Eosinophilic granulomatosis with polyangiitis associated with abducens nerve palsy.

We present the case of a 61-year-old man who reported diplopia due to a right abducens nerve palsy. The patient complained of fever every night (37.5° C), paresthesia of the second and third hand fingers, and he showed an increased C-reactive protein, high erythrocyte sedimentation rate, and high eosinophilia. He had a history of allergic asthma, chronic rhinosinusitis, and surgically treated nasal polyps. His past medical history and labs led us to identify the eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome. EGPA is a potentially life-threatening condition, and a proper diagnosis was critical to managing this patient's abducens nerve palsy.

Multimodal Imaging Findings and Treatment with Dexamethasone Implant in Three Cases of Idiopathic Macular Telangiectasia Type 1.

This is a report of 3 patients diagnosed with idiopathic macular telangiectasia type 1 (MacTel 1) at Medical Retina Center of the University of Eye Clinic of Genova and then prospectically followed for a mean time of 26 months between 2016 and 2019. It is the first report of patients affected by MacTel 1 treated with dexamethasone (DEX) implant as a first choice of treatment. Aim of our study is to better characterize the disease using a multimodal wide-field imaging and to determine efficacy of DEX implant on MacTel 1 in terms of central macular thickness (CMT) and best-corrected visual acuity (BCVA). MacTel 1 is a rare unilateral disease, characterized by telangiectatic retinal capillaries, cystoid macular edema, and lipid deposition occurring temporal to the fovea. Patients underwent a comprehensive ophthalmic examination, BCVA, swept-source optical coherence tomography (SS-OCT), SS-OCT angiography (SS-OCTA), ultra-widefield (UWF) color, and fluorescein angiography (FA) fundus photograph. All the patients presented monolateral reduced BCVA and macular edema with increased CMT evaluated by SS-OCT. With SS-OCTA, we showed that the telangiectasia-associated vascular changes originate in the deep retinal vascular plexus and as a consequence macular edema and exudation develop causing vision loss. Furthermore, UWF imaging helped us to highlight vascular changes typical of Coats Disease at the far retinal periphery. All the patients were treated with DEX intravitreal implant, showing a decrease in CMT and a stabilization of visual acuity. Due to the recurrent nature of macular edema, patients underwent a mean of 4 DEX implants during the follow-up period. In order to address the clinical features of this uncommon disease avoiding diagnostic errors, it might be important to use a multimodal imaging approach. The anatomical and functional beneficial effects of DEX implant were well evident although transient.

Choroidal changes in intermediate age-related macular degeneration patients with drusen or pseudodrusen.

Reticular pseudodrusen are associated with a thinner choroid. The aim of our study was to determine the differences in central choroidal thickness and choriocapillaris vascular flow area between eyes with and without reticular pseudodrusen using swept-source optical coherence tomography and swept-source optical coherence tomography angiography. We conducted a retrospective case control study which included 27 eyes from 27 consecutive patients with intermediate age-related macular degeneration and 17 eyes from 17 healthy participants. Complete ophthalmic examinations were carried out including axial length measurements; fundus color retinography; fundus autofluorescence; swept-source optical coherence tomography and swept-source optical coherence tomography angiography; central choroidal thickness and choriocapillaris vascular flow area. Patients were classified as no reticular pseudodrusen, mild reticular pseudodrusen, and severe reticular pseudodrusen. Mean central choroidal thickness in patients exhibiting severe reticular pseudodrusen (110 ± 56 µm) was significantly smaller than in patients with no reticular pseudodrusen (201 ± 76 µm, p < 0.01). Mean choriocapillaris vascular flow area in severe reticular pseudodrusen patients (45.2% ± 3.0%) was also significantly less than in patients with no (47.9% ± 1.6%, p < 0.001) and mild reticular pseudodrusen (47.7% ± 1.0%, p < 0.05). Stepwise multiple regression models confirmed the association of reticular pseudodrusen with central choroidal thickness (p < 0.001) and choriocapillaris vascular flow area (p < 0.01) even after accounting for age, axial length, and refractive error. Soft drusen were not associated with changes in either central choroidal thickness (p = 0.13) nor choriocapillaris vascular flow area (p = 0.29). A significant, positive relationship was found between central choroidal thickness and choriocapillaris vascular flow area (r = 0.44, p = 0.01). Therefore, both central choroidal thickness and choriocapillaris vascular flow area are decreased in eyes with reticular pseudodrusen, as compared to healthy eyes and intermediate age-related macular degeneration eyes not exhibiting reticular pseudodrusen. In addition, central choroidal thickness and choriocapillaris vascular flow area are related, and the reduction of either is directly associated to the severity of reticular pseudodrusen. Further studies are needed to assess the clinical significance of these findings.

Motor skills in children affected by strabismus.

OBJECTIVES: To compare motor skills in patients with infantile strabismus and age and sex-matched control subjects aged 5-11 years. METHODS: Motor performances were assessed by the Italian version of Developmental Coordination Disorder Questionnaire 2007 (DCDQ) in children with infantile strabismus and age and sex-matched control subjects. Patients affected by specific neurological, cognitive and behavioural disorders were excluded from the study. RESULTS: There were 43 patients included in the study, 23 in the strabismus group (14 males, 9 females, mean age 7.5 ± 2.0 years) and 24 in the control group (14 males and 10 females, mean age 7.2 ± 1.7 years. The overall DCDQ score was significantly lower in children with strabismus compared with control subjects (58.7 ± 11.3 vs. 74.2 ± 1.5; P < 0.001). Children with strabismus and no stereopsis showed a lower DCDQ score compared with those with normal stereopsis (50.8 ± 9.5 vs. 67.3 ± 4.8; P < 0.001). CONCLUSION: Motor skills are reduced in children with strabismus compared with control subjects. Strabismus and lack of binocular vision are factors potentially contributing to developmental coordination disorder.

Peribulbar anesthesia for strabismus surgery in adult patients.

PURPOSE: To evaluate the efficacy and safety of peribulbar anesthesia during strabismus surgery. METHODS: Medical records of patients undergoing strabismus surgery and peribulbar anesthesia were reviewed. The overall efficacy of peribulbar anesthesia was evaluated as requirement of supplemental peribulbar anesthesia, impossibility to perform eye muscles surgery due to inadequate efficacy of the block and peribulbar block complications that occurred up to 6 weeks postoperatively. Presence of oculocardiac reflex (OCR) and presence of decreased visual acuity and afferent pupillary defect postoperatively were reported. RESULTS: A total of 510 patients comprised our study group. The total amount of peribulbar injections was 717. Four patients (0.7%) required supplemental injection in the superonasal quadrant. Five of 510 (0.9%) required an anesthesiologic intervention with intravenous atropine. Eighty patients of 510 (15.6%) complained about transitory complete ptosis and/or amaurosis postoperatively. No complications were observed up to 6 weeks postoperatively. CONCLUSION: Peribulbar anesthesia was an effective and safe option during strabismus surgery in adult patients.

Efficacy of a Cycloplegic Agent Administered as a Spray in the Pediatric Population.

PURPOSE: To evaluate the efficacy and tolerability of cyclopentolate 1% administered as a spray in pediatric patients between 3 and 6 years old. METHODS: In this prospective, randomized, parallel group study, healthy volunteers were randomly assigned to receive cyclopentolate 1% as a single drop or a single puff into closed eyes. RESULTS: There were 61 patients included in the study; 31 received cyclopentolate 1% as drops and 30 received cyclopentolate 1% as spray. The mean age at presentation was 4.5 ± 1.07 years (range: 3 to 6 years) and 4.2 ± 1.06 years (range: 3 to 6 years) in the drops and spray groups, respectively. The distress level was significantly lower at the time of receiving cyclopentolate as a spray (P < .0001), with the exception of patients aged 6 years. There were no significant differences in pupil diameter between the two groups (P = .51), whereas 5 of 30 patients (16.6%) with dark irises who received cyclopentolate spray did not have adequate cycloplegia to allow for accurate refraction. CONCLUSIONS: Cycloplegia achieved with cyclopentolate 1% administered as a spray may be an option in uncooperative children because it is less distressing compared to cyclopentolate 1% drops. However, physicians should be aware that cycloplegia obtained is only partially effective in children with dark irises. [J Pediatr Ophthalmol Strabismus. 2020;57(5):301-304.].

Effect of Hematite Doping with Aliovalent Impurities on the Electrochemical Performance of α-Fe2O3@rGO-Based Anodes in Sodium-Ion Batteries.

The effect of the type of dopant (titanium and manganese) and of the reduced graphene oxide content (rGO, 30 or 50 wt %) of the α-Fe2O3@rGO nanocomposites on their microstructural properties and electrochemical performance was investigated. Nanostructured composites were synthesized by a simple one-step solvothermal method and evaluated as anode materials for sodium ion batteries. The doping does not influence the crystalline phase and morphology of the iron oxide nanoparticles, but remarkably increases stability and Coulombic efficiency with respect to the anode based on the composite α-Fe2O3@rGO. For fixed rGO content, Ti-doping improves the rate capability at lower rates, whereas Mn-doping enhances the electrode stability at higher rates, retaining a specific capacity of 56 mAhg-1 at a rate of 2C. Nanocomposites with higher rGO content exhibit better electrochemical performance.

Management of Pediatric Ophthalmology Patients During the COVID-19 Outbreak: Experience From an Italian Tertiary Eye Center.

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for coronavirus disease 2019 (COVID-19), which represents a public health threat and has been declared a pandemic by the World Health Organization. The authors describe the treatment of pediatric patients with ophthalmological problems during the COVID-19 pandemic in an Italian tertiary eye center. [J Pediatr Ophthalmol Strabismus. 2020;57(4):213-216.].

Real-Life Data in the Treatment of Neovascular Age-Related Macular Degeneration: Results from the Imaculaweb Registry Evaluated in a Single Italian Medical Retina Center.

INTRODUCTION: The aim of this study is to assess and compare the long-term clinical efficacy of anti-VEGF drugs using the Imaculaweb registry. METHODS: In this observational study based on the Imaculaweb registry, outcome measures were the number of injections, the change in mean visual acuity (VA) and central macular thickness (CMT), and the time between diagnosis and the first injection. RESULTS: In total, 126 eyes of 109 patients were included in the study. The mean VA was 49.4 ± 21.4, 54.1 ± 22.2, 51.6 ± 24.9, and 48.3 ± 25.7 letters at baseline and at the 1-, 2-, and 3-year follow-ups, respectively. Significant VA increases (p = 0.0002 for the first year and p = 0.045 for the second year) were documented at years 1 and 2 but not at year 3 (p = 0.8). The mean number of injections was 5.2, 2.6, and 2.3 at the 1-, 2-, and 3-year follow-ups, respectively. In the first year, 30% of the patients received at least 7 injections, while only 6.4% received <3 injections. CMT decreased significantly during the overall follow-up period, and intra- and subretinal fluid decreased (p < 0.0001). CONCLUSION: Imaculaweb turned out to be an effective tool to collect and share clinical data as well as to monitor patient outcome.

Real-Life Management of Patients with Retinal Vein Occlusion Using I-Macula Web Platform.

AIM: Real-life evaluation in the management of patients affected by macular edema secondary to retinal vein occlusion. MATERIAL AND METHODS: A retrospective, observational study using the I-Macula Web platform. RESULTS: Thirty-five patients (37 eyes; 15 females and 20 male) affected by RVO were analysed. At 12 months, there was a statistically significant improvement of best-corrected visual acuity (p = 0.0235) and central macular thickness (p < 0.0001). The mean change in visual acuity was 8.9 letters. Twenty-seven eyes underwent DEX implant (n = 62; mean: 2.29) only. Of these, 8, 4, 14, and 1 eyes underwent 1, 2, 3, and 4 DEX implants, respectively. The remaining 10 eyes were also injected with ranibizumab (n = 49; mean: 4.9). At 12 months, 12 eyes (32.5%) presented a dry macula, whereas the remaining 25 eyes (67.5%) still had macular edema. Mean interval between the first and second treatment (T1) and between the second and third treatment (T2) were 5.15 and (T2) 3.7 months, respectively. Where only DEX implants were received, T1 and T2 was 5.1 and 4.9 months, respectively. CONCLUSIONS: This study confirms that DEX implants and/or anti-VEGF drugs improve visual acuity and central macular thickness in patients affected by RVO.

Choroidal Vascular Flow Area in Central Serous Chorioretinopathy Using Swept-Source Optical Coherence Tomography Angiography.

Purpose: To report the choroidal vascular flow area in eyes with central serous chorioretinopathy (CSC) compared with healthy subjects and unaffected fellow eyes using swept-source (SS) optical coherence tomography (OCT) angiography. Methods: Prospective case series of 19 eyes of 19 consecutive patients affected by CSC, compared with 15 unaffected fellow eyes and 20 eyes of 10 healthy subjects. Patients underwent SS-OCT angiography in order to evaluate the choroidal vascular flow area of choriocapillaris (CC) and deeper choroidal layers. Results: The choroidal vascular flow area was higher in eyes with CSC than in control eyes (53.4 ± 5.8% vs. 49.45 ± 8.16%; P = 0.0001). Within the choroid of CSC patients choroidal vascular flow area of the CC was significantly lower than the deeper level (50.97 ± 2.8% vs. 54.22 ± 6.3%; P = 0.025). There were no differences within the choroid of control eyes. The choroidal vascular flow area at the level of the CC was higher in the unaffected fellow eye (50.74 ± 0.9%; P = 0.019) than in control eyes. Choroidal vascular flow area of unaffected fellow eyes did not differ from CSC eyes (P = 0.17). The choroidal vascular flow area at the level of the CC was higher in the CSC eyes (P = 0.0009) compared with unaffected fellow eyes. Conclusions: Choroidal vascular flow area is larger in CSC eyes compared with control eyes. However, within the choroid of eyes with CSC, there might be some differences in flow area between CC and deeper choroidal levels. This difference might be secondary to a compensatory mechanism of the choroid.

I-Maculaweb: A Tool to Support Data Reuse in Ophthalmology.

This paper intends to present a Web-based application to collect and manage clinical data and clinical trials together in a unique tool. I-maculaweb is a user-friendly Web-application designed to manage, share, and analyze clinical data from patients affected by degenerative and vascular diseases of the macula. The unique and innovative scientific and technological elements of this project are the integration with individual and population data, relevant for degenerative and vascular diseases of the macula. Clinical records can also be extracted for statistical purposes and used for clinical decision support systems. I-maculaweb is based on an existing multilevel and multiscale data management model, which includes general principles that are suitable for several different clinical domains. The database structure has been specifically built to respect laterality, a key aspect in ophthalmology. Users can add and manage patient records, follow-up visits, treatment, diagnoses, and clinical history. There are two different modalities to extract records: one for the patient's own center, in which personal details are shown and the other for statistical purposes, where all center's anonymized data are visible. The Web-platform allows effective management, sharing, and reuse of information within primary care and clinical research. Clear and precise clinical data will improve understanding of real-life management of degenerative and vascular diseases of the macula as well as increasing precise epidemiologic and statistical data. Furthermore, this Web-based application can be easily employed as an electronic clinical research file in clinical studies.

Early Swept-Source Optical Coherence Tomography Angiography Findings in Unilateral Acute Idiopathic Maculopathy.

Unilateral acute idiopathic maculopathy (UAIM) is a rare disorder presenting in young people with an acute onset of unilateral central visual loss often associated with a prodromal flu-like illness. The authors present the early anatomical findings of a 35-year-old man clinically diagnosed with UAIM using swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography.

Association between the efficacy of half-dose photodynamic therapy with indocyanine green angiography and optical coherence tomography findings in the treatment of central serous chorioretinopathy.

PURPOSE: To determine the efficacy of half-dose photodynamic therapy (PDT) in relation to indocyanine green angiography (ICGA) and optical coherence tomography (OCT) findings for treating chronic central serous chorioretinopathy (CSC). DESIGN: Observational case series. METHODS: Thirty-eight eyes of 37 patients with chronic CSC and symptoms for at least 6 months were recruited. PDT was performed using half the normal dose of verteporfin. A total light energy of 50 J/cm(2) over 83 seconds was delivered to the area of choroidal hyperfluorescence as observed on ICGA. The resolution of the subretinal fluid and recurrence rates were assessed in relation to the different degrees of choroidal hyperfluorescence and the distribution of fluid in the neuroepithelium, namely subretinal fluid or posterior retinal cystoid degeneration. RESULTS: After half-dose PDT a dry macula was obtained in 86.8% and 92.1% of the eyes at 1 month and at the last follow-up (14.2 ± 5.8 months) respectively. ICGA at baseline showed intermediate and intense hyperfluorescence in 39.4% and 60.5% of the eyes respectively. All eyes with intermediate hyperfluorescence had only subretinal fluid at OCT and a dry macula was obtained in 87% and 100% at 1 month and at the last follow-up after half-dose PDT. In the intense hyperfluorescence group, 82.6% and 17.4% of the eyes had subretinal fluid only or both subretinal fluid and posterior retinal cystoid degeneration respectively. In the intense hyperfluorescence group with subretinal fluid only, a dry macula was obtained in 89.5% and 100% of the eyes at 1 month and at the last follow-up respectively. In the intense hyperfluorescence group with both subretinal fluid and posterior retinal cystoid degeneration, a dry macula was obtained in 75% and 25% of the eyes at 1 month and at the last follow-up respectively. Overall, of the 23 eyes with intense hyperfluorescence, 20 eyes (87%) had a dry macula starting from 1 month for the entire follow-up period. CONCLUSION: The half-dose PDT success rate in eyes with chronic CSC depends also on the distribution of fluid in the neuroepithelium. Half-dose PDT might not be effective or the recurrence rate might be high in eyes with posterior retinal cystoid degeneration.

Glycerol hydrogenolysis promoted by supported palladium catalysts.

Catalytic hydrogenolysis, with high conversion and selectivity, promoted by supported palladium substrates in isopropanol and dioxane at a low H(2) pressure (0.5 MPa), is reported for the first time. The catalysts, characterized by using BET isotherms, transmission electron microscopy (TEM), temperature-programmed reduction (TPR), powder X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS), were obtained by coprecipitation and impregnation techniques. The coprecipitation method allows catalysts with a metal-metal or a metal-support interaction to be obtained, which enhances the catalytic performance for both the conversion of glycerol and the selectivity to 1,2-propanediol. Analogous reactions carried out with catalysts prepared by using impregnation are less efficient. A study of the solvent and temperature effect is also presented. The obtained results allow the hydrogenolysis mechanism to be inferred; this involves both the direct replacement of the carbon-bonded OH group by an incoming hydrogen or the formation of hydroxyacetone as an intermediate, which subsequently undergoes a hydrogenation process to give 1,2-propanediol. Finally, catalytic tests on a large-scale reaction at a higher H(2) pressure and recycling of the samples were carried out with the better performing catalysts (Pd/CoO and Pd/Fe(2)O(3) prepared by using coprecipitation) to verify possible industrial achievements.

Single-plaque vegetating bromoderma.

Potassium bromide is still in use for the treatment of multidrug-resistant seizures. It is a known cause of severe drug-induced skin disorders. The clinical presentation of bromoderma may be similar to that of pyoderma gangrenosum when occurring with a single lesion. The case of a young girl with a single vegetating plaque of bromoderma on the leg is reported. The presence of pustules at the periphery of the plaque provides the clinical clue to the diagnosis.