Efficacia di una terapia senza bendaggio con gel a base di trealosio ialuronato sodico carbomero, nella riparazione del danno corneale epiteliale di tipo meccanico vs terapia a base di pomata antibiotica oftalmica con bendaggio

Introduzione: la superficie oculare è una complessa unità funzionale, il cui normale funzionamento è regolato dal sistema nervoso, particolarmente espresso a livello corneale. Diverse patologie possono portare ad una alterazione della superficie oculare e tra queste le patologie traumatiche della superficie oculare. In caso di trauma lo scopo principale della terapia della superficie oculare è di riparare il danno epiteliale. L’effetto protettivo e riparativo di una formulazione in gel a base di trealosio/ialuronato sodico/carbomero può trovare una valida applicazione nei processi di riparazione di danno epiteliale. Scopo: valutare l’efficacia riparativa nei confronti del danno epiteliale di tipo meccanico, di una formulazione in gel a base di trealosio/ialuronato sodico/carbomero, senza bendaggio oculare in confronto ad una terapia topica antibiotica con bendaggio oculare. Materiali e metodi: studio osservazionale condotto su 262 pazienti afferiti presso la clinica Oculistica di Roma nel periodo maggio 2014 – giugno 2017 per una lesione corneale e/o corneo-congiuntivale di natura da corpo estraneo o per abrasione corneale traumatica. È stata ottenuta l’approvazione del Comitato Etico ed il consenso informato dei pazienti. Il primo gruppo era costituito da 158 pazienti sottoposti a rimozione di corpo estraneo corneale e trattati per 7 giorni con le seguenti modalità: 83 pazienti con una formulazione in gel a base di trealosio/ialuronato sodico/carbomero quattro volte al giorno senza bendaggio oculare; 75 pazienti con una terapia topica antibiotica quattro volte al giorno con bendaggio oculare. Il secondo gruppo costituito da 104 pazienti con abrasione corneale e trattati con le stesse modalità descritte nel primo gruppo di pazienti (50 vs 54 rispettivamente). Risultati: dopo 4 giorni di trattamento la percentuale di guarigione dei pazienti trattati con la formulazione in gel a base di trealosio/ialuronato sodico/carbomero rispetto ai pazienti trattati con terapia topica antibiotica era significativamente superiore in entrambi i gruppi (73% vs 32%; p<0,01 Gruppo 1) (78% vs 29%; p<0,01 Gruppo 2). La differenza si è mantenuta anche dopo 7 giorni di trattamento (98% vs 91%; p<0,01 Gruppo 1) (100% vs 87% Gruppo 2; p<0,01). Una differenza statisticamente significativa dopo 4 giorni di trattamento è stata riscontrata per i parametri soggettivi come dolore (0,22 vs 0,47; p<0,01 Gruppo 1) (0.1 vs 0.5; p<0,01 Gruppo 2), bruciore (0,23 vs 0,79; p<0,01 Gruppo 1) (0.1 vs 0.8; p<0,01 Gruppo 2) e sensazione di corpo estraneo (0,51 vs 1,37; p<0,01 Gruppo 1) (0.4 vs 1.8; p<0,01 gruppo 2). Conclusioni: la terapia con una formulazione in gel a base di trealosio/ialuronato sodico/carbomero senza bendaggio sembra una valida alternativa all’applicazione di pomata oftalmica antibiotica con bendaggio.Introduction: The ocular surface is a complex functional unit whose normal functions are regulated by the nervous system, particularly expressed at the corneal level. Various diseases, and also traumatic injuries, can lead to the alteration of the ocular surface. In case of trauma, the main purpose of ocular surface therapy is to repair the epithelial damage. A gel formulation based on trehalose/sodium hyaluronate/carbomer may represent a valid strategy to help the epithelial repair processes, thanks to its protective and repairing action. Aim: To evaluate the effect of a gel formulation based on trehalose/sodium hyaluronate/carbomer without eye patching compared to topical antibiotic therapy with eye patching, in recovering epithelial damage caused by mechanical injury. Materials and methods: An observational study involving 262 patients referred to the Ophthalmology Clinic in Rome between May 2014 and June 2017 for corneal and/or cornealconjunctival lesion caused by a foreign body or by traumatic corneal abrasion. Ethical approval was obtained , and only consenting subjects were involved. The first group involved 158 patients who underwent corneal foreign body removal and were treated for 7 days as follows: 83 patients received a gel formulation based on trehalose/sodium hyaluronate/carbomer four times a day, without occlusive eye patch; 75 patients were treated with topical antibiotic therapy four times a day and occlusive eye patch. The second group included 104 patients with corneal abrasion who underwent the same treatments described for the first group of patients (50 vs 54 patients, respectively). Results: After 4 days of treatment, the recovery rate was significantly higher in both groups of patients treated with the gel formulation based on trehalose/sodium hyaluronate/carbomer, compared to patients treated with topical antibiotic therapy (73% vs 32%, p<0.01; Group 1) (78% vs 29%, p<0.01; Group 2). The difference was maintained even after 7 days of treatment (98% vs 91%, p<0.01; Group 1) (100% vs 87%, p<0.01; Group 2). A statistically significant difference was found after 4 days of treatment in subjective parameters such as pain (0.22 vs 0.47, p<0.01; Group 1) (0.1 vs 0.5, p<0.01; Group 2), burning sensation (0.23 vs 0.79, p<0.01; Group 1) (0.1 vs 0.8, p<0.01; Group 2) and foreign body sensation (0.51 vs 1.37, p<0.01; Group 1) (0.4 vs 1.8, p<0.01; Group 2). Conclusions: Treatment with a gel formulation based on trehalose/sodium hyaluronate/carbomer without occlusive patch seems a valid alternative to the application of an antibiotic ophthalmic ointment and occlusive eye patching

COVID-19 and ophthalmology practice at University Hospital “Policlinico Umberto I” in Rome

COVID-19 is a newly defined disease, affecting the respiratory system. It is caused by a novel coronavirus, called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The growing importance of the outbreak led the World Health Organization (WHO) to declare it a public health emergency of international concern on 30 January 2020 and to later officially describe it as a pandemic on 11 March 2020. Italy was the first European country to be heavily impacted by COVID-19, with the number of cases and deaths caused by the virus surging in the months of March and April 2020. Ophthalmologists represent a high-risk category for the spread of the infection, mainly because the examination demands close contact with the patient, exposing the clinician to tear, conjunctival secretions and to aerosol droplets

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work

Recent Developments in Gene Therapy for Neovascular Age-Related Macular Degeneration: A Review

Age-related macular degeneration (AMD) is a complex and multifactorial disease and a leading cause of irreversible blindness in the elderly population. The anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized the management and prognosis of neovascular AMD (nAMD) and is currently the standard of care for this disease. However, patients are required to receive repeated injections, imposing substantial social and economic burdens. The implementation of gene therapy methods to achieve sustained delivery of various therapeutic proteins holds the promise of a single treatment that could ameliorate the treatment challenges associated with chronic intravitreal therapy, and potentially improve visual outcomes. Several early-phase trials are currently underway, evaluating the safety and efficacy of gene therapy for nAMD; however, areas of controversy persist, including the therapeutic target, route of administration, and potential safety issues. In this review, we assess the evolution of gene therapy for nAMD and summarize several preclinical and early-stage clinical trials, exploring challenges and future directions

Improving keratoconus management with central corneal regularization and corneal collagen cross-linking protocol treatment

Purpose. To evaluate safety and efficacy of customized central corneal regularization (CCR), together with simultaneous accelerated corneal collagen cross-linking (A-CXL) - CCR-CXL protocol, to treat keratoconus-related corneal ectasia. Design. Retrospective, comparative observational case series. Methods. Patients that had undergone combined CCR-CXL protocol. Main inclusion criteria were keratoconus visual acuity deterioration and contact lens intolerance. All patients underwent complete ophthalmological evaluation, corrected distance visual acuity (CDVA) and Scheimpflug-corneal tomography. Central corneal regularization was performed by ablation using flying spot laser. Subsequently, the stroma was saturated with 0.17% riboflavin-5-phosphate added every 2 minutes, followed by A-CXL 9 mW/cm2 for 10 minutes. CDVA, medium keratometry value (Kmed), and total corneal morphological irregularity index (CMI) of patients were analyzed before surgery and after 1, 3 and 12 months. A P value of.05 or less was considered statistically significant. Results. 46 eyes of 39 keratoconus patients were treated. At 1 month, the mean CDVA (LogMar) increased from 0.19 ± 0.02 to 0.12 ± 0.02 (P < .05), and the difference remained stable at month 12. Kmax decrease was statistically significant from 57.02 ± 5.65 to 50.21 ± 4.48 (P < .05). CMI decreased significantly from 47.8 ± 2.84 to 30.1 ± 2.4 (P < .01). Conclusions. CCR-CXL protocol is safe and effective in arresting keratectasia progression and increasing corneal optic regularity in keratoconus. These findings showed a significant improvement in CDVA, keratometry values and corneal optical aberrations after being treated with the CCR-CXL protocol. Copyright © Società Editrice Universo (SEU

Janus kinase inhibitors: a new tool for the treatment of axial spondyloarthritis

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease involving the spine, peripheral joints, and entheses. This condition causes stiffness, pain, and significant limitation of movement. In recent years, several effective therapies have become available based on the use of biologics that selectively block cytokines involved in the pathogenesis of the disease, such as tumor necrosis factor-α (TNFα), interleukin (IL)-17, and IL-23. However, a significant number of patients show an inadequate response to treatment. Over 10 years ago, small synthetic molecules capable of blocking the activity of Janus kinases (JAK) were introduced in the therapy of rheumatoid arthritis. Subsequently, their indication extended to the treatment of other inflammatory rheumatic diseases. The purpose of this review is to discuss the efficacy and safety of these molecules in axSpA therapy

The Role of Human Pluripotent Stem Cells in Amyotrophic Lateral Sclerosis: From Biological Mechanism to Practical Implications

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder, characterized by progressive loss of both upper and lower motor neurons, resulting in clinical features such as muscle weakness, paralysis, and ultimately, respiratory failure. Nowadays, there is not effective treatment to reverse the progression of the disease, that leads to death within 3–5 years after the onset. Nevertheless, the induced pluripotent stem cells (iPS) technology could be the answer, providing disease modelling, drug testing, and cell-based therapies for this pathology. The aim of this work was to conduct a literature review of the past 5 years about the role of iPS in ALS, to better define the neurobiological mechanisms involved in the pathogenesis and the potential future therapies. The review also deals with advanced and currently available technologies used to reprogram cell lines and generate human motor neurons in vitro, which represent the source to study the pathological processes, the relationship between phenotype and genotype, the disease progression and the potential therapeutic targets of these group of disorders. Specific treatment options with stem cells involve Advance Gene Editing Technology, neuroprotective agents, and cells or exosomes transplantation, aimed to replace dead or damaged nerve cells. In summary, this review comprehensively addresses the role of human pluripotent stem cells (hPSCs) in motor neuron diseases (MND), with a focus on physiopathology, diagnostic and prognostic implications, specific and potential future treatment options. Understanding the biological mechanisms and practical implications of hPSCs in MND is crucial for advancing therapeutic strategies and improving outcomes for patients affected by these devastating diseases

Advances in the pathogenesis and treatment of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a genetically predisposed, female-predominant disease, characterized by multiple organ damage, that in its most severe forms can be life-threatening. The pathogenesis of SLE is complex and involves cells of both innate and adaptive immunity. The distinguishing feature of SLE is the production of autoantibodies, with the formation of immune complexes that precipitate at the vascular level, causing organ damage. Although progress in understanding the pathogenesis of SLE has been slower than in other rheumatic diseases, new knowledge has recently led to the development of effective targeted therapies, that hold out hope for personalized therapy. However, the new drugs available to date are still an adjunct to conventional therapy, which is known to be toxic in the short and long term. The purpose of this review is to summarize recent advances in understanding the pathogenesis of the disease and discuss the results obtained from the use of new targeted drugs, with a look at future therapies that may be used in the absence of the current standard of care or may even cure this serious systemic autoimmune disease

Text-message reminders increase uptake of routine breast screening appointments : a randomised controlled trial in a hard-to-reach population

Background: There is a need for interventions to promote uptake of breast screening throughout Europe. Methods: We performed a single-blind randomised controlled trial to test whether text-message reminders were effective. Two thousand two hundred and forty women receiving their first breast screening invitation were included in the study and randomly assigned in a 1 : 1 ratio to receive either a normal invitation only (n=1118) or a normal invitation plus a text-message reminder 48 h before their appointment (n=1122). Findings: In the intention-to-treat analysis, uptake of breast screening was 59.1% among women in the normal invitation group and 64.4% in the text-message reminder group (χ2=6.47, odds ratio (OR): 1.26, 95% confidence intervals (CI): 1.05–1.48, P=0.01). Of the 1122 women assigned to the text-message reminder group, only 456 (41%) had a mobile number recorded by their GP and were thereby sent a text. In the per-protocol analysis, uptake by those in the control group who had a mobile number recorded on the GP system was 59.77% and by those in the intervention group who were sent a reminder 71.7% (χ2=14.12, OR=1.71, 95% CI=1.29–2.26, P<0.01). Interpretation: Sending women a text-message reminder before their first routine breast screening appointment significantly increased attendance. This information can be used to allocate resources efficiently to improve uptake without exacerbating social inequalities

Unlocking the versatile potential: Adipose-derived mesenchymal stem cells in ocular surface reconstruction and oculoplastics

This review comprehensively explores the versatile potential of mesenchymal stem cells (MSCs) with a specific focus on adipose-derived MSCs. Ophthalmic and oculoplastic surgery, encompassing diverse procedures for ocular and periocular enhancement, demands advanced solutions for tissue restoration, functional and aesthetic refinement, and aging. Investigating immunomodulatory, regenerative, and healing capacities of MSCs, this review underscores the potential use of adipose-derived MSCs as a cost-effective alternative from bench to bedside, addressing common unmet needs in the field of reconstructive and regenerative surgery