The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size. Reflecting on all available evidence, a staged management algorithm was derived that presents a step-wise approach to implementing the various management and therapeutic options according to disease severity. While this exercise indicated that differentiating between aqueous-deficient and evaporative dry eye disease was critical in selecting the most appropriate management strategy, it also highlighted challenges, based on the limited evidence currently available, in predicting relative benefits of specific management options, in managing the two dry eye disease subtypes. Further evidence is required to support the introduction, and continued use, of many of the treatment options currently available to manage dry eye disease, as well as to inform appropriate treatment starting points and understand treatment specificity in relation to dry eye disease subtype.

TFOS DEWS II Management and Therapy Report

https://serval.unil.ch/resource/serval:BIB_3A01220E0FF1.P001/REF.pdf

Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis.

Keratoconus: A review

http://studioelenaalbe.it/pdf-pubblicazioni/013-CXL%20Ophthalmology%202009.pdf

Refractive, Topographic, Tomographic, and Aberrometric Analysis of Keratoconic Eyes Undergoing Corneal Cross-Linking

PURPOSE:Toevaluate 1-yearoutcomes of cornealcollagencrosslinking(CXL) fortreatment of keratoconus and corneal ectasia. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective randomized controlled clinical trial. METHODS:Collagen crosslinking was performed in eyes withkeratoconus orectasia. Thetreatment group received standard CXL and the sham control group received riboflavin alone. Principal outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, astigmatism, and topography-derived outcomes of maximum and average keratometry (K) value. RESULTS: The UDVA improved significantly from 0.84 logMAR G 0.34 (SD) (20/137) to 0.77 G 0.37 logMAR (20/117) (P Z .04) and the CDVA, from 0.35 G 0.24 logMAR (20/45) to 0.23 G 0.21 logMAR (20/34) (P<.001). Fifteen patients (21.1%) gained and 1 patient lost (1.4%) 2 or more Snellen lines of CDVA. The maximum K value decreased from baseline by 1.7 G 3.9 diopters (D) (P<.001), 2.0 G 4.4 D (P Z .002), and 1.0 G 2.5 D (P Z .08) in the entire cohort, keratoconus subgroup, and ectasia subgroup, respectively. The maximum K value decreased by 2.0 D or more in 22 patients (31.0%) and increased by 2.0 D or more in 3 patients (4.2%). CONCLUSIONS: Collagen crosslinking was effective in improving UDVA, CDVA, the maximum K value, and the average K value. Keratoconus patients had more improvement in topographic measurements than patients with ectasia. Both CDVA and maximum K value worsened between baseline and 1 month, followed by improvement between 1, 3, and 6 months and stabilization thereafter.

/pdf/corneal-collagen-crosslinking-for-keratoconus-and-corneal-434y96ibvk.pdf

Corneal collagen crosslinking for keratoconus and corneal ectasia: One-year results

Sensitivity and specificity of posterior corneal elevation measured by Pentacam in discriminating keratoconus/subclinical keratoconus.

Purpose. To investigate retinal function using microperimetry in patients affected by idiopathic epiretinal membrane (iERM) and cataract who underwent combined surgery: 4-year follow-up. Design. Prospective, interventional case series. Methods. 30 eyes of 30 consecutive patients with iERM and age-related cataract underwent 25-gauge vitrectomy and cataract surgery. At baseline, 90 and 180 days, and 1 and 4 years, we examined retinal mean sensitivity (MS), retinal mean defect (MD), fixation stability, and frequency of microscotomas using MP1 microperimetry. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) using a spectral domain optical coherence tomography (SD-OCT) were also performed. Results. All patients completed 1-year follow-up, while 23 patients reached last follow-up. Baseline MS and MD (10.48 ± 4.17 and -9.18 ± 4.40 dB) significantly changed at one year (12.33 ± 3.66 and -7.49 ± 3.31 dB, p < 0.01), at four years (14.18 ± 3.46 and -4.66 ± 2.85, p < 0.01), and between one and four years (p < 0.01) after surgery. Compared to baseline, CRT and BCVA significantly changed at one year and remained stable at four years. No variations were observed in fixation stability and frequency of microscotomas compared to baseline. Conclusions. Long-term follow-up using microperimetry seems useful to evaluate patients after iERM surgery: retinal sensitivity changes even when BCVA and CRT remain stable.

/pdf/microperimetric-assessment-after-epiretinal-membrane-surgery-4dz4b3a2yy.pdf

Microperimetric Assessment after Epiretinal Membrane Surgery: 4-Year Follow-Up

Reproducibility and Repeatability of Central Corneal Thickness Measurement in Keratoconus Using the Rotating Scheimpflug Camera and Ultrasound Pachymetry

Hypertension is associated with cardiovascular risk and systemic target organ damage. Retinopathy is considered one of the indicators of target organ damage. This review focuses on recent studies on hypertensive retinopathy and their implications for clinical care. Early recognition of hypertensive retinopathy signs remains an important step in the risk stratification of hypertensive patients.

https://bjo.bmj.com/content/bjophthalmol/89/12/1646.full.pdf

Federico Grignolo

Papers

Sensitivity and specificity of posterior corneal elevation measured by Pentacam in discriminating keratoconus/subclinical keratoconus.

Microperimetric Assessment after Epiretinal Membrane Surgery: 4-Year Follow-Up

Reproducibility and Repeatability of Central Corneal Thickness Measurement in Keratoconus Using the Rotating Scheimpflug Camera and Ultrasound Pachymetry

Hypertensive retinopathy revisited: some answers, more questions

Half-Fluence Versus Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy