Optic Nerve Neuroprotection in Glaucoma: A Narrative Review.

In recent years, researchers have been interested in neuroprotective therapies as a cutting-edge therapeutic strategy to treat neurodegenerative disorders by shielding the brain system from harmful events. Millions of individuals worldwide suffer from glaucoma, an ocular neurodegenerative disease characterized by gradual excavation of the optic nerve head, retinal axonal damage, and consequent visual loss. The pathology's molecular cause is still mostly unknown, and the current treatments are not able to alter the disease's natural progression. Thus, the modern approach to treating glaucoma consists of prescribing medications with neuroprotective properties, in line with the treatment strategy suggested for other neurodegenerative diseases. For this reason, several naturally derived compounds, including nicotinamide and citicoline, have been studied throughout time to try to improve glaucoma management by exploiting their neuroprotective properties. The purpose of this review is to examine the naturally derived compounds that are currently utilized in clinical practice for neuroprotection in glaucomatous patients based on scientific data, emphasizing these compounds' pivotal mechanism of action as well as their proven therapeutic and neuroprotective benefits.

Reply to Schimmelbusch, K.J.; Collison, F.T. Comment on "Rosa et al. Optic Nerve Drusen Evaluation: A Comparison between Ultrasound and OCT. J. Clin. Med. 2022, 11, 3715".

We appreciate the comments of Schimmelbusch et al. [...].

Simultaneous Branch Retinal Artery and Central Retinal Vein Occlusion Improved with No Ocular Therapy: A Case Report.

A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases.

Optic Nerve Ultrasound Evaluation in Children: A Review.

Managing patients with neurocritical illness requires monitoring and treating elevated intracranial pressure (ICP), especially in cases in children. In terms of precise and real-time measurements, invasive ICP measurements are presently the gold standard for the initial diagnosis and follow-up ICP assessments. As a rapid and non-invasive way to detect elevated ICP, point-of-care ultrasonography (POCUS) of optic nerve sheath diameter (ONSD) has been proposed. The utility of bedside POCUS of ONSD to detect elevated ICP with excellent diagnostic test accuracy in adults has already been demonstrated. Nonetheless, data on the relationship between POCUS of ONSD and ICP in children are scarce. Therefore, the purpose of this review is to point out the most recent findings from the pediatric published literature and briefly discuss what was assessed with ONSD ultrasound examination, and also to describe and discuss the diagnostic procedures available for optic nerve ultrasound appraisal. A search of the medical databases PubMed and Scopus was carried out. The terms such as "ocular ultrasonography", "ICP assessment", "children", "point-of-care ultrasound", and "POCUS" were searched. In conclusion, the use of the standardized A-scan technique coupled with the B-scan technique should be suggested to provide data that are as accurate, precise, repeatable, and objective as possible.

Intraocular Pressure Measurements in Standing, Sitting, and Supine Position: Comparison between Tono-Pen Avia and Icare Pro Tonometers.

Background: Intraocular pressure (IOP) is influenced by body position. The purpose of this study is to compare the IOP measurements obtained with two different devices, to investigate IOP changes in standing, sitting, and supine positions. Methods: In this comparative prospective case series, IOP was measured in sitting, supine, prone, and standing (standing 1) positions and again five minutes after standing (standing 2), utilizing an Icare Pro (ICP) and a Tono-Pen Avia (TPA) in the 64 eyes of 32 healthy subjects. Results: Compared to the sitting position, both devices showed an increase in the IOP both in supine and standing 2 positions (p < 0.05). The mean IOP difference between the two devices was: in the sitting position, 0.57 ± 2.10 mmHg (range: −3.80 to 6.60 mmHg) (p < 0.05), in the supine position, 0.93 ± 2.49 mmHg (range: −4.50 to 7.10 mmHg) (p < 0.05), in the standing 1 position, 0.37 ± 1.96 mmHg (range: −5.20 to 5.00 mmHg) (p = 0.102), and in the standing 2 position 0.73 ± 2.03 mmHg (range: −4.5 to 6.4 mmHg) (p < 0.001). Conclusions: The results highlight an agreement between the TPA and ICP, both confirming not only the increase in IOP in the supine position, but also showing an increase in the standing 2 position. Therefore, it is suggested to perform such measurements in patients with glaucoma, to explain its progression in an apparently normal tension or in compensated patients.

Real-World Clinical Outcomes of Ribociclib in Combination with a Non-Steroidal Aromatase Inhibitor and a Luteinizing Hormone-Releasing Hormone Agonist in Premenopausal HR+/HER2- Advanced Breast Cancer Patients: An Italian Managed Access Program.

Ribociclib plus an aromatase inhibitor and ovarian function suppression is the preferred first-line option for pre-/perimenopausal women with hormone receptor-positive/human epidermal growth factor receptor-2-negative advanced or metastatic breast cancer. We opened an italian managed access program (MAP) that permitted access to ribociclib to selected patients and allowed to collect informative results on the clinical impact of the therapy. The MAP (April 2018-May 2020) included 64 premenopausal patients, with characteristics similar to those of the MONALEESA-7 trial. Of 57 patients with a known response, 48 (84.2%) achieved a clinical benefit (i.e., complete response, N = 7 (12.3%); partial response, N = 17 (29.8%); stable disease, N = 24 (42.1%)), while 9 (15.8%) experienced tumor progression. Some patients (N = 15-23.4%) needed ribociclib dose reduction because of adverse events. Thereafter, the treatment was well tolerated, and no new safety signals emerged. Our study is the first reported Italian real-world evidence of ribociclib effectiveness in premenopausal HR+/HER2- advanced breast cancer patients. Response and clinical benefit rates were particularly encouraging compared with those of the ribociclib group of MONALEESA-7. Our work confirms that ribociclib in combination with endocrine therapy is highly effective in the treatment of premenopausal HR+/HER2- advanced breast cancer patients with an expected safety profile.

Recent Evidence of Tea Tree Oil Effectiveness in Blepharitis Treatment.

The purpose of our study is to see how beneficial is tea tree oil (TTO) for treating chronic blepharitis topically, with a focus on the Demodex mite. To discover all possibly relevant published papers, an accurate Pubmed database search analysis of the current literature was undertaken from 2012 to December 2021. Fourteen papers dealing with the use of TTO to treat chronic blepharitis have been found. The effectiveness of TTO treatment was tested in vitro by 4 authors and in vivo by 10 authors. All studied confirmed efficacy of TTO treatment, even cyclic, on Demodex mite blepharitis. TTO can be used for lid scrubs, facial cleanser, eyelid patch, eyelid gel, eyelash shampoo or, more commonly, as TTO impregnated eyelid wipes. The scientific evidence of TTO for chronic blepharitis treatment gives a lot of confidence for the progress that this treatment may have in the future clinical practice.

Optic Nerve Drusen Evaluation: A Comparison between Ultrasound and OCT.

This observational study compared optic coherence tomography (OCT) and B-scan in the detection of optic disc drusen. In total, 86 eyes of 50 patients with optic disc drusen (ODD) (36 bilateral) with a mean age of 34.68 ± 23.81 years, and 54 eyes of 27 patients with papilledema, with a mean age of 35.42 years ± 17.47, were examined. Patients with ODD, diagnosed with ultrasound, underwent spectral-domain OCT evaluation. With US, 28 ODD cases were classified as large (4 buried and 24 superficial), 58 were classified as point-like (6 buried, 49 superficial and 3 mixed). Then, all patients underwent OCT. OCT was able to detect the presence of ODD and/or peripapillary hyperreflective ovoid mass structure (PHOMS) in 69 eyes (p < 0.001). In particular, 7 eyes (8.14%) showed the presence of ODD alone, 25 eyes (29.07%) showed only PHOMS and 37 eyes (43.02%) showed ODD and PHOMS. In 17 eyes (19.77%) no ODD or PHOMS were detected. In the papilledema group, no ODD were observed with both US and OCT. OCT showed the presence of drusen or similar lesions in only 80.23% of the cases highlighted by the US scan, so it does not allow for certain ODD diagnoses, especially in the case of buried ODD.

A case of retinal vascular involvement in a 6-year-old patient with Covid-19.

PURPOSE: This study evaluated fundus changes in a 6-year-old child who contracted Sars-CoV-2 without developing symptoms of the disease. MATERIALS AND METHODS: The patient underwent a complete ophthalmic evaluation, which included assessment of visual acuity with and without correction, extensive ophthalmological examination, cicloplegic refraction by retinoscopy and funduscopic examination, OCT, and angio-OCT examination. RESULTS: Fundoscopic examination in a young patient with previous Sars-CoV-2 infection showed marked vascular tortuosity, evident both at the posterior pole and retinal periphery, especially on the arterial vasculature, and cotton wool spots along the retinal vessels, highlightable also at OCT and angio-OCT examination. These alterations persist at a 6-month follow-up. CONCLUSIONS: In COVID-19 infection, even in asymptomatic pediatric patients, vasculitis develops also affecting the retinal vessels, appreciable on fundus examination. A thorough eye examination in all COVID-19 patients with close follow-up is therefore important. This is the first case report on retinal changes in a pediatric patient.

Comparison between two devices in the detection of corneal thickness changes after cataract surgery.

This study compared corneal thickness (CT) changes obtained with specular microscopy (SM) and a rotating Scheimpflug camera (RSC) after conventional phacoemulsification surgery (PS). One hundred sixty six eyes of 83 patients were analyzed before and one month after PS. One eye underwent PS, while the fellow phakic one was used as control. CT was measured with SM at the center of the cornea and with RSC at the pupil center, at the corneal apex and at the thinnest point. In the operated eye, SM showed a larger CT mean increase than those one detected at the three different measurements' points evaluated by RSC. Inversely, in the fellow phakic eye, SM showed a greater CT mean decrease than those one registered by RSC at its three measurement's points. Thus, one month after surgery, even if cornea appears clear at the slit-lamp, a significant thickness increase is still present. This is even more evident if the slight decrease of the fellow phakic eye is considered. The differences between the two devices are probably related to the different measured areas.

Infections in breast implants: a review with a focus on developing countries.

The risk of surgical site infection is always present in surgery; the use of prosthetic materials is linked to an increased possibility of infection. Breast augmentation and breast reconstruction with implants are gaining popularity in developing countries. Implant infection is the main complication related to breast aesthetic and reconstructive surgery. In the present paper, we reviewed the current microbiological knowledge about implant infections, with particular attention to risk factors, diagnosis, clinical management, and antibiotic prophylaxis, focusing on reports from developing countries. After breast aesthetic surgery, up to 2.9% of patients develop a surgical site infection, with an incidence of 1.7% for acute infections and 0.8% for late infections. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53%. The clinical features are not constant, and bacterial culture with antibiogram is the gold standard for diagnosis and for identification of antibiotic resistance. While waiting for culture results, empiric therapy with vancomycin and extended-spectrum penicillins or cephalosporins is recommended. Some patients require removal of the infected prosthesis. The main methods to bring down the risk of infection are strict asepsis protocol, preoperative antibiotic prophylaxis, and irrigation of the surgical pocket and implant with an antibiotic solution.