Objective: To report the demographics and the clinical course of patients with multiple evanescent white dot syndrome (MEWDS) and to investigate for those factors which influence visual acuity (VA) recovery.Methods: This is a retrospective single-centre observational study. Electronic medical records and retinal imaging of patients with a diagnosis of MEWDS with a minimum follow-up of 3 months were reviewed. Patients were categorised into three groups according to the VA at presentation and at the last visit: group 1 >0.48 logarithm of the minimum angle of resolution (LogMAR), group 2 ≤0.48 and ≥0.18 LogMAR and group 3 <0.18 LogMAR. All patients had non-invasive multimodal imaging including optical coherence tomography, near-infrared reflectance imaging and blue fundus autofluorescence at presentation and during follow-up.Results: A total of 51 eyes from 51 patients (41 women, mean age 29.8±7.8 years) were included. Significantly more patients presented in the autumn (X²=8.69, p=0.034). The percentage of eyes recovering vision to 0.0 LogMAR or better was 80.3% (41/51). Worse presenting vision and young age at presentation were independent significant predictive variables for poorer final VA (p=0.002 and p=0.02, respectively). No imaging features were significantly predictive of complete versus incomplete recovery, but disc hyperfluorescence on fluorescein angiography was more common in those with incomplete recovery.Conclusions: Although the majority of cases have a benign prognosis, the clinical spectrum of MEWDS includes incomplete visual recovery. In our series, poor presenting VA and young age were associated with poor VA outcome. Further study is warranted to confirm these findings.

The aim of this prospective explorative study was to evaluate the safety and the effectiveness of topical polyvinylpyrrolidone-iodine (PVP-I) administered during the time-to-results period for pathogen identification and susceptibility testing in patients with infectious keratitis (IK). A corneal swab (CS) for antimicrobial evaluation was performed at enrollment (T0) and topical 0.66%-PVP-I was administered until the laboratory results were available (T1). Ulcer and infiltrate areas and infiltrate depths were compared between T0 and T1 (i.e., time-to-result period). Patients were then shifted to a specific antimicrobial therapy and followed up until resolution of their infiltrates (Tlast-TL). Twenty-five eyes were enrolled, and none showed clinical worsening leading to protocol withdrawal. At T1, ulcer and infiltrate areas showed significant improvement in Gram-positive IK (n = 13–52%; p = 0.027 and p = 0.019, respectively), remained stable in fungal IK (n = 5–20%; both p = 0.98) and increased in those with Gram-negative bacteria (n = 4–16%; p = 0.58 and p = 0.27). Eyes with negative cultures (n = 3–12%) showed complete resolution at T1 and did not initiate any additional antimicrobial therapy. The administration of 0.66% PVP-I during the time-to-result period seems to be a safe strategy in patients with IK while often sparing broad-spectrum antimicrobial agents. In addition, it showed to be effective in eyes with a Gram-positive bacterial infection.

Sequencing of the low-complexity ORF15 exon of RPGR, a gene correlated with retinitis pigmentosa and cone dystrophy, is difficult to achieve with NGS and Sanger sequencing. False results could lead to the inaccurate annotation of genetic variants in dbSNP and ClinVar databases, tools on which HGMD and Ensembl rely, finally resulting in incorrect genetic variants interpretation. This paper aims to propose PacBio sequencing as a feasible method to correctly detect genetic variants in low-complexity regions, such as the ORF15 exon of RPGR, and interpret their pathogenicity by structural studies. Biological samples from 75 patients affected by retinitis pigmentosa or cone dystrophy were analyzed with NGS and repeated with PacBio. The results showed that NGS has a low coverage of the ORF15 region, while PacBio was able to sequence the region of interest and detect eight genetic variants, of which four are likely pathogenic. Furthermore, molecular modeling and dynamics of the RPGR Glu-Gly repeats binding to TTLL5 allowed for the structural evaluation of the variants, providing a way to predict their pathogenicity. Therefore, we propose PacBio sequencing as a standard procedure in diagnostic research for sequencing low-complexity regions such as RPGR^ORF15, aiding in the correct annotation of genetic variants in online databases.

Purpose: To report the incidence, features, and clinical outcomes of macular neovascularization (MNV) in a large Italian cohort of patients with extensive macular atrophy with pseudodrusen-like appearance. Methods: Retrospective, longitudinal study including 79 extensive macular atrophy with pseudodrusen-like appearance patients (158 eyes) with ≥6 months of follow-up at three retina clinics. Medical records and imaging were reviewed for demographic and clinical data, including age, best-corrected visual acuity (BCVA), MNV features, and retinal pigment epithelium atrophy size, measured by short-wavelength autofluorescence and refined with near-infrared and optical coherence tomography imaging. Main outcomes included cumulative MNV incidence, MNV risk factors, and BCVA and retinal pigment epithelium atrophy changes in eyes with and without MNV. Results: Over a mean follow-up of 40.4 months, MNV developed in 14 eyes (10 patients), with a 4-year cumulative incidence of 15.2%. Most MNVs were Type 2 (86%) and subfoveal (64%). Cox regression identified younger age, fellow eye involvement, smaller retinal pigment epithelium atrophy size, and greater central subfield thickness (all P < 0.01) as significant risk factors for MNV. While eyes with MNV had lower baseline BCVA (58.4 vs. 71.4 letters, approximately 20/63 vs. 20/40 Snellen; P = 0.005), BCVA decline over time was similar between the two groups (−3.9 vs. −4.1 letters/year, P = 0.69). However, retinal pigment epithelium atrophy progressed faster in MNV eyes (3.4 vs. 2.8 mm²/year, P = 0.02). Conclusion: In this extensive macular atrophy with pseudodrusen-like appearance cohort, MNV had a cumulative incidence of 15.2% at 4 years. Although BCVA outcomes were comparable, MNV was associated with faster atrophy progression, potentially because of a more aggressive disease phenotype or fibro-atrophic changes.