Background Limited data suggest that treatment with statins is associated with a reduced risk of Graves’ orbitopathy (GO) in patients with Graves’ disease (GD), attributed to the anti-inflammatory rather than to the hypolipemic effects of these medications. The aim of the present study was to investigate whether there is an association between high cholesterol and GO. The primary outcome was the relation between GO and low-density lipoprotein (LDL)-cholesterol. The secondary outcomes were the relation between severity or activity [the clinical activity score (CAS)] of GO and LDL-cholesterol. Methods We conducted a cross-sectional investigation in consecutive patients with GD who came to our observation to undergo radioiodine treatment, a stratification aimed at forming two distinct groups of patients under the same conditions. We enrolled 250 patients, 133 with and 117 without GO. Ophthalmological assessments and serum lipids measurements were performed. Results In multivariate analyses with correction for the duration of hyperthyroidism, a variable that differed between patients with respect to the presence or absence of GO, a correlation between the presence of GO and both total (P=0.01) and LDL-cholesterol (P=0.02) was observed. In patients with hyperthyroidism lasting <44 months, total and LDL-cholesterol were higher (P=0.01 and P=0.008, respectively) among GO patients. In this subgroup, based on the presence/absence of GO, we established cut-off values for total (191 mg/dl) and LDL-cholesterol (118.4 mg/dl), above which an increased risk of GO was observed (total cholesterol RR: 1.47; P=0.03; LDL-cholesterol RR: 1.28; P=0.03). GO severity and CAS did not correlate with serum lipids. However, CAS was found to be higher (P=0.02) in patients with high total cholesterol. When the analysis was restricted to untreated GO patients, we found a correlation between CAS and both total (P=0.04) and LDL-cholesterol (P=0.03), after adjustment for GO duration. Conclusions In patients with a short duration of hyperthyroidism, total and LDL-cholesterol correlate with the presence of GO, suggesting a role of cholesterol in the development of GO. Depending on GO duration, total and LDL-cholesterol correlate with GO activity, suggesting a role of cholesterol in the clinical expression of GO.

Background: Optical coherence tomography (OCT) has recently been introduced in the operating theatre. The aim of this review is to present the actual role of microscope-integrated optical coherence tomography (MI-OCT) in ophthalmology. Method: A total of 314 studies were identified, following a literature search adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. After full-text evaluation, 81 studies discussing MI-OCT applications in ophthalmology were included. Results: At present, three microscope-integrated optical coherence tomography systems are commercially available. MI-OCT can help anterior and posterior segment surgeons in the decision-making process, providing direct visualization of anatomic planes before and after surgical manoeuvres, assisting in complex cases, and detecting or confirming intraoperative complications. Applications range from corneal transplant to macular surgery, including cataract surgery, glaucoma surgery, paediatric examination, proliferative diabetic retinopathy surgery, and retinal detachment surgery. Conclusion: The use of MI-OCT in ophthalmic surgery is becoming increasingly prevalent and has been applied in almost all procedures. However, there are still limitations to be overcome and the technology involved remains difficult to access and use.

Bullous central serous chorioretinopathy (bCSCR) is a rare variant of the central serous chorioretinopathy, complicated by an exudative retinal detachment with shifting fluid. This systematic review aims to present the epidemiology, the pathogenesis, the clinical presentation, the imaging, the differential diagnosis, and the latest treatments of this disease. A total of 60 studies were identified following a literature search adhering to PRISMA guidelines. After full-text evaluation, 34 studies about bCSCR were included. bCSCR usually affects middle-aged men, and the principal risk factor is corticosteroid medications. Pathogenesis is related to an increased choroidal vessel and choriocapillaris permeability, with subsequent subretinal fluid accumulation, rich in fibrin, which may provoke the exudative retinal detachment. Clinical presentation and imaging are fundamental to distinguish bCSCR from other pathologies, avoiding unappropriated treatment. Corticosteroid withdraws (if assumed) and laser photocoagulation of leakage sites seen at angiography may speed up retinal reattachment. Verteporfin photodynamic therapy, transpupillary thermal therapy, oral eplerenone and scleral thinning surgery are other therapeutic options. An early diagnosis might prevent disease progression due to harmful medications as well as unnecessary surgery.

To compare early visual and anatomical outcomes after either sulfur hexafluoride (SF6) or perfluoropropane (C3F8) tamponade for macular hole repair. 147 eyes affected by primary full-thickness macular hole underwent pars plana vitrectomy with dye assisted removal of the internal limiting membrane and gas tamponade. Prone position was prescribed for 48 h after surgery. All patients were divided into 3 groups depending on the size of the hole: small (250–400 µm). Eyes within the same group randomly received either SF6 (70 eyes) or C3F8 (77 eyes). A complete ophthalmic evaluation, including best corrected visual acuity and anatomic status of the macular holes, was conducted preoperatively, at 1 week and 1 month after surgery. Macular hole volume was calculated using optical coherence tomography scans. The Wilcoxon Signed Ranks Test, the Mann–Whitney Test, the Spearman’s rank-order correlation coefficient and the study of variance for repeated measures were used for statistical analysis. Mean best-corrected visual acuity improved from 0.92 logMAR to 0.28 logMAR (P < 0.001). A reduction of the dimensions of macular holes was observed in all cases, with a total repair of 90 % (63/70 eyes) in the SF6 group and 91 % in the C3F8 group (70/77 eyes). There was a negative correlation between the initial minor diameter, the volume of the hole and the rate of anatomic success. Short-term anatomical and visual outcomes were similar in eyes treated with either SF6 or C3F8, independently of the stage of the macular hole. The initial volume and the minor diameter of the hole may be considered as valid tools for predicting surgical success. Age and gender did not appear to have influenced the prognosis.

(1) Background: We aimed to systematically review the current literature to evaluate if in patients with postoperative endophthalmitis treated with pars plana vitrectomy, silicone oil tamponade could provide a useful contribution to the control and eradication of infection and if it could influence anatomical recovery and functional outcome. (2) Randomized controlled trials, cross-sectional studies, case series, and case reports published in the English language in peer-reviewed journals were included. No restriction was placed based on the study location. We used medical subject headings (MeSH) and text words. We searched MEDLINE (OVID and PubMed), Google Scholar, ISI Web of Science (Thom-on-Reuters), and the Cochrane Library (Wiley) from January 1995 to the present. To ensure literature saturation, we scanned the reference lists of included studies or relevant reviews identified through the search. Risk of Bias was assessed using the Newcastle-Ottawa scale for longitudinal studies and Cochrane risk-of-bias tool for randomized trials. (3) Results: abstracts of 75 articles were selected for full-text reading; after full-text reading, 44 articles were taken into consideration in the systematic review. 5 out of 7 in vitro experimental studies demonstrated antimicrobial activity against different species of bacteria and fungi. The use of SO as endotamponade associated with PPV led to better visual acuity and a lower rate of retinal detachment and the need for additional surgery. (4) Conclusions: Silicone oil reduces the risk of postoperative retinal detachment, especially in case of undetected retinal breaks, produces compartmentalization of the eye, may lead to early visual recovery, allows laser photocoagulation, prevents severe postoperative hypotony and has antimicrobic activity due to an inhibitory effect for several species of pathogens. Concerns regarding possible toxic effects on the retina and optic disc, compartmentalization and impaired washout of pathogen toxins have been reported. It may also influence intravitreal antibiotic distribution and clearance.

Adherence is crucial in medical glaucoma therapy, although half of the patients skip eyedrops. In recent years alternative drug-delivery systems have been developed. One of the most promising seems the contact lens (CL). This systematic review aims to present the in vivo efficacy of different CL drug-delivery systems. A total of 126 studies were identified following a literature search adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. After full-text evaluation, 19 studies about CL drug-delivery systems were included. To date, the following drug-delivery systems have been investigated in vivo: drug-soaked CL, CL with physical barriers (vitamin E), molecularly imprinted CL, CL with implants, and nanoparticle-loaded CL. Nanoparticle-loaded CL and CL with implants seem the most promising drug-delivery systems, although initial burst drug release and patient acceptance may limit their widespread use in current practice. Clinical trials are warranted to understand the role of CL as a drug-delivery system in improving glaucomatous patient care.