Maura Mancini

Purpose: We aimed to compare the anatomical and functional outcomes, postoperative complications, and intraocular lens (IOL) positioning of two different techniques of sutureless scleral fixation: the Yamane double-needle flanged technique and the Carlevale intraocular lens. Methods: This retrospective, single-center, comparative observational study included 100 eyes of 100 patients who underwent secondary scleral-fixated IOL implantation between January 2021 and December 2024. Sixty-nine eyes underwent Yamane fixation and 31 eyes received a Carlevale IOL. Best-corrected visual acuity (BCVA), postoperative complications, and anatomical stability were evaluated. In a subgroup of 33 patients, IOL tilt and decentration were objectively assessed at 6 months using second-generation swept-source anterior segment optical coherence tomography (AS-OCT; Casia 2, Tomey, Nagoya, Japan). Results: Both techniques provided significant visual improvements compared with baseline. AS-OCT demonstrated comparable anatomical stability between groups, with mean tilt values of 6.9° and 6.4° and mean decentration values of 0.61 mm and 0.48 mm for the Yamane and Carlevale groups, respectively, without statistically significant differences. Cystoid macular edema was observed numerically more often in the Yamane group (23.1% vs. 15.4% at 6 months; p = 0.604), and anterior chamber blood Tyndall effect was recorded respectively in 13% vs. 6% of eyes; these differences were not statistically significant. Early postoperative complications were generally mild and self-limiting in both groups. Conclusions: Both the Yamane technique and the Carlevale IOL were associated with significant visual improvement and acceptable safety profiles for secondary sutureless scleral fixation in eyes without adequate capsular support. In this sample the Carlevale IOL showed a trend toward better centration, whereas second-generation swept-source AS-OCT proved to be a valuable objective imaging modality for the postoperative evaluation of scleral-fixated IOLs. Larger prospective multicenter studies are needed to confirm these findings.

Purpose: Spray-based formulations have been proposed as an alternative approach for ocular surface treatment, particularly to improve ease of administration. However, limited data are available regarding their ability to reach and persist on the ocular surface when applied to closed eyelids. Patients and Methods: This prospective, single-center study evaluated the presence and short-term persistence on the ocular surface of a liposome-based periocular spray in patients with dry eye disease. A total of 20 patients (40 eyes) were included. Tear film parameters were assessed using the Keratograph® 5M at baseline and at 15, 30, and 60 minutes after spray application. Outcome measures included non-invasive Keratograph break-up time (NIKBUT), tear meniscus height, bulbar conjunctival redness and patient-reported ocular discomfort. Results: NIKBUT values showed a significant increase at all post-application time points compared with baseline (p < 0.05), indicating improved tear film stability. Tear meniscus height exhibited a transient increase at 15 minutes (p < 0.05), returning toward baseline thereafter. No significant changes were observed in bulbar conjunctival redness. Subjective ocular discomfort scores significantly decreased following spray application (p < 0.05). No adverse events were reported. Conclusions: Periocular application of a liposome-based spray on closed eyelids resulted in measurable short-term improvements in tear film stability and patient-reported symptoms without inducing ocular surface irritation. These findings support the ability of this administration route to deliver functional effects on the ocular surface in patients with dry eye disease.

Background: Neurodegeneration in the cornea, particularly in diabetic patients, is an emerging area of research that highlights the potential of tear fluid as a source of biomarkers. Neurofilaments light chain (Nf-L), which are structural proteins found in neurons, have been identified as promising candidates for early biomarkers of neurodegeneration. Objective: This study investigates the correlation Nf-L levels in tears and corneal in vivo confocal microscopy (IVCM) parameters in patients with diabetes mellitus without retinopathy with the aim of associating Nf-L level with corneal neurodegeneration. Design: Case-control observational study. Methods: We enrolled 20 patients with diabetes mellitus type 2 (DM) and 20 healthy controls (HC): we studied the levels of Nf-L in serum and tears, and we looked for a correlation with the parameters detected on IVCM, including corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD) and corneal nerve branching density (CNBD). Results: Serum Nf-L levels showed no difference between DM (mean ± SD 14.00 ± 2.18 pg/mL) and HC (mean ± SD 15.18 ± 2.28 pg/mL). Instead we detected a significant increase in Nf-L levels in DM tears (right eye mean ± SD 321.23 ± 192.40 pg/mL; left eye mean ± SD 277.90 ± 254.23 pg/mL) compared to HC (right eye mean ± SD 25.80 ± 22.0 pg/mL; left eye mean ± SD 27.96 ± 20.21 pg/mL). Furthermore, a negative correlation was evident between Nf-L levels and IVCM parameters: CNFL/Nf-L r −.4234 P < .001; CNFD/Nf-L −.4959 P < .001; CNBD/Nf-L r −.5310 P < .0005. Conclusion: Our findings indicate that Nf-L levels are significantly elevated in the tears of DM patients and that high Nf-L levels correlate with lower corneal IVCM parameters, suggesting that tears Nf-L could be a reliable biomarker for early corneal neurodegeneration in diabetes without retinopathy.

Purpose: To evaluate the impact of pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment on corneal innervation and ocular surface integrity, and to assess the influence of intraoperative tamponade type (silicone oil vs. gas) on corneal sensitivity, tear film stability, epithelial damage, and subbasal nerve morphology. Methods: In this prospective multicenter study, 50 eyes of 50 patients undergoing primary PPV with 360-degree endolaser photocoagulation were enrolled. The patients were stratified based on tamponade type: silicone oil (n = 30) or C ₃ F ₈ gas (n = 20). Assessments performed at baseline and 1 month postoperatively included Cochet–Bonnet corneal sensitivity, tear break-up time, fluorescein staining, and in vivo confocal microscopy for subbasal nerve analysis (corneal nerve fibers density, corneal nerve fibers length, corneal nerve branch density). Corneal epithelial complications (persistent epithelial defects and neurotrophic ulcers) were also recorded. Results: Postoperatively, significant reductions were observed in corneal sensitivity (from 4.2 ± 1.1 cm to 2.5 ± 1.3 cm, P = 0.0006), tear break-up time (from 7.4 ± 2.1 to 3.6 ± 2.5 seconds, P = 0.0003), and subbasal nerve parameters (corneal nerve fibers density, corneal nerve fibers length, corneal nerve branch density, all P < 0.001). Corneal complications were reported in 8 patients (16%), 6 of whom were in the silicone oil group. Silicone oil was associated with significantly worse outcomes in all parameters compared with gas tamponade ( P < 0.001). Conclusions: PPV for rhegmatogenous retinal detachment significantly impairs corneal innervation and ocular surface integrity, with silicone oil tamponade associated with more severe reductions in corneal sensitivity, tear film stability, and subbasal nerve morphology. These findings highlight the importance of tamponade choice and warrant strategies to minimize postoperative ocular surface damage.

Introduction: Bilateral Acute Iris Transillumination (BAIT) is a rare ocular condition characterized by acute iris depigmentation, pigment dispersion in the anterior chamber, sphincter paralysis, and frequently elevated intraocular pressure. However, atypical presentations may occur, complicating diagnosis and expanding the clinical spectrum of the disease. Case Presentation: A 25-year-old woman presented with acute onset of severe photophobia associated with migraine and visual aura. Slit-lamp examination revealed bilateral diffuse 360° iris transillumination and nearly fixed atonic mydriasis, in the absence of pigment dispersion, anterior chamber inflammation, or intraocular pressure elevation. Systemic evaluation revealed recent respiratory illness and associated dermatologic manifestations. No ocular treatment was initiated due to the absence of inflammatory signs or ocular hypertension. Photophobia resolved spontaneously, while iris abnormalities persisted. Conclusion: This case suggests a possible pigment-negative or incomplete variant of BAIT, characterized by the absence of pigment dispersion and normal intraocular pressure. Recognition of such atypical presentations is essential to avoid misdiagnosis and unnecessary treatment, and may contribute to a broader understanding of the clinical spectrum and pathophysiology of BAIT.

The ocular surface microbiome plays a critical role in maintaining ocular health, preventing infections, and regulating immune responses. Contact lens (CL) wear has been linked to alterations in microbial composition, potentially leading to dysbiosis and increased susceptibility to ocular infections. This review aims to summarize current evidence on the effects of CL use on the ocular microbiome and to discuss strategies to preserve microbial homeostasis. A literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language human studies published between January 2005 and January 2025. We included original studies and systematic reviews evaluating the ocular surface bacterial community in contact lens (CL) wearers using either sequencing-based approaches (microbiome; e.g., 16S rRNA gene sequencing/metagenomics) or culture-based methods (microbiota). Two authors screened titles/abstracts and full texts. Overall, 12 studies met the inclusion criteria and were qualitatively synthesized. Across included studies, CL wear was associated with reproducible changes in the ocular surface bacterial community, most commonly a shift toward a skin-like profile and increased detection/relative abundance of opportunistic taxa (e.g., Pseudomonas, Acinetobacter, and Staphylococcus aureus) together with reduced representation of typical ocular commensals in several sequencing-based datasets. Culture-based studies reported increased recovery of opportunistic bacteria from lenses and storage cases, supporting contamination/biofilm-related mechanisms. Lens care solutions and preservatives were reported to modulate bacterial profiles and may contribute to dysbiosis, although evidence remains heterogeneous across study designs and analytic pipelines. CL use is associated with significant alterations in the ocular microbiome, increasing the risk of microbial keratitis and corneal inflammatory events. Strategies to maintain microbial balance, including careful selection of lens care products and development of antimicrobial lenses, may improve ocular surface health in CL wearers. Future longitudinal studies with standardized sampling and analytic workflows are needed to clarify causal links between CL-associated microbial changes and clinical outcomes.

Background: Scleral fixation of intraocular lenses (IOLs) is a valuable option in cases of aphakia or inadequate capsular support, yet conventional sutured and sutureless approaches can pose technical challenges and complication risks. The needle-guided scleral fixation technique offers a simplified, single-suture solution that enhances safety and reproducibility. Methods: In this retrospective interventional case series, 30 eyes with insufficient capsular support underwent IOL implantation using Meduri’s needle-guided single-suture technique at the G. Martino University Hospital, Messina. The surgical method employs a 24-gauge needle to guide a double-armed 10-0 polypropylene suture through the sclera for precise IOL anchorage, minimizing vitreous manipulation. Outcomes were assessed over 24 months, including best-corrected visual acuity (BCVA), IOL centration, intraocular pressure (IOP), and postoperative complications. Results: Mean BCVA improved from X to Y LogMAR at two years (p < 0.05). All IOLs remained well-centered without tilt or decentration. Mild conjunctival hyperemia occurred in 70% of cases, resolving spontaneously. No suture erosion, vitreous hemorrhage, or retinal detachment was observed. Conclusions: The needle-guided single-suture technique provides a stable, efficient, and reproducible method for posterior chamber IOL fixation in aphakic eyes lacking capsular support. Its minimal learning curve and reduced surgical complexity make it an attractive alternative to both traditional sutured and modern sutureless methods, particularly in centers without vitreoretinal expertise.

Purpose To evaluate the precision, safety, and efficacy of congenital cataract surgery performed using the 27-gauge vitrectomy system in infants. Methods This retrospective study analyzed 44 eyes from 22 pediatric patients (aged 3–5 months) with bilateral congenital cataracts. The following parameters were assessed: intraocular pressure, corneal diameters, axial length, and the occurrence of intraoperative and postoperative complications. Visual function was evaluated based on visual behavior in response to various stimuli. All patients were followed for a minimum of 6 months. Results A significant reduction in intraocular pressure was observed (from 15.8 ± 5.7 mmHg preoperatively to 12.2 ± 1.1 mmHg postoperatively, p = 4.64 × 10⁻⁷). The average duration of the surgical procedure was 30 ± 5 min. Postoperative complications were minimal and transient, including conjunctival hyperemia in 30% of eyes (resolved within one week) and mild anterior chamber reaction in 12% of eyes. No significant complications, such as retinal detachment or glaucoma, were observed during follow-up. Conclusion The use of the 27-gauge vitrectomy system for congenital cataract surgery in infants provides high surgical precision, low complication rates, and effective postoperative outcomes. Further prospective studies with longer follow-up are needed to confirm the long-term safety and efficacy of this approach.

Purpose: This study examines the role of axial length (AL) in the detection of retinal displacement in patients treated for rhegmatogenous retinal detachment (RRD) with pars plana vitrectomy (PPV). Methods: A total of 39 eyes from 39 patients undergoing PPV with tamponade using either 16% diluted hexafluoroethane gas (C₂F₆) or 1000-centistoke silicone oil were included. Retinal displacement and its direction were assessed via blue-fundus autofluorescence (B-FAF) imaging. The evaluated variables included AL, demographic data, white-to-white distance (WTW), trocar gauge ( 23 G vs 25 G ), type of retinopexy, intraoperative use of perfluorocarbon liquid (PFCL), number of detached quadrants, type of tamponade, postoperative metamorphopsia, and best-corrected visual acuity (BCVA). Results: Retinal displacement was detected in 28.2% of patients (11/39), with 90.9% (10 patients) having undergone gas tamponade (p = 0.004). AL was significantly associated with the detection of retinal displacement (p < 0.0001). Among the 21 patients who received gas tamponade, the incidence of displacement was 80% in those with AL > 26 mm compared to 18.2% in those with AL ≤ 26 mm (p = 0.018). The intraoperative use of PFCL also showed a positive correlation with retinal displacement (p = 0.002). Retinal displacement did not negatively impact BCVA but was significantly associated with postoperative metamorphopsia (p < 0.0001). Conclusions: Postoperative retinal displacement is significantly influenced by the type of tamponade, being more frequent with gas tamponade, and by the intraoperative use of PFCL. AL was associated with the detection of retinal displacement, although its causal role remains uncertain.

Background: To evaluate intrascleral plug stability and correct centring of the IOL in three different surgical techniques using intraoperative anterior segment OCT. Methods: This retrospective scientific study was conducted by reviewing patient records from the Ophthalmology Unit at the Civico Hospital of Palermo, covering the period between 2021 and 2022. Three distinct groups of patients, each consisting of 7 eyes from 7 individual patients, were included in this study. The first group received a quadrangular scleral flap (3.5 × 3.5 mm) that covered intrascleral plugs. The second group had two intrascleral pockets created with the insertion of plugs inside these pockets. The third group had one intrascleral pocket created to cover the intrascleral plugs. Intraoperative anterior segment (AS)-OCT was used to monitor the positioning of the plugs and the tilt of the IOL. The analyzed parameters are: best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, macular thickness, endothelial cell loss, intraoperative and postoperative complications, IOL tilting, and optic plate decentration. Results: The examined parameters showed uniformity among the groups. Postoperative best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, and macular thickness exhibited no significant differences between the three groups. Endothelial cell loss ranged between 10.4% and 13.1% across the patient groups. No intraoperative or postoperative complications were reported. No IOL tilting or optic plate decentration was reported. The duration of surgeries was similar among the groups. Conclusions: The three different scleral fixation techniques have been shown to be equally effective, demonstrating the usefulness of intraoperative AS-OCT for the stability and centring of Carlevale IOLs.