tunability of the transmission spectrum of the optical filter, the intensity of light passing through the filter is modulated by temperature. The tuned spectrum lies in the visible region and, therefore, can be directly detected by a visible-light photodetector. The thermal response of the luminance of the OLED-photonic crystal ensemble is 3.8 cd m(-2) K(-1). Furthermore, we demonstrate that the local temperature profile can be time and spatially resolved with a resolution of 530 by 530 pixel, thus enabling a potential application as an infrared imaging sensor featuring low power consumption and low fabrication costs.

A hybrid CMOS-imager with a solution-processable polymer as photoactive layer.

The solution-processability of organic photodetectors allows a straightforward combination with other materials, including inorganic ones, without increasing cost and process complexity significantly compared with conventional crystalline semiconductors. Although the optoelectronic performance of these organic devices does not outmatch their inorganic counterparts, there are certain applications exploiting the benefit of the solution-processability. Here we demonstrate that the small pixel fill factor of present complementary metal oxide semiconductor-imagers, decreasing the light sensitivity, can be increased up to 100% by replacing silicon photodiodes with an organic photoactive layer deposited with a simple low-cost spray-coating process. By performing a full optoelectronic characterization on this first solution-processable hybrid complementary metal oxide semiconductor-imager, including the first reported observation of different noise types in organic photodiodes, we demonstrate the suitability of this novel device for imaging. Furthermore, by integrating monolithically different organic materials to the chip, we show the cost-effective portability of the hybrid concept to different wavelength regions.