We investigated the ocular surface (OS) system modifications after completely successful glaucoma surgery in thirty-eight patients undergoing trabeculectomy (surgical group), using laser scanning confocal microscopy (LSCM) and impression cytology (IC). Twenty-six medically controlled glaucomatous patients served as controls (medical group). LSCM, IC, and the ocular surface disease index (OSDI) and National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) questionnaires, were performed at baseline and after six months. The main outcomes were: goblet cell density (GCD), limbal dendritic cell density (LDCD), subbasal corneal nerve inhomogeneity (SCNI), Meibomian gland density and inhomogeneity (MGD, MGI), and HLA-DR positivity. There were no significant baseline differences between groups. At the sixth month, the surgical group showed a GCD increase (p < 0.001), and a LDCD, SCNI, MGI, HLA-DR (p < 0.001), OSDI and NEI VFQ-25 scores decrease (p < 0.05). The medical group did not show significant OS modifications, showing LSCM and IC parameters significantly worse compared to the surgical group (p < 0.001). The OSDI score correlated with GCD, MGI, SCNI, LDCD, and HLA-DR (p < 0.001; p < 0.05; p < 0.01). The present study found that the whole OS system objectively improved after completely successful glaucoma filtration surgery. These changes positively affected the OSDI score, but not the NEI VFQ-25 score.

PURPOSE: To investigate the in vivo corneal microscopic changes after femtosecond laser–assisted stromal lenticule addition keratoplasty in keratoconus by means of in vivo confocal microscopy. METHODS: Patients affected by advanced keratoconus were included in the study. Negative meniscus-shaped stromal lenticules, produced with a femtosecond laser (VisuMax; Carl Zeiss Meditec) from eye bank corneas were transplanted into a stromal pocket dissected in the recipient cornea at a depth of 120 µm. In vivo confocal microscopy was performed during the 12-month follow-up to investigate changes of the corneal and lenticule structure. RESULTS: Ten patients were enrolled in the study. No changes of the dendritic cell population were documented during the follow-up period. Mild edema and stromal keratocyte activation gradually decreased during the first month. Subbasal nerve density returned to preoperative values after 6 months. Donor-recipient interfaces appeared hyperreflective but gradually improved over time with significantly reduced reflectivity after 3 months. No evidence of stromal inflammatory cell migration or matrix opacification was observed. Endothelial and keratocyte density remained stable over time. A variable degree of stromal radially distributed folds, not visible on biomicroscopy, was observed in the lenticule and in the posterior recipient stroma. CONCLUSIONS: Stromal lenticule addition keratoplasty produces transitory nerve plexus density reduction and minor inflammatory reaction that rapidly decreases during the first month. Donor-recipient interface reflectivity is comparable to a femtosecond laser refractive procedure with no sign of stromal opacification or stromal rejection in 1 year of follow-up. [ J Refract Surg . 2020;36(8):544–550.]

Background: The purpose of this study is to determine the prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy. Methods: It is a prospective, multicenter, cross-sectional study. Thirteen ophthalmic units equally distributed across the Italian territory have been involved in the study. For a period of 3 months, all subjects undergoing phacoemulsification received an Optical Coherence Tompgraphy (OCT) scan and were screened for the anamnestic presence of diabetes. In addition, five selected units collected blood samples from all their patients to measure glycated hemoglobin (HbA1c) levels and detect the presence of occult diabetes (HbA1c > 6.5%). In diabetic patients, levels of retinopathy were measured and diabetic macular edema was considered significant (clinically significant macular edema) when foveal thickness was above 30% of normal levels. Results: A total number of 3657 subjects have been screened. Among them, 20.4% were diabetics. Prevalence of diabetes was significantly higher in males (24.7%) than in females (17%). Levels of HbA1c were tested in a representative sample of 1216 consecutive subjects, and occult diabetes was diagnosed in 4.8% of cases. No significant differences were observed between age groups or different geographic areas. Among diabetic patients, diabetic macular edema of any kind was present in 27.5% (clinically significant macular edema (6.6%)). No significant differences were seen in the prevalence of diabetic macular edema between males and females or between age groups. Among the 745 diabetic patients, no signs of retinopathy were seen in 537 subjects (76.3%), while 101 patients (14.3%) had nonproliferative retinopathy, 13 (1.7%) had nontreated

Toric IOL implantation is an effective procedure for correction of preexisting corneal astigmatism, improving visual performance, and inducing a low amount of higher-order aberrations. Moreover, the toric IOLs is well positioned early after surgery and stable over time.

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