Nutritional optic neuropathy is a cause of bilateral, symmetrical, and progressive visual impairment with loss of central visual acuity and contrast sensitivity, dyschromatopsia, and a central or centrocecal scotoma. The clinical features are not pathognomonic, since hereditary and toxic forms share similar signs and symptoms. It is becoming increasingly common due to the widespread of bariatric surgery and strict vegetarian or vegan diets, so even the scientific interest has recently increased. In particular, recent studies have focused on possible pathogenetic mechanisms, and on novel diagnostic and therapeutic strategies in order to prevent the onset, make a prompt diagnosis and an accurate nutritional supplementation, and to avoid irreversible optic nerve atrophy. Nowadays, there is clear evidence of the role of cobalamin, folic acid, thiamine, and copper, whereas further studies are needed to define the role of niacin, riboflavin, and pyridoxine. This review aims to summarize the etiology, diagnosis, and treatment of nutritional optic neuropathy, and it is addressed not only to ophthalmologists, but to all physicians who could come in contact with a patient with a possible nutritional optic neuropathy, being a fundamental multidisciplinary approach.

Purpose: To analyze epidemiology, clinical features, and surgical outcomes of type III acute acquired concomitant esotropia (Bielschowsky esotropia (BE)). Methods: The medical charts of patients diagnosed with acquired concomitant esotropia between 2013 and 2021 were reviewed. Assessed data were age, gender, age at diplopia onset, age at the diagnosis, refraction, visual acuity, neuroimaging, diplopia onset, angle of deviation, stereopsis, surgical procedure, amount of surgery, and relapse of diplopia after surgery. Moreover, we investigated the correlation between the use of electronic devices and the onset of diplopia. Results: One hundred seventeen patients (mean age 35.07 ± 15.81 years) were included in the study. The mean delay to the diagnosis was 3.29 ± 3.62 years. Myopia range was 0 to 17 diopters spherical equivalent. 66,3% spent more than 4 hours a day using laptops, tablets, or smartphones at the onset of diplopia, and 90,6% presented a subacute onset. None showed neurologic signs or symptoms. Patients who underwent surgery were ninety-three, with a rate of surgical success of 93.6%, and a relapse rate of 17.2%. A negative correlation resulted between pre-operative deviation and age at diagnosis (ρ = -0.261; p<0.05), whereas factors associated with surgical failure were older age at diplopia onset (p = 0.042) and longer delay between onset and diagnosis (p = 0.002). Conclusion: We registered an outstanding increase in prevalence of BE, which could be related to the exponential increase in the use of electronic devices for professional, educational, and recreational purposes. A prompt diagnosis and an augmented dose of surgery allows good motor and sensory results.

Objective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet’s membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 ± 4.5 D to 43.5 ± 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 ± 0.4 to 0.3 ± 0.2 LogMAR; the central corneal thickness was reduced from 629 ± 39 μm to 532 ± 45 µm; and the endothelial cell density was 1926 ± 199 cells/mm². None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation.

Background: The study aimed to assess the diagnostic and therapeutic management of infectious keratitis at a tertiary referral center, focusing on how microbiological analysis influences clinical outcomes. Methods: A retrospective review was conducted on 220 patients (221 eyes) with infectious keratitis treated between November 2021 and January 2025. Data collected included clinical presentation, microbiological findings, treatment approaches, and outcomes. Statistical analyses examined the relationships between microbiological results, improvements in visual acuity, and the need for rescue surgery. Results: Bacterial keratitis accounted for 64% of cases, followed by viral (20%), fungal (13%), and Acanthamoeba (3%). Microbiological testing was performed in 107 cases, with a culture positivity rate of 75.7%. Positive microbiological findings were significantly associated with better visual acuity (p = 0.019) and a reduced, though not statistically significant, need for rescue surgery. Use of contact lenses and ocular trauma were independent risk factors for culture positivity. Delayed referral (more than 15 days) was linked to longer treatment durations and a higher likelihood of surgical intervention (p < 0.001). Microbiological diagnosis correlates with improved visual outcomes and a decreased need for surgical procedures. Conclusion: Early referral and targeted therapy are essential for optimizing prognosis. The use of contact lenses and cases of ocular trauma should prompt early diagnostic sampling.

Intraoperative optical coherence tomography (iOCT) has emerged as a pivotal technology in anterior segment surgery, particularly in cases limited by corneal opacity, edema, or altered anatomy. By providing real-time, cross-sectional imaging, iOCT enables surgeons to visualize otherwise hidden structures and to perform critical intraocular maneuvers with greater precision and safety. Its integration into the surgical microscope allows continuous monitoring of tissue–instrument interaction, transforming traditionally “blind” procedures into image-guided interventions. This review highlights the role of iOCT in endothelial keratoplasty, deep anterior lamellar keratoplasty (DALK), management of acute corneal hydrops, synechiolysis, glaucoma drainage device implantation, and ocular trauma. In endothelial procedures, iOCT helps confirm Descemet membrane removal, graft orientation, and resolution of interface fluid. In DALK, it facilitates accurate cannula placement, stromal depth assessment, and evaluation of leucoma extension to guide surgical strategy. During hydrops management, iOCT supports precise air/gas injection and compression suture placement. Additionally, it enhances safety in synechiolysis, shunt implantation, and repair of traumatic corneal injuries.

Background: Urban air pollution, particularly fine particulate matter (PM2.5 and PM10), poses health risks, including damage to the ocular surface. This pilot study (BIKE-EYE) aimed to assess ocular exposure to airborne pollutants during bicycle commuting and to evaluate particle presence in human tear fluid. Methods: Fifteen healthy volunteers wore portable sensors measuring PM2.5 and PM10 during daily bike commutes over six months. Exposure was calculated as time-weighted integrals over the ten days preceding an ophthalmologic exam assessing conjunctival hyperemia, epithelial damage, tear film quality, and meibomian gland function. Ocular symptoms were assessed via the Ocular Surface Disease Index (OSDI). Tear samples were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Results: Higher pollutant exposure was significantly associated with conjunctival hyperemia and corneal epithelial damage, while temperature and humidity showed no effect. OSDI scores moderately correlated with PM levels. SEM/EDS analysis confirmed airborne particles in post-exposure tear samples, including carbonaceous material, aluminosilicates, iron, and sulfur compounds. Conclusions: Ocular surface alterations and conjunctival hyperemia were significantly associated with air pollution exposure, while subjective symptoms showed weaker trends. The detection of particulate matter in human tear fluid supports the use of the ocular surface as a sensitive, non-invasive tool for biomonitoring. These findings highlight its potential role in early warning systems for pollution-related health effects, with implications for public health surveillance and urban planning.