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Introduction A standard practice for addressing wet age-related macular degeneration (WetAMD) is to deliver anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Formulations with higher concentrations, such as aflibercept 8 mg (Eylea HD; Bayer AG, Leverkusen, Germany), which are administered in larger volumes, may raise concerns about potential increases in intraocular pressure (IOP) and other ocular complications. The objective of this study was to evaluate and compare short-term IOP changes following intravitreal injection of aflibercept 8 mg (Eylea HD, 0.07 mL) versus faricimab-svoa (Vabysmo, 0.05 mL; Roche Pharma, Basel, Switzerland/Genentech, South San Francisco, CA, USA) in patients with WetAMD.  Methods A retrospective observational analysis was conducted involving patients with WetAMD who received intravitreal injections of aflibercept 8 mg (n = 64 eyes) or faricimab-svoa (n = 73 eyes). IOP was measured before the injection and 30 minutes after. The research recorded lens condition, the need for paracentesis, and the application of Iopidine drops. Patients were categorized into phakic and pseudophakic subgroups, and further stratified based on post-injection IOP levels: <20 mmHg, 20-25 mmHg, 25-30 mmHg, and >30 mmHg. Results Both treatment groups showed notable increases in IOP at 30 minutes after injection (Eylea HD: +4.50 ± 4.32 mmHg, Vabysmo: +3.66 ± 5.20 mmHg; p = 0.083). However, there were no instances requiring paracentesis, and only one patient from each group needed Iopidine drops. Pseudophakic patients experienced slightly higher IOP increases (Eylea HD: +4.71 ± 4.18 mmHg, Vabysmo: +4.55 ± 5.65 mmHg; p = 0.784) compared to phakic patients. The majority of patients maintained IOP levels under 30 mmHg. Gender distribution was 49% male and 51% female. Conclusions Intravitreal injections of aflibercept 8 mg and faricimab-svoa caused a small and temporary increase in IOP and there were no cases requiring urgent management. Our results confirm the short-term ocular safety of aflibercept 8 mg and faricimab-svoa for the treatment of WetAMD and highlight the need for individualized monitoring for patients at risk of increased IOP.

PURPOSE: The aim of this study was to report a novel surgical technique for scleral fixation of Carlevale intraocular lens (IOL) without conjunctival dissection using Hoffman pockets. METHODS: An 80-year-old woman with IOL dislocation in her right eye required IOL exchange. After removing the dislocated IOL, a Carlevale IOL was implanted, securing the self-blocking harpoons within scleral pockets which were constructed using Hoffman technique. RESULTS: Surgical procedure was uneventful. During the next 3-month follow-up, Carlevale IOL remained stable within the scleral pockets, and no signs of IOL dislocation or decentration were observed. Visual acuity significantly improved from 20/200 preoperatively up to 20/32 postoperatively due to corneal scaring from previous herpetic keratitis. No postoperative complications were recorded. CONCLUSION: Creating scleral pockets without conjunctival dissection using Hoffman pockets technique represents a reliable and effective method for achieving both secure fixation and effective scleral covering of Carlevale IOL haptics. The absence of conjunctival opening, apart from patient postoperative comfort, reduces risk of postoperative complications, including conjunctival erosion and infection. The presented technique offers a promising alternative for Carlevale IOL scleral fixation.

The purpose of this study is to present an experimental model that explains the calcification pattern of hydrophilic acrylic intraocular lenses (IOLs) following endothelial keratoplasty (EK) procedures using the intracameral injection of air or gas. Pseudophakic eyes with hydrophilic acrylic IOLs undergoing EK procedures with intraocular air or gas injection are at risk of IOL calcification. Using air/aqueous humor (AH) dynamics, we attempted to explain the physicochemical mechanisms operating upon filling the anterior chamber with air (or gas) at pressures of at least 30-40 mmHg and for a period of 10-60 minutes in the presence of a hydrophilic acrylic IOL. After a short period of time, usually 10-15 minutes, the air bubble was reduced to 60-90% of the anterior chamber volume, completely covering the pupil and hydrophilic acrylic IOL surface. We have constructed a constant temperature and pressure artificial eye anterior chamber reactor (ACEACR) to simulate the anterior chamber air/gas pressure dynamics involved in applying EK surgery procedures in the presence of a hydrophilic acrylic IOL. The analysis of the opacified IOLs in the test model showed deposits of calcium phosphate crystallites on the surface of calcified IOLs similar to clinical findings. Calcific deposits appeared as a white circular area outlining the mineralization front of the interface between the air/gas bubble and the IOL exposed in synthetic aqueous humor (SAH). The calcification pattern of hydrophilic acrylic IOLs following EK procedures is caused by the development of locally higher calcium and phosphate concentration in comparison with the corresponding bulk AH, inside the AH meniscus formed at the air/bubble/IOL interface.

We report an unusual, rare case of opacification of the hydrophilic acrylic intraocular lens (IOL) 23 years after the initial surgery with significant visual deterioration. Opacification of the hydrophilic acrylic IOL was primarily due to the formation of folds on the surface of the lens material, and less so due to calcium phosphate deposits. Calcification opacification can be attributed to recent events, as evidenced by deposits of dicalcium phosphate dihydrate (CaHPO42H2O) and octacalcium phosphate (Ca8H2(PO4)65H2O), both of which are transient calcium phosphate phases, converting hydrolytically to the thermodynamically most stable hydroxyapatite (Ca10(PO4)6(OH)2). To our knowledge, this case of hydrophilic acrylic IOL opacification is the only one that has been described so late, 23 years after cataract surgery.

Fingolimod is an efficacious treatment option in the management of multiple sclerosis, while variable ocular adverse effects have been associated with its use. Herein, we present a case with development of central serous retinopathy (CSR) in the long-term after commencement of fingolimod treatment. A 53-year-old female with relapsing-remitting multiple sclerosis presented with central vision metamorphopsia in the left eye. Medical history revealed that the patient had been on treatment with fingolimod for eight years. Ophthalmological examination revealed retinal findings suggestive of CSR changes. Given the necessity to continue fingolimod treatment, the patient commenced topical nonsteroidal anti-inflammatory (nepafenac) medication for the retinal condition. There was a prompt and successful resolution of fluid following treatment; however, a subsequent presumed ocular surface disease urged the discontinuation of anti-inflammatory drops. Four weeks later, the patient presented with recurrence of fluid in the subRPE level. Thereafter, fingolimod treatment was switched to dimethyl fumarate. The patient's condition remained clinically stable without recurrence of fluid during a three-month follow-up period. Our case provides insight into the fingolimod associated retinal findings manifesting as CSR changes, indicating that ocular complications may occur even in the long-term, while discontinuation of treatment may lead to reversal of structural findings and maintain functional outcomes.

Dexamethasone intravitreal implant (Ozurdex®; Allergan, Inc., CA, USA) has been proved to be effective in a variety of clinical settings including cases of pseudophakic cystoid macular edema. Uncommonly, this implant can migrate from the vitreous cavity and into the anterior chamber, especially in vitrectomized eyes with lens capsule defects. We report herein a rare case of anterior chamber migration and illustrate the passageway of the dexamethasone intravitreal implant through a new type of scleral fixated lens, the Carlevale IOL (Soleko-Italy). A 78-year-old woman was left aphakic following a complicated right eye hypermature cataract surgery with posterior capsule rupture and zonular dehiscence. Shortly thereafter, she underwent a planned combined pars plana vitrectomy with the placement of a Carlevale sutureless scleral fixated intraocular lens for the treatment of her aphakia. Due to a subsequent persistent cystoid macular edema that was unresponsive to topical treatment and sub-tenon corticosteroids, an intravitreal dexamethasone implant was injected. Eleven days after implantation, the patient presented with a floating implant in the anterior chamber and corneal edema. Following an immediate surgical removal, corneal edema resolved and visual acuity improved. One year later, results remain stable without macular edema recurrence. Anterior chamber migration of the Ozurdex implant is a potential complication in vitrectomized eyes, even when new types which are larger and specially designed for scleral fixation intraocular lenses are utilized. Corneal complications can be reversible following an immediate removal of the implant.

BACKGROUND: Hydrophilic intraocular lens opacification is a rare complication due to calcification. With current new surgical techniques, including lamellar endothelial keratoplasty and vitrectomies, this irreversible complication is becoming more common. In this case study, we present clinical and laboratory features of a case of Carlevale hydrophilic acrylic IOL calcification. CASE PRESENTATION: Observational case report of a single incident case. An 83-year-old man was referred to our ophthalmic department complaining of right eye vision blurring for six months. Slit-lamp biomicroscopy revealed IOL opacification. Deposits of calcium phosphate were found both on the IOL's surface and inside it, according to thorough investigation using optical, scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX) spectrometry. CONCLUSIONS: To the best of our knowledge, this is the first case to describe the laboratory evidence of Carlevale hydrophilic IOL calcification, suggesting possible explanation mechanisms based on underlying pathology and surgical technique. It reminds us that these findings suggest that physicians should be aware of possible hydrophilic IOL calcification.

BACKGROUND: Exposure to high-altitude conditions during flight or similar activities affects many aspects of visual function, which is critical not only for flight safety but for any altitude-related activity. We aimed to summarize the available literature pertaining to ocular changes during flight or equivalent short-term high-altitude exposure (e.g., hypobaric chamber, effortless ascent lasting ≤ 24 h) and to highlight future research priorities. METHODS: Using the PubMed/MEDLINE and Web of Science/ISI Web of Knowledge databases with structured search syntax, we conducted a systematic review of the literature spanning a 40-year period (January 1, 1983, to October 10, 2023). Articles pertaining to ocular changes during flight or flight-equivalent exposure to altitude were retrieved. The reference lists of retrieved studies were also searched, and citations of these references were included in the results. RESULTS: Of 875 relevant PubMed and ISI publications, 122 qualified for inclusion and 20 more were retrieved from the reference lists of initially selected records, for a total of 142 articles. Reported anterior segment changes included deterioration in tear film stability and increased dry eye incidence, increased corneal thickness, discomfort and bubble formation in contact lens users, refraction changes in individuals with prior refractive surgery, decreased intraocular pressure, and alterations in pupillary reaction, contrast sensitivity, and visual fields. Photoreceptor-visual pathway changes included alterations in both photoreceptors and neuro-transduction, as evidenced in dark adaptation, macular recovery time, reduction in visual field sensitivity, and optic neuritis (likely an element of decompression sickness). Retinochoroidal changes included increases in retinal vessel caliber, retinal blood flow, and choroidal thickness; central serous chorioretinopathy; and retinal vascular events (non-arteritic ischemic optic neuropathy, high-altitude retinopathy, and retinal vein occlusion). CONCLUSIONS: The effect of short-term high-altitude exposure on the eye is, in itself, a difficult area to study. Although serious impairment of visual acuity appears to be rare, ocular changes, including tear film stability, contact lens wear, central corneal thickness, intraocular pressure, contrast sensitivity, stability of refractive surgeries, retinal vessels, visual fields, and macula recovery time, should be considered in civilian aviators. Our report provides guidance to climbers and lowlanders traveling to altitude if they have pre-existing ocular conditions or if they experience visual symptoms while at altitude. However, key outcomes have been contradictory and comprehensive studies are scarce, especially those pertaining to the choroid and retina. Such studies could not only deepen our understanding of high-altitude ocular pathophysiology, but could also offer valuable information and treatment possibilities for a constellation of other vision-threatening diseases.

PURPOSE: The purpose of the study is to evaluate the comparability of corneal power measurements, anterior chamber depth (ACD), and white-to-white (WTW) distance between a high-resolution Scheimpflug-based tomography (Pentacam HR; Oculus GmbH, Wetzlar, Germany) and a swept-source optical biometry, IOL Master 700; Carl Zeiss Meditec AG, Jena, Germany) in patients having undergone a myopic refractive surgery. METHODS: This prospective, interinstrument reliability analysis included 31 individuals with a previous myopic laser refractive correction. Standard keratometry and total keratometry (TK) of the flattest and steepest axis of the IOL Master 700 were compared with standard keratometry (simulated keratometry [SimK]), true net power (TNP), equivalent keratometer readings (EKR), and total corneal refractive power of the Pentacam. The Bland-Altman analysis evaluated the agreement between the measurements of both devices. A paired t-test was performed to compare the mean values of the variables obtained by the two devices. RESULTS: Mean age of the participants was 31.87 ± 13.17 years. Ten patients (32.3%) had undergone laser in situ keratomileusis surgery, and 21 (67.7%) had undergone photorefractive keratectomy surgery. The two devices generated statistically significant differences in almost all the comparisons between their corneal keratometry values, ACD, and WTW. The two devices agreed in some of the flat axis values and more specifically on SimK1 and K1, EKR K1 along 1 mm-zone and K1, as well as on the comparison between the EKR keratometry values along 1, 2, and 3 mm-zone with their corresponding TKs. CONCLUSION: IOL Master 700 and Pentacam HR do not show good concordance and cannot be used interchangeably when measuring keratometry values in postrefractive eyes, rendering the IOL power calculation in postrefractive eyes really challenging.

BACKGROUND: Cataract surgery in keratoconic patients is challenging because of the corneal distortion, which can lead to inaccurate keratometry readings. This study is a comparison of the accuracy of keratometry readings by two types of devices in a tertiary hospital. PURPOSE: To evaluate the comparability of corneal power measurements, anterior chamber depth (ACD), and white-to-white (WTW) distance between Scheimpflug-based tomography (Pentacam AXL; OCULUS GmbH, Wetzlar, Germany) and swept-source optical biometry (IOLMaster 700; Carl Zeiss Meditec AG, Jena, Germany) in patients with keratoconus. METHODS: This pilot, prospective, interinstrument reliability study included 30 keratoconic eyes of 15 individuals who had not undergone any kind of corneal surgery. Standard K and total refractive power (TK®) of the flattest and steepest axes of the IOLMaster 700 were compared with the standard keratometry (SimK), true net power (TNP), equivalent keratometer readings (EKR), and total corneal refractive power (TCRP) of the Pentacam. The Bland-Altman analysis was used to evaluate the agreement between the measurements of both devices. The paired-samples t-test and the Wilcoxon signed-rank test were performed to compare the mean values of the variables obtained with the devices. RESULTS: The K1 value of the IOLMaster 700 was significantly higher from EKR K1 along the 3-mm (mean difference: 0.79 diopters, p = 0.01), 4-mm (mean difference: 1.01 D, p = 0.01), and 4.5-mm zones (mean difference: 1.20 D, p = 0.01) and TNP K1 along the 3-mm (mean difference: 0.88 D, p < 0.001) and 4-mm zones (mean difference: 0.97 D, p < 0.001). The TK1 value was significantly higher from EKR K1 along the 2-mm (mean difference: 0.42 D, p = 0.04), 3-mm (mean difference: 0.83 D, p = 0.003), 4-mm (mean difference: 1.05 D, p = 0.004), and 4.5-mm zones (mean difference: 1.24 D, p = 0.005) and TNP K1 along the 3-mm (mean difference: 0.92 D, p < 0.001) and 4-mm zones (mean difference: 1.01 D, p < 0.001). The K2 value of the IOLMaster 700 was significantly higher from TK2 (mean difference: 0.11 D, p = 0.04) and all the corresponding variables of the Pentacam device. The TK2 value was significantly higher from all the corresponding variables of the Pentacam device. The Pentacam also yielded significantly lower values for the WTW distance (mean difference: 0.31 mm, p < 0.001) and no significant difference in terms of ACD values (p = 0.9). CONCLUSION: The IOLMaster measured significantly greater keratometry readings in the steep axis for all the variables studied. The keratometry and WTW measurements of the investigated devices cannot be used interchangeably in keratoconus.

To assess the agreement among four types of intraocular pressure (IOP) measurements: IOP obtained by Goldmann applanation tonometer (IOP-GAT),IOP obtained by an air-puff tonometer (Nidek NT-510)(IOP-NCT), the non-corrected IOP obtained by the Corneal Visualization Scheimpflug Technology (IOP-Corvis) and the biomechanically corrected IOP obtained by the Corvis ST (bIOP-Corvis) in healthy patients with a broad spectrum of IOP values. Methods: This prospective, observational study recruited 113 healthy individuals. Each patient underwent IOP evaluation via GAT, Nidek NT-510 and Corvis ST. Difference in mean in IOP readings was assessed by one-way repeated-measures analysis of variance (ANOVA).Tonometer intermethod agreement was assessed by the Bland-Altman method. The difference between the four IOP measurements was correlated against corneal (CCT) and age with Pearson's correlation test. Results: IOP-Corvis showed the highest values (16.59  ±  3.08 mmHg),followed by IOP-NCT (16.05  ±  3.43 mmHg), IOP-GAT (15.62 ± 3.08 mmHg) and bIOP-Corvis (15.10 ± 2.67 mmHg).There were statistically significant differences in IOP measurements among all the ANOVA pairwise comparisons except between IOP-GAT and bIOP-Corvis (p = 0.07),as well as between IOP-GAT and IOP-NCT (p = 0.25). Bland Altman analysis revealed a notable bias (all p < 0.05) among IOP-GAT and bIOP-Corvis, IOP-GAT and IOP-Corvis, IOP-GAT and IOP-NCT, bIOP-Corvis and IOP-Corvis, bIOP-Corvis and IOP-NCT,IOP-Corvis and IOP-NCT of 0.51, -0.97, -0.43, -1.49, -0.95, 0.53 mmHg respectively. We observed a strong correlation of the difference between bIOP-Corvis and IOP-Corvis with CCT and patient age. Conclusion: Compared with GAT and Nidek NT-510, the Corvis-derived IOPs were recorded either the highest as IOP-Corvis or the lowest as bIOP-Corvis. Even if the differences among the tonometers were relatively small, the IOP values obtained with the Corvis ST, NCT and GAT were not interchangeable.

PURPOSE: To evaluate preoperatively dry eye disease (DED) in patients with pathological Tear Break Up Time (TBUT), utilising subjective Ocular Surface Disease Index (OSDI) with its subcategories and objective Keratograph 5M characteristics. METHODS: Fifty-four cataract patients were included in this prospective study having a screening slit lamp TBUT of less than 10 s and more or equal to 5 s. Subjective evaluation of DED was performed with OSDI questionnaire and objective evaluation with Keratograph 5M. Tear Meniscus Height (TMH), bulbar and limbal redness and meibography grade were evaluated. Further analysis of OSDI subcategories, Visual Function Related (VFR), Ocular Symptoms related (OS) and Environmental Triggered (ET), was performed with linear and logistic multivariate regression models. Age, gender and logMAR visual acuity (VA) were also included in our models. RESULTS: Following the initial TBUT screening we identified 27(50%) normal and 27(50%) dry eye patients, using OSDI questionnaire. There was no statistical difference in TMH (p = 0.64), bulbar redness (p = 0.54), limbal redness (p = 0.72) and meibography grade (p = 0.25), between normal and dry eye OSDI group. In our regression analysis, average logMAR VA was highly associated with a higher total OSDI score (p < 0.001) and with a higher OSDI-VFR score (p < 0.001). Female gender was associated with a higher OSDI-ET score (p = 0.03). Multivariate logistic regression models were performed by sorting patients into 2 categories of normal and dry eye group according to their total OSDI,OSDI-VRF,OSDI-OS and OSDI-ET score. An increase in logMAR VA increased the odds of having abnormal total OSDI score (p = 0.007) and OSDI-VFR score (p = 0.006). Females had increased odds of having abnormal OSDI-ET score (p = 0.044). CONCLUSIONS: Clinicians should be aware of OSDI limitations when screening cataract patients for dry eyes, as there is high correlation with VA. Female patients were more susceptible to environmental factors. Keratograph results should be interpreted with caution when they are evaluated in conjunction with OSDI during preoperative assessment of DED in cataract patients.

OBJECTIVE: Parstatin, the N-terminal 41-amino-acid peptide cleaved by thrombin from protease-activated-receptor 1, was shown to be highly effective in preventing ocular angiogenesis and as such it has potential therapeutic applications in ocular neovascular diseases. In the frame of a safety program in preclinical development, we investigated whether parstatin exerts any cytotoxic effect in critical ocular cell populations. MATERIALS AND METHODS: Human retinal pigment epithelium cell-19 line (ARPE-19) and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay were used to investigate parstatin's effect in cell cultures. Parstatin 24-41 was used as a control peptide which lacks the hydrophobic domain to demonstrate the specificity and the structure-dependent effect of parstatin. Both peptides were used at concentrations ranging from 0.1-30 μM for 24, 48 and 72 hours. RESULTS: In the presence of parstatin the rate of ARPE-19 cell growth and viability were significantly decreased in a concentration-dependent and time-dependent manner, with an IC50 of approximately 10 μM. When ARPE-19 cells were treated with parstatin 24-41 no inhibitory effect was observed at any concentration or exposure time used. CONCLUSIONS: Parstatin has a clear detrimental effect on the viability of ARPE-19 cells and raises concerns about its use in the eye because of its possible toxic effects.

PURPOSE: To investigate the nature and characteristic features of deposits causing opacification of intraocular lenses (IOLs) based on the examination of clinical findings using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDX) analysis. DESIGN: Retrospective, observational case series. METHODS: This is a multicenter study of 6 hydrophilic acrylic IOLs (Lentis LS-502-1; Oculentis GmbH, Berlin, Germany) with a hydrophobic surface that were explanted from 5 patients because of opacification. Three patients had an uncomplicated phacoemulsification. One patient underwent combined phacoemulsification and pars plana vitrectomy for retinal detachment and later silicone oil endotamponade owing to redetachment. The last patient had a pars plana vitrectomy and silicone oil instillation combined with phacoemulsification for tractive retinal detachment and diabetic retinopathy. The explanted lenses were submitted to our laboratory and were examined by SEM and EDX in order to identify the morphologic features and the composition of the deposits. RESULTS: SEM and EDX analyses confirmed the presence of calcific deposits in the interior of the opacified hydrophilic IOLs, with a pattern showing the formation of lumps on the surface. The lumps were due to subsurface formation of calcium phosphate crystalline deposits. The crystallite clusters seemed to diffuse from the IOL interior to the surface. CONCLUSIONS: We demonstrated the calcification pattern of the hydrophilic IOL (Lentis LS-502-1) with a hydrophobic surface. Although hydrophilic acrylic lenses have a hydrophobic surface, the development of calcification is a possible threat initiating from the hydrophilic subsurface of the IOLs.

Glycosaminoglycans (GAGs) due to their hydrophilic character and high anionic charge densities play important roles in various (patho)physiological processes. The identification and quantification of GAGs in biological samples and tissues could be useful prognostic and diagnostic tools in pathological conditions. Despite the noteworthy progress in the development of sensitive and accurate methodologies for the determination of GAGs, there is a significant lack in methodologies regarding sample preparation and reliable fast analysis methods enabling the simultaneous analysis of several biological samples. In this report, developed protocols for the isolation of GAGs in biological samples were applied to analyze various sulfated chondroitin sulfate- and hyaluronan-derived disaccharides using fluorophore-assisted carbohydrate electrophoresis (FACE). Applications to biologic samples of clinical importance include blood serum, lens capsule tissue and urine. The sample preparation protocol followed by FACE analysis allows quantification with an optimal linearity over the concentration range 1.0-220.0 µg/mL, affording a limit of quantitation of 50 ng of disaccharides. Validation of FACE results was performed by capillary electrophoresis and high performance liquid chromatography techniques.