Trachoma and the Importance of Sexual Infective Route in Developed Countries. Comment on Gallenga et al. Why the SAFE-S Strategy for Trachoma? Are Musca sorbens or Scatophaga stercoraria Really the Culprit?-A Brief Historical Review from an Italian Point of View. Pathogens 2023, 12, 1419.

We have read the review article entitled "Why the SAFE-S Strategy for Trachoma [...].

Comparison of the Polychromatic Image Quality of Two Refractive-Segmented and Two Diffractive Multifocal Intraocular Lenses.

Evaluating chromatic aberration for a multifocal intraocular lens (MIOL) in vitro is essential for studying its performance because it helps determine the most appropriate lens for each patient, enhancing surgical outcomes. While refractive MIOLs with angular power variation have shown positive clinical outcomes, studies of these MIOLs on optical benches primarily employed monochromatic green light, neglecting the impact of longitudinal chromatic aberration (LCA) on MIOL performance. To address this gap, we evaluated the through-focus modulation transfer function (TF-MTF) and the point spread function (PSF) of two refractive segmented extended depth of focus intraocular lenses (IOLs) (Femtis Comfort and Precizon Presbyopic), comparing the results with those obtained with two widely known diffractive multifocal intraocular lenses (AcrySof IQ ReSTOR and FineVision Pod F). Measurements of the TF-MTF were conducted using both monochromatic and polychromatic light in a customized optical bench. The refractive designs exhibited distinct haloes in the PSFs. When comparing the refractive and diffractive designs, opposite signs of LCA were observed at near foci. These findings emphasize the influence of the optical design of IOLs on their performance under polychromatic light, providing valuable information for vision care professionals when selecting the most suitable lens for each patient.

Optical Performance of a Segmented Extended-Depth-of-Focus Intraocular Lens under the Influence of Different Values of Spherical Aberration Generated by Refractive Surgery.

BACKGROUND: Corneal refractive surgery induces high-order aberrations, specifically spherical aberration (SA). These aberrations can have implications when patients later develop cataracts and require the implantation of multifocal intraocular lenses (MIOLs). MIOLs with asymmetric designs pose challenges in predicting outcomes, particularly in these cases. The aim of this study was to evaluate how different values of SA, resulting from various types of refractive surgeries, affect the optical performance of the FEMTIS Comfort intraocular lens. METHODS: The through-focus modulation transfer function (TF-MTF) curve and high-contrast images of tumbling E were used as parameters to assess the optical performance of the MIOL. These parameters were measured using an adaptive optics visual simulator. RESULTS: Increasingly negative values of SA make the MIOL more bifocal, moderating its extended-depth-of-focus characteristic. Conversely, higher positive SA values cause the TF-MTF curve to shift towards positive vergences, leading to worsened distance vision in the +1.00 to +2.00 D range, but improved vision in the +0.50 D to +1.00 D range. CONCLUSIONS: Assessing SA in patients prior to implanting MIOLs with asymmetric designs is necessary for predicting outcomes and making informed decisions based on the visual requirements of patients.

Optical performance of a new design of a trifocal intraocular lens based on the Devil's diffractive lens.

In this work, we propose a new diffractive trifocal intraocular lens design with focus extension, conceived to provide a high visual performance at intermediate distances. This design is based on a fractal structure known as the "Devil's staircase". To assess its optical performance, numerical simulations have been performed with a ray tracing program using the Liou-Brennan model eye under polychromatic illumination. The simulated through the focus visual acuity was the merit function employed to test its pupil-dependence and its behavior against decentering. A qualitative assessment of the multifocal intraocular lens (MIOL) was also performed experimentally with an adaptive optics visual simulator. The experimental results confirm our numerical predictions. We found that our MIOL design has a trifocal profile, which is very robust to decentration and has low degree of pupil dependence. It performs better at intermediate distances than at near distances and, for a pupil diameter of 3 mm, it works like an EDoF lens over almost the entire defocus range.

Neurotrophic Keratopathy Treated with Topical Recombinant Human Nerve Growth Factor (Cenegermin): Case Series Study with Long-Term Follow-Up.

The authors report the use of topical recombinant human nerve growth factor cenegermin 0.02% in 5 patients diagnosed with neurotrophic keratopathy (NK) in a real-life setting. These 5 patients affected with stage II and III NK mainly of herpetic cause received cenegermin six times daily for 8 weeks. It was initiated upon refractoriness to prior conventional topical treatment. Visual acuity, corneal sensitivity test at four corneal quadrants, fluorescein staining, OC,T and photography were performed weekly during 9 weeks of follow-up from the completion of treatment. At the ninth week of follow-up, corneal sensitivity improvement and healing of corneal ulcers were found in all patients. No adverse events were reported, and no corneal ulcer recurrence was observed over a 4-year follow-up period. Cenegermin should be used in combination with conventional therapy for advanced NK, as it is an effective treatment for healing corneal ulcers, improving the corneal surface homeostasis and avoiding surgery.

In Vitro Chromatic Performance of Three Presbyopia-Correcting Intraocular Lenses with Different Optical Designs.

Most of the new premium models of intraocular lenses for presbyopia correction use diffractive optics in their optical design. The presence of multiple foci and the difference of the diffractive efficiency for different wavelengths have a great impact in the lens optical performance. In this context, there is a limited information available for clinicians to understand the optical principles that differentiate each design and their potential influence on clinical outcomes. Optical bench studies with polychromatic light are necessary to solve this limitation. In this work, a custom made optical bench was employed to assess with polychromatic light the through the focus optical quality of three different IOL designs: trifocal, EDOF effect; and enhanced monofocal. By using different and complimentary approaches: images of the USAF test, axial PSFs and TF-MTFs, each design revealed its intrinsic features, which were not previously reported for these IOLs models in a comparative way. It was found that the chromatic aberration plays a very important role in the performance of each IOL. Our results could help clinicians to understand the optical principle of each lens and also provide useful information for choosing the lens that best suits the needs of the individual patient.

Polychromatic Assessment of a Refractive Segmented EDOF Intraocular Lens.

This study aimed to evaluate in vitro performance refractive segmented EDOF intraocular lenses under polychromatic light using an optical bench that complies with the ISO 11979-2 Norm. The through focus modulation transfer function (TF-MTF) of the Femtis Comfort LS-313 MF15 (Oculentis GmbH, Berlin, Germany) IOL was evaluated for IOLs with three different base powers. The effect of the asymmetry of the segmented designs was evaluated with 3 different wavelengths and with polychromatic light at a 3.0 mm and 5.0 mm pupil diameter. It was demonstrated that the TF-MTF curves exhibit a bifocal profile that, in practice, results in an EDOF design. As a consequence of the LCA, the TF-MTF values in white light were lower than in monochromatic light. Images of the USAF test chart were obtained to confirm the prediction of the TF-MTFs. We found that Femtis Comfort is a bifocal low-addition IOL and this fact can result in an EDOF effect which was obtained previously in clinical trials. Moreover, we showed that the base power influences the IOL optical quality, which results as more effective for high powers (hyperopic eyes) than for low powers (myopic eyes). The LCA of the segmented refractive design was very low and presumably not clinically relevant.

Impact of Different Clinical Baseline Characteristics on Intravitreal Dexamethasone Implant Ozurdex® Outcomes.

PURPOSE: To determine the impact of different baseline clinical characteristics on the improvement in best corrected visual acuity (BCVA) in patients with diabetic macular edema (DME) who underwent the intravitreal dexamethasone implant (DEX) Ozurdex®. METHODS: This was a single center retrospective study conducted on patients with DME, either naïve or previously treated, who were treated with one or more DEX and had a follow-up of at least 6 months. The main outcome measure was the proportion of DEX achieving an improvement ≥15 letters in BCVA. RESULTS: The study analyzed 192 DEX implants administered to 97 eyes (65 patients). Among the 192 DEX analyzed, 57 (29.7%) implants achieved a BCVA improvement ≥15 letters (ETDRS) from baseline, with a mean time for achieving such improvement of 89.2 (39.7) days. Eyes who received an additional DEX and those with a duration of DME < 6 months had a greater probability of achieving a BCVA improvement ≥15 letters (odds-ratio: 2.55, p = 0.0028 and odds-ratio: 1.93, p = 0.0434). The mean (standard deviation) change in BCVA from baseline was 7.5 (14.5) letters, p < 0.0001. The mean change in central macular thickness (CMT) from baseline was -128.0 (151.0) µm, p < 0.0001. The mean number of DEX implanted was 1.9 (0.8). Four (2.1%) DEX experienced an intraocular pressure increased ≥10 mm Hg; all the cases were successfully managed with topical antiglaucoma medication. CONCLUSION: The results of this study confirmed previous evidence suggesting that DEX is effective for improving BCVA and CMT in patients with DME.

A new trifocal corneal inlay for presbyopia.

Corneal inlays (CIs) are the most recent surgical procedure for the treatment of presbyopia in patients who want complete independence from the use of glasses or contact lenses. Although refractive surgery in presbyopic patients is mostly performed in combination with cataract surgery, when the implantation of an intraocular lens is not necessary, the option of CIs has the advantage of being minimally invasive. Current designs of CIs are, either: small aperture devices, or refractive devices, however, both methods do not have good performance simultaneously at intermediate and near distances in eyes that are unable to accommodate. In the present study, we propose the first design of a trifocal CI, allowing good vision, at the same time, at far, intermediate and near vision in presbyopic eyes. We first demonstrate the good performance of the new inlay in comparison with a commercially available CI by using optical design software. We next confirm experimentally the image forming capabilities of our proposal employing an adaptive optics based optical simulator. This new design also has a number of parameters that can be varied to make personalized trifocal CI, opening up a new avenue for the treatment of presbyopia.

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures.

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th ) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic.

Use of Vivostat PRF® in Acanthamoeba keratitis.

We present a case of a 27-year-old contact lens male user who was diagnosed with Acanthamoeba keratitis. Given the inefficiency of medical treatment and high risk of corneal perforation, we decided to use Vivostat PRF®, with satisfactory results. To our knowledge, this is the first described case in medical literature in which Vivostat PRF® is used as part of Acanthamoeba keratitis treatment.

Recomendaciones para la atención oftalmológica durante el estado de alarma por la pandemia de enfermedad por coronavirus COVID-19 / Recommendations for eye care during the alarm state bythe coronavirus disease pandemic COVID-19

OBJETIVO: Minimizar la exposición al virus SARS-CoV-2, reducir las posibilidades de transmisión cruzada entre pacientes y personal sanitario, y evitar el desarrollo de complicaciones postoperatorias por la atención a pacientes con enfermedades oculares durante la pandemia de Enfermedad por Coronavirus 2019 (COVID-19). MÉTODOS: Elaboración de un documento de revisión del estado del conocimiento sobre COVID-19 y consenso entre diferentes sociedades oftalmológicas españolas y afines, al objeto de proporcionar guías y recomendaciones de máximos recursos primariamente condicionadas por el estado de alerta, confinamiento y distanciamiento social que acontece en España desde el 16 de marzo de 2020. RESULTADOS: Las recomendaciones promoverán la adopción de medidas de actuación y protección para el desarrollo de la actividad asistencial en consultas externas, área quirúrgica y hospitalización, tanto para pacientes no confirmados - asintomáticos y sintomáticos - como confirmados de COVID-19. Deberán ser adaptadas a las circunstancias y disponibilidad de Equipos de Protección Individual (EPI) en cada uno de los Centros y Comunidades Autónomas, debiendo ser actualizadas en función de las fases de la pandemia y de las medidas que adopte el Gobierno de la Nación. CONCLUSIONES: Durante la pandemia COVID-19, la atención a los potenciales riesgos de salud para la población ocasionados por el coronavirus deberá prevalecer sobre la posible progresión de enfermedades oculares comunes. Tanto médicos oftalmólogos como restantes profesionales de la salud ocular deberán asumir una posible progresión de dichas enfermedades ante la imposibilidad de un seguimiento adecuado de los pacientes

OBJECTIVE: Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID -19). METHODS: COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of máximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. Results: The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of Personal Protective Equipment (PPE) in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. Conclusions: During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up

Cyclosporine 0.1% (Ikervis®) as a corticoid-sparing agent in Lyell syndrome with KeraKlear® keratoprosthesis.

Cyclosporine 0.1% was used in a patient with Lyell syndrome, which had undergone a KeraKlear® keratoprosthesis implant due to the severe ocular involvement to avoid overuse of corticoid agents. To the best of our knowledge, this is the first reported case of cyclosporine 0.1% eye drops to use in Lyell syndrome previously treated with keratoprosthesis implant.

Usefulness of Liquid Biopsy Biomarkers from Aqueous Humor in Predicting Anti-VEGF Response in Diabetic Macular Edema: Results of a Pilot Study.

The objective was to investigate the usefulness of the "liquid biopsy" of aqueous humor (AH) to predict the clinical response after intravitreal injections (IVT) of anti-VEGF agents for treating diabetic macular edema (DME). For this purpose, AH samples obtained during the first anti-VEGF IVT from 31 type two diabetic patients were analyzed. Patients were classified into three groups according to their anti-VEGF response: rapid responders (n = 11), slow responders (n = 11), and non-responders (n = 9). In addition, patients (n = 7) who showed good response to corticosteroids but a delayed or no response to anti-VEGF therapy were analyzed. Levels of 17 different cytokines, chemokines, and growth factors in AH were measured using a multiplex immunoassay. We found higher concentrations of VEGF in rapid responders to anti-VEGF therapy compared to non-responders. In addition, slow responders to anti-VEGF treatment showed higher levels of inflammatory markers than rapid responders, but did not reach statistical significance. Finally, those patients who responded to corticosteroids but not to anti-VEGF therapy showed significantly lower levels of VEGF than patients with rapid response (p = 0.01). In conclusion, "liquid biopsy" of AH could be useful to determine whether the predominant pathogenic event is primarily angiogenic or inflammatory in nature. This approach would allow physicians to select a more rational and cost-effective treatment. Further studies to validate these preliminary results are warranted.

Fractal-structured multifocal intraocular lens.

In this work, we present a new concept of IOL design inspired by the demonstrated properties of reduced chromatic aberration and extended depth of focus of Fractal zone plates. A detailed description of a proof of concept IOL is provided. The result was numerically characterized, and fabricated by lathe turning. The prototype was tested in vitro using dedicated optical system and software. The theoretical Point Spread Function along the optical axis, computed for several wavelengths, showed that for each wavelength, the IOL produces two main foci surrounded by numerous secondary foci that partially overlap each other for different wavelengths. The result is that both, the near focus and the far focus, have an extended depth of focus under polychromatic illumination. This theoretical prediction was confirmed experimentally by means of the Through-Focus Modulation Transfer Function, measured for different wavelengths.

Diffractive corneal inlay for presbyopia.

A conceptually new type of corneal inlays for a customized treatment of presbyopia is presented. The diffractive inlay consists on a small aperture disc having an array of micro-holes distributed inside the open zones of a Fresnel zone plate. In this way, the central hole of the disc lets pass the zero order diffraction and produces an extension of the depth of far focus of the eye, while the diffracted light through the holes in the periphery produce the near focus. Additionally, the micro-holes in the inlay surface fulfill the essential requirement of allowing the flow of nutrients through it to the cells of the corneal stroma. Theoretical and optical-bench experimental results for the polychromatic axial Point Spread Function (PSF) were obtained, showing an improved performance compared to the small aperture corneal inlay currently in the market (Kamra). Images of a test object, obtained at several vergences in the surroundings of the far and near foci, are also shown. Picture: Simulation of the appearance of the Diffractive corneal inlay on a real eye.

Aflibercept as First-Line Therapy in Patients with Treatment-Naïve Neovascular Age-Related Macular Degeneration: Prospective Case Series Analysis in Real-Life Clinical Practice.

PURPOSE: To assess the 13-month effectiveness and safety of aflibercept in naïve patients with neovascular age-related macular degeneration (nvAMD) in a real-life clinical setting. METHODS: Thirty-two treatment-naïve patients with nvAMD participated in a prospective two-center study. Patients received intravitreal injections of aflibercept (Eylea®), a loading dose of three monthly injections (2 mg/0.05 ml) every 4 weeks for the first 3 months, followed by intravitreal injections every 2 months. RESULTS: At 3 and 13 months, the mean best-corrected visual acuity improved significantly as compared with baseline (logMAR 0.53 ± 0.30 and 0.55 ± 0.32 vs. 0.30 ± 0.24, respectively, p < 0.001). At 3 and 13 months, 46.8% of patients (15/32) gained ≥15 ETDRS letters. The mean decrease in central macular thickness was also significant at 3 months (252 ± 35 µm) and at 13 months (249 ± 38 µm) as compared with pretreatment values (383 ± 76 µm) (p < 0.01). Also, 50% resolution of pigment epithelial detachment (PED) was observed in 8 out of 9 eyes (88.9%) with PED at baseline. Intravitreal injections were well tolerated and no adverse events were recorded. CONCLUSION: Aflibercept was effective and safe for treating nvAMD in naïve patients in routine daily practice.

Levels of thrombopoietin in aqueous humor of patients with noninfectious acute anterior uveitis.

PURPOSE: To measure thrombopoietin (TPO) levels in the serum and aqueous humors of patients with noninfectious acute anterior uveitis. METHODS: A prospective, comparative, controlled study. Serum and aqueous humors were obtained from the eyes of 16 patients with noninfectious acute anterior uveitis. TPO levels were measured using an enzyme-linked immunosorbent assay (ELISA). The results obtained were compared with those of a control group. RESULTS: Serum concentrations of TPO were not significantly different between control individuals and patients with active anterior uveitis. Aqueous humor TPO levels were 54.46±16.24 pg/mL in the eyes of patients with uveitis, and 34.32±11.63 pg/mL in the eyes of controls. The difference between the two groups was significant (Mann-Whitney U-test for independent data, P=0.0008), with uveitis patients exhibiting significantly higher levels of TPO. CONCLUSION: The high levels of TPO in the aqueous humors of uveitis patients points toward a cytoprotective role of this factor in inflammatory repair processes and the recovery of tissue homeostasis.

Ahmed valve, suture-less implantation: A new approach to an easier technique.

PURPOSE: Tissue adhesives have been used in ophthalmology instead of sutures to minimize the operating time. This case series investigated the effectiveness and safety of use of cyanoacrylate in Ahmed valve implantation through pars plana for refractory glaucoma. PATIENTS AND METHODS: Seventeen eyes of 17 patients with refractory glaucoma underwent Ahmed valve scleral suture-less implantation through pars plana with a cyanoacrylate suture of the plate. Refractory glaucoma was defined as intraocular pressure (IOP) ≥ 21 mm Hg with antiglaucoma eye drops, good adherence to treatment, and no previous glaucoma surgery. IOP control and development of complications were evaluated during the follow-up (mean follow-up, 13.23 mo, 6 to 28 mo). RESULTS: IOP control, defined as IOP ≤ 21 mm Hg with or without antiglaucoma eye drops, was achieved in 82.2% of patients, and 58.8% were able to eliminate antiglaucoma eye drops. Mean surgical time was 9.76 ± 2.60 and 6 ± 0.81 minutes in patients with previous vitrectomy (4 cases). Postoperative complications included transiently increased IOP, transient hyphema, early postoperative hypotony (4 cases), and tube block by the vitreous (2 cases): 1 resolved by Nd:YAG and the other by second vitrectomy. No cases of tube or plate extrusion, plate migration, choroidal or retinal detachment, or vitreous hemorrhage were observed. CONCLUSIONS: These results are promising and demonstrate a safe and effective alternative to the traditional scleral suture. Our data suggest that Ahmed valve implantation through pars plana with cyanoacrylate is a safe and effective method for refractory glaucoma. Further studies are needed to confirm our observation.

Treatment of refractory dry eye associated with graft versus host disease with 0.03% tacrolimus eyedrops.

PURPOSE: We investigate the efficacy of 0.03% topical tacrolimus eyedrops for the treatment of dry eye in graft versus host disease (GVHD) patients resistant/intolerant to 0.05% topical cyclosporine. METHODS: Forty-three patients were enrolled in this prospective study. After completing a 1-year run-in period of using artificial tears, 50% autologous serum eyedrops, and punctal plug occlusion, all the symptomatic patients (n=29) were treated with 0.05% topical cyclosporine (Restasis(®); Allergan, Inc.). After 1 month, the patients who presented topical or systemic intolerance to cyclosporine were instructed to instill 0.03% topical tacrolimus once a day for 3 months (n=14). All the patients were allowed to continue with their basal dry eye treatment. Visual acuity, fluorescein staining, Schirmer test, fluorescein tear break-up time, and tear meniscus height measurement were evaluated fortnightly (minimum 3 months). Subjective assessments of symptoms were also reported at the beginning and at the end of the study. RESULTS: Dry eye symptoms and signs improved statistically (P<0.05) and significantly with tacrolimus and cyclosporine topical treatment. No significant differences were observed between both the groups. The mean follow-up time was 12.14±2.69 months (range 10-18 months). CONCLUSION: The findings of this prospective pilot study suggest that cyclosporine-intolerant patients with dry eye associated with GVHD can be effectively treated with topical tacrolimus.