Background: We report our findings in a patient who developed central retinal vein occlusion (CRVO) and was a chronic user of olanzapine, an antipsychotic medication. Case presentation: A 50-year-old Caucasian man, non-smoker, was referred to our clinic with the chief complaint of floater appearance in his left eye for the past 3 days. His past medical history indicated that he had been taking antipsychotic drugs (olanzapine) for about 3 years, with no other systemic disease or risk factors for CRVO. In the examination, his best-corrected visual acuity (BCVA) was 0.7 in the left eye. The fundus showed signs of nonischemic CRVO with subhyaloid hemorrhage and intraretinal hemorrhage in the posterior pole and superior and inferior retina, without macular edema, confirmed by optical coherence tomography (OCT). We ruled out other probable differential diagnoses and risk factors which lead to CRVO through a complete physical exam and blood analysis (complete blood count, glucose, urea, creatinine, lipid profile, erythrocyte sedimentation rate, C-reactive protein, prothrombin time, partial thromboplastin time, Bleeding time (BT), fibrinogen level, proteins, antiphospholipid antibodies, homocysteine blood level, antithrombin III, protein C and S, factor V Leiden, prothrombin mutation, angiotensin-converting enzyme level, other autoantibodies, and human leukocyte antigen [HLA]-B51). Finally, we confirmed the probable side effect of olanzapine in CRVO, which has not been previously reported. A possible pro-thrombogenic mechanism of olanzapine at the molecular level is an affinity for 5-HT_2Aserotonin receptors. Blocking these receptors results in increased platelet aggregation and increased blood coagulability. Conclusions: These results indicate that CRVO can be a complication of chronic use of antipsychotic medications such as olanzapine, as shown for the first time in our case report. Clinicians should question patients who develop a sudden CRVO whether they are using antipsychotic medications such as olanzapine.

Background: Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases. Aim: To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards). Results: No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1 Conclusion: pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA.

(1) Background: This study aimed to evaluate and compare the clinical optical image quality following implantation with different premium IOLs by the analysis of the point spread function (PSF) Strehl ratio using a Pyramidal WaveFront-based sensor (PWS) aberrometer at two different pupil sizes. (2) Methods: This study included 96 eyes of 70 patients implanted with: (1) 19 AcrySof SA60AT (control group); (2) 24 LENTIS Mplus LS-313 MF30; (3) 33 LENTIS Mplus LS-313 MF15; and (4) 20 Precizon Presbyopic. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root-mean-square (RMS), and low- and high-order aberrations’ RMS measured by PWS aberrometer. Results: SA60AT had the highest significant PSFw2 Strehl ratio at both 3- and 4-mm pupil size (0.41 ± 0.11 and 0.28 ± 0.07) followed by LENTIS Mplus 15 (group C, 0.35 ± 0.1 and 0.21 ± 0.06) and a near tie between LENTIS MPLUS 30 (group B, 0.27 ± 0.08 and 0.18 ± 0.06) and Precizon Presbyopic (group D, 0.27 ± 0.07 and 0.17 ± 0.04). MPlus MF15 was found to be significantly better than MPlus MF30 at both 3.00 mm (p < 0.0001) and 4.00 mm (p = 0.002). (4) Conclusions: The PSFw2 represents a new tool to objectively evaluate the far distance retinal image quality of multifocal IOLs, and the far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens.

Introduction: Normal-tension glaucoma is known as a multifactorial optic neuropathy. A number of lines of evidence suggested that vascular factors played a significant role in the development of normal-tension glaucoma. The mechanisms underlying the abnormal ocular blood flow in normal-tension glaucoma are still not clear. Peripheral vascular disease seems to be associated with glaucoma populations independent of other cardiovascular risk factors. We found this presentation, for the first time, to our knowledge, as another probable vascular abnormality related to our patient with normal-tension glaucoma, although it is necessary to confirm its pathological effect in future studies. Case presentation: Our patient was a 48-year-old Spanish man without any personal and family history of interest except for circulatory problems of the lower limbs with repetitive ulcers at the frontal and lateral aspects of his legs. His chief complaint was vision loss when he came to consult us. In exploration, his best corrected visual acuity was 20/20 in both eyes; initial intraocular pressure in the right eye was 14–16 mmHg and in the left eye was 16–18 mmHg, with a mild sclerosis of the lens in slit-lamp examination. No inflammation or pigmented lesion was detected in the anterior chamber. Open angle confirmed by Goldman four quadrants gonioscopy. Funduscopic examination revealed a vertical cup disc ratio of 0.6 in the right eye and 0.8 in the left eye. The patient’s neuroretinal rim was normal in the right eye, and superior thinning in the left eye was determined. Examination of the patient’s visual field showed inferior mild probable nasal scotoma in the right eye and an inferior deep arcuate scotoma defect in the left eye. His optical coherence tomography examination revealed thinning of the peripapillary nerve fiber layer thickness in the left eye and superior loss of macular retinal ganglion cells in the left eye. Normal intraocular pressure values were measured on the intraocular pressure curve without treatment (maximum value, 18–20 mmHg), discarding higher intraocular pressures measured out of office. Ultrasonic pachymetry measured 515/520 μm, and normal intraocular pressure measured with a PASCAL tonometer ruled out probable corneal biomechanical underestimations. The patient’s polysomnography study was normal and excluded sleep apnea syndrome. The patient’s serial mean blood pressure was normal, especially in the lower limbs (mean value, 125/70 mmHg), ruling out the possibility of systemic hypotension. Thyroidal and coagulation abnormalities, autoimmune disease, and inflammatory disease were excluded. Normal immunologic study and normal vascular biopsy were observed, as well as normal brain magnetic resonance imaging and a normal carotid vascular study. The primary diagnosis was moderate medium peripheral arterial disease in the lower limbs, which was confirmed by echography after ruling out other probable vascular abnormalities related to normal-tension glaucoma. Conclusion: After ruling out other systemic diseases and vascular abnormalities related to normal-tension glaucoma, we found peripheral arterial disease as a probable vascular abnormality related to normal-tension glaucoma in our patient. To our knowledge, this is the first time such a case has been reported. Thus, further research is needed to determine the relevance of these results to the general population.

Background: Corneal astigmatism is a major determinant of visual outcomes after cataract surgery, and its accurate preoperative characterization is essential for surgical planning and toric intraocular lens (IOL) selection. Data from Southern European populations remain limited. Methods: We conducted a retrospective cohort study including 600 eyes from 306 consecutive cataract patients aged ≥ 40 years undergoing preoperative biometry at a tertiary university hospital in Southern Italy. Axial length (AL), anterior chamber depth (ACD), keratometric power (K), and corneal astigmatism (CA) were measured using partial coherence interferometry. Results: The mean patient age was 72.5 ± 8.5 years. The mean AL, ACD, and average K were 23.5 ± 1.6 mm, 3.1 ± 0.5 mm, and 43.9 ± 1.5 D, respectively. The mean CA was 1.02 ± 0.76 D. Notably, 39.8% of eyes had CA ≥ 1.0 D and 9.3% had CA ≥ 2.0 D. Eyes with AL > 26 mm accounted for 7.1% of the cohort. Conclusion: A substantial proportion of cataract patients in Southern Italy present with clinically significant corneal astigmatism, highlighting the importance of systematic preoperative screening. These findings support the routine consideration of toric IOLs to optimize refractive outcomes and meet the rising expectations of cataract surgery patients.