PURPOSE:To evaluate the peripapillary area in eyes of patients with Idiopathic Normal Pressure Hydrocephalus (iNPH) before and after shunt surgery. METHODS:Twenty iNPH patients were prospectively recruited. Enhance depth imaging-optical coherence tomography (EDI-OCT) was performed to image the peripapillary region. Using a 360-degree 3.4 mm diameter peripapillary circle scan, the peripapillary choroidal thickness (PPCT) was manually measured and compared with 20 healthy-age-matched controls. PPCT was assessed before and after at least 6 months from VP shunt surgery in 12 patients. RESULTS:Mean age of iNPH patients was 75 ±7.4 years, and 45% were females. Mean PPCT was increased in non-shunted iNPH patients compared to healthy individuals (113 ± 39 vs 82 ± 43 μ m, p=0.026). Also, OCT scans in the peripapillary region showed a set of recurrent alterations, such as subclinical optic disc edema (ODE) (30%), choroidal folds (40%) peripapillary intraretinal cysts (30%), peripapillary atrophy (85%), peripapillary pigment epithelium alterations (45%), and pachyvessels (70%). After 79± 29 weeks from VP shunt surgery, 84% (10 out of 12) of iNPH patients presented a reduction in PPCT (111 ± 47 vs 95 ± 49, p=0.011). This reduction was associated with a subjective improvement of the neurological symptoms in 9 out of 10 of patients, and resolution of ODE (75%), intraretinal cysts (66%), and choroidal folds (20%). CONCLUSIONS:The ophthalmological findings observed in iNPH patients may be attributed to a framework of venous overload choroidopathy. Shunt surgery relieved peripapillary choroidal congestion, leading to improvements in OCT parameters.

Introduction:The NewColorIris and BrightOcular implants were initially developed to address congenital iris defects. However, they found application for cosmetic purposes. Unfortunately, these implants are frequently linked to severe complications, including glaucoma, endothelial dysfunction, cataract development, and iris abnormalities. In this context, we present an unusual complication that manifested long after the implantation of the BrightOcular artificial iris. Case Presentation:A 28-year-old woman presented to our emergency room with blurred vision in both eyes. She had undergone bilateral cosmetic iris implantation (BrightOcular, Stellar Devices, New York, NY, USA) 6 years earlier in Tunisia. At the first examination, her best corrected visual acuity was hand motion in the right eye and 20/100 in the left eye, and intraocular pressure (IOP) was 45 mm Hg and 30 mm Hg, respectively. Despite the maximum-tolerated glaucoma medical treatment, the elevated IOP persisted, leading to the decision to perform bilateral sequential Baerveldt glaucoma drainage device implantation. However, she subsequently developed combined central retinal artery and vein occlusion in the right eye and hypotensive maculopathy in the left eye; the latter resolving within 1 month. Two months post-surgery, extensive neovascularization above the implant of the right eye was observed, and this was successfully treated with three sequential injections of bevacizumab. Conclusion:Cosmetic iris implantation is associated with severe, sight-threatening complications. Herein, we describe a previously unreported case of angle neovascularization with new vessels growing over the artificial iris implant. The condition regressed after intravitreal anti-vascular endothelial growth factor injections.

The NewColorIris and BrightOcular implants were initially developed to address congenital iris defects. However, they found application for cosmetic purposes. Unfortunately, these implants are frequently linked to severe complications, including glaucoma, endothelial dysfunction, cataract development, and iris abnormalities. In this context, we present an unusual complication that manifested long after the implantation of the BrightOcular artificial iris. A 28-year-old woman presented to our emergency room with blurred vision in both eyes. She had undergone bilateral cosmetic iris implantation (BrightOcular, Stellar Devices, New York, NY, USA) 6 years earlier in Tunisia. At the first examination, her best corrected visual acuity was hand motion in the right eye and 20/100 in the left eye, and intraocular pressure (IOP) was 45 mm Hg and 30 mm Hg, respectively. Despite the maximum-tolerated glaucoma medical treatment, the elevated IOP persisted, leading to the decision to perform bilateral sequential Baerveldt glaucoma drainage device implantation. However, she subsequently developed combined central retinal artery and vein occlusion in the right eye and hypotensive maculopathy in the left eye; the latter resolving within 1 month. Two months post-surgery, extensive neovascularization above the implant of the right eye was observed, and this was successfully treated with three sequential injections of bevacizumab. Cosmetic iris implantation is associated with severe, sight-threatening complications. Herein, we describe a previously unreported case of angle neovascularization with new vessels growing over the artificial iris implant. The condition regressed after intravitreal anti-vascular endothelial growth factor injections.

OBJECTIVE:To assess the frequency of open-angle glaucoma in Caucasian patients affected by idiopathic normal pressure hydrocephalus (iNPH) prior to ventriculo-peritoneal shunt surgery, and to evaluate the progression of optic nerve damage 1-year postsurgery. METHODS:Thirty-five consecutive patients diagnosed with iNPH were prospectively recruited between November 2021 and June 2023. Assessments included visual acuity, intraocular pressure, macular ganglion cell complex thickness, retinal nerve fiber layer thickness, visual field test, central corneal thickness, axial length, and corneal hysteresis. Patients with newly diagnosed open-angle glaucoma were initiated on intraocular pressure-lowering medications. Eighteen patients were re-evaluated after a mean of 1 year postshunt surgery to assess the progression of optic nerve damage. RESULTS:A total of 35 eyes of 35 iNPH patients were included. The mean age of participants was 75.75 ± 6.67 years, with 34.3% being females. Primary open-angle glaucoma was identified in 22.8% of nonshunted iNPH patients, including 11.4% who received a new diagnosis. After a mean follow-up of 14.9 ± 4.8 months postsurgery, there were no significant changes in retinal nerve fiber layer and ganglion cell complex thickness, nor were there any observed progressions in visual field defects or significant alterations in corneal biomechanics (P > 0.05). CONCLUSIONS:Approximately 1 in 5 nonshunted iNPH patients exhibited primary open-angle glaucoma, with 50% being undiagnosed. These findings indicate the importance of conducting ophthalmological evaluations at the time of iNPH diagnosis, as early intervention may mitigate optic nerve damage progression following shunt surgery.

Purpose: To compare the peripapillary choroidal vascularity index (PPCVI) in eyes with papilledema secondary to idiopathic intracranial hypertension (IIH) and pseudopapilledema due to optic disc drusen (ODD) using a novel deep learning algorithm. Design: A retrospective observational cohort study. Subjects: The study included 30 eyes of 15 patients with papilledema secondary to IIH, 30 eyes of 15 patients with ODD, and 78 eyes of 39 age- and sex-matched healthy controls. All cases of IIH and ODD were confirmed with lumbar puncture and B-scan ultrasonography, respectively. Methods: OCT was performed using a 3.4 mm diameter 360° peripapillary circle scan. Choroidal segmentation was automatically performed with a deep learning ResUNet model and a volumetric smoothing algorithm. The choroidal vascularity index was quantified in each peripapillary scan. Statistical comparisons were made between groups and in IIH patients before and after resolution of papilledema. Linear mixed models were used for analysis. Main Outcome Measures: Mean PPCVI, expressed as a percentage, across study groups and longitudinally in IIH eyes. Results: There were no significant differences among groups regarding age, sex, visual acuity, or intraocular pressure (P > 0.05). Mean PPCVI was significantly reduced in the papilledema group compared with the pseudopapilledema and control groups (31.7% ± 8.4% vs. 39.0% ± 8.1% and 40.7% ± 5.6%, respectively; P < 0.001). After a mean follow-up of 36 ± 12.1 months, IIH patients with resolved papilledema showed a significant increase in PPCVI (34.8% ± 8.0% vs. 31.7% ± 8.4%, P = 0.033), although values remained lower compared with pseudopapilledema and control groups (P < 0.001). Conclusions: Reduced PPCVI could be a potential biomarker for differentiating papilledema from pseudopapilledema. An increase in PPCVI after resolution of papilledema supports its utility as a potential parameter for monitoring disease activity. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose Idiopathic normal pressure hydrocephalus (iNPH) is associated with an increased prevalence of open-angle glaucoma, attributed to variations of the pressure gradient between intraocular and intracranial compartments at the level of the lamina cribrosa (LC). As ocular biomechanics influence the behavior of the LC, and a lower corneal hysteresis (CH) has been associated to a higher risk of glaucomatous optic nerve damage, in this study we compared ocular biomechanics of iNPH patients with healthy subjects. Methods Twenty-four eyes of 24 non-shunted iNPH patients were prospectively recruited. Ocular biomechanical properties were investigated using the ocular response analyzer (Reichert Instruments) for the calculation of the CH, corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc). Results were compared with those of 25 eyes of 25 healthy subjects. Results In iNPH eyes, the median CH value and interquartile range (IQR) were 9.7 mmHg (7.8–10) and 10.6 mmHg (9.3–11.3) in healthy controls ( p = 0.015). No significant differences were found in IOPcc [18.1 mmHg (14.72–19.92) vs. 16.4 mmHg (13.05–19.6)], IOPg [15.4 mmHg (12.82–19.7) vs. 15.3 mmHg (12.55–17.35)], and CRF [9.65 mmHg (8.07–11.65) vs. 10.3 mmHg (9.3–11.5)] between iNPH patients and controls. Conclusions In iNPH patients, the CH was significantly lower compared to healthy subjects. This result suggests that ocular biomechanical properties may potentially contribute to the risk of development of glaucomatous optic nerve damage in iNPH patients.

Background To describe a case of bilateral multifocal chorioretinitis as the only presentation of acute West Nile virus (WNV) infection in the absence of neurological involvement.Case presentation A 78-year-old Italian woman was admitted to our emergency department because she noticed blurry vision in both eyes. She did not report fever, fatigue, or neurological symptoms in the last few days. Multimodal imaging showed the presence of bilateral hyperfluorescent lesions with a linear distribution, that corresponded to hypocyanescent spots on indocyanine green angiography. Antibody serology showed the presence of IgM antibodies, IgG antibodies, and ribonucleic acid (RNA) for WNV. Magnetic resonance imaging (MRI) of the brain ruled out central nervous system involvement. Three months later, the patient reported spontaneous resolution of her symptoms and remission of the chorioretinal infiltrates.Conclusions In endemic areas, it is important to think of acute WNV infection as an explanatory etiology in cases of multifocal chorioretinitis, even without neurological involvement.

Citation: Maltoni L, Baraldi C, Roda M, Grendele A, Dika E, Vaccari S. A Growing Conjunctival Pigmentation – Videodermoscopy of Conjunctival Melanoma. Dermatol Pract Concept. 2024;14(1):e2024091. DOI: https://doi.org/10.5826/dpc.1401a91

Abstract Backgrounds To report the long-term surgical outcomes and the impact on daily life activities of strabismus surgery in patients with Thyroid Associated Orbitopathy (TAO) with and without previous orbital decompression. Methods Patients who underwent strabismus surgery for TAO were retrospectively reviewed. The primary outcome was to evaluate the influence of orbital decompression on the outcomes of TAO related strabismus surgery. Surgical success was defined by the resolution of diplopia and a post-operative deviation < 10 prism diopters (PD). The secondary outcomes were the clinical features, surgical approaches, and impact on daily life activities. Results A total of 45 patients were included in the study. The decompression surgery group (DS) included 21 patients (46.7%), whereas the non-decompression surgery group (NDS) patients were 24 (53.3%). The mean follow-up time from the last strabismus surgery was 2,8 years (range 8–200 months). Successful surgical outcome was achieved in 57,1% of patients in the DS, and 75% of patients in the NDS (p = 0,226). DS patients required almost twice the number of surgical interventions for strabismus compared to the NDS (1,95 vs. 1,16 respectively, p = 0,006), a higher number of extraocular muscles recessed in the first surgery (2,67 vs. 1,08 respectively, p < 0.001), and a lower rate of unidirectional surgery compared to NDS (23% vs. 95%, p < 0,001). At the pre-operative assessment, 71.4% of DS patients had eso-hypotropia, while no patients had this type of strabismus in the NDS group (p < 0.001). On the other hand, the hypotropia rate was 79.2% in NDS patients and only 4.8% in DS patients (p < 0.001). Moreover, 21,8% of NDS patients used prism lenses in daily life activities, compared to 42.9% of patients that used prism lenses to reduce the impairment in their daily life activities (p = 0.016). Conclusions The results of our study showed that DS patients required almost twice the number of strabismus surgical procedures, a higher number of extraocular muscles recessed in the first surgery, and an increased need for prism lenses to correct the residual deviation compared to the NDS, but with similar long-term surgical outcomes.

Objectives: To study the density, spacing, and regularity of retinal cone photoreceptors using an Adaptive Optics (AO) retinal camera (Rtx1TM, Imagine Eyes, Orsay, France) in patients with Primary Open Angle Glaucoma (POAG) and to compare the outcomes with those of healthy age-matched control subjects. Methods: The study included 43 eyes with POAG and 31 eyes of normal subjects. POAG patients were divided into three groups according to the severity of the visual field defect. The AO Rtx1TM was used to obtain images of the parafoveal cone mosaic to calculate cone values. Analysis was performed at two and four degrees of eccentricity from the fovea along the four meridians (nasal, temporal, superior, inferior). Results: In POAG eyes, the mean +/- standard deviation (SD) cone density at 2 degrees considering all meridians was significantly lower than in normal controls (23,058.6 +/- 3532.0 cones/mm2, and 25,511.7 +/- 3157.5 cones/mm2, respectively; p = 0.003). Cone spacing was 7.3 +/- 0.5 mu m in POAG and 7.0 +/- 0.4 mu m in normal controls (p = 0.005), and cone regularity was 90.5 +/- 4.9% and 93.5 +/- 1.9% in POAG and normal controls, respectively (p < 0.001). At 4 degrees similar trends were observed. However, no significant differences were found among patients with different severity of POAG (p > 0.05). Conclusions: Using AO Rtx1 (TM), significant differences in retinal photoreceptors mosaic pattern were found between POAG eyes and age-matched controls, indicating a reduction in photoreceptors in POAG. No significant differences in retinal photoreceptor values were found among the three POAG groups.

Purpose To analyze epidemiology, clinical features, and surgical outcomes of type III acute acquired concomitant esotropia (Bielschowsky esotropia (BE)). Methods The medical charts of patients diagnosed with acquired concomitant esotropia between 2013 and 2021 were reviewed. Assessed data were age, gender, age at diplopia onset, age at the diagnosis, refraction, visual acuity, neuroimaging, diplopia onset, angle of deviation, stereopsis, surgical procedure, amount of surgery, and relapse of diplopia after surgery. Moreover, we investigated the correlation between the use of electronic devices and the onset of diplopia. Results One hundred seventeen patients (mean age 35.07 ± 15.81 years) were included in the study. The mean delay to the diagnosis was 3.29 ± 3.62 years. Myopia range was 0 to 17 diopters spherical equivalent. 66,3% spent more than 4 hours a day using laptops, tablets, or smartphones at the onset of diplopia, and 90,6% presented a subacute onset. None showed neurologic signs or symptoms. Patients who underwent surgery were ninety-three, with a rate of surgical success of 93.6%, and a relapse rate of 17.2%. A negative correlation resulted between pre-operative deviation and age at diagnosis (ρ = -0.261; p<0.05), whereas factors associated with surgical failure were older age at diplopia onset (p = 0.042) and longer delay between onset and diagnosis (p = 0.002). Conclusion We registered an outstanding increase in prevalence of BE, which could be related to the exponential increase in the use of electronic devices for professional, educational, and recreational purposes. A prompt diagnosis and an augmented dose of surgery allows good motor and sensory results.

Purpose: To evaluate the utility of telemedicine in the treatment of adult patients with strabismus.Methods: A 27-question online survey was sent to oph-thalmologists of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Adult Strabis-mus Committee. The questionnaire focused on the fre-quency of telemedicine utilization, the benefits in the diagnosis, follow-up, and treatment of adult strabismus, and barriers of current forms of remote patient visits.Results: The survey was completed by 16 of 19 mem-bers of the committee. Most respondents (93.8%) re-ported 0 to 2 years of experience with telemedicine. Telemedicine was found to be useful for initial screening and follow-up of established patients with adult strabis-mus, mainly to reduce wait time for a subspecialist visit (46.7%). A successful telemedicine visit could be com-pleted with a basic laptop (73.3%) or a camera (26.7%) or could be assisted by an orthoptist. Most participants agreed that common forms of adult strabismus (cranial nerve palsies, sagging eye syndrome, myogenic strabis-mus, and thyroid ophthalmopathy) could be examined via webcam. It was easier to analyze horizontal than ver-tical strabismus. Among the paralytic forms, sixth nerve palsy was the easiest one to assess. Latent forms of stra-bismus can be partially diagnosed and evaluated using telemedicine, but half of the respondents underlined the importance of in-person examinations in these cas-es. Sixty-nine percent believed that telemedicine could be a low-cost and time-efficient health service solution.Conclusions: Most members of the AAPOS Adult Stra-bismus Committee consider telemedicine to be a use-ful supplement to the current adult strabismus practice.

International Journal of DermatologyEarly View Correspondence Conjunctival amelanotic nevus: clinical and dermoscopic clues Sabina Vaccari MD, Sabina Vaccari MD Dermatology – IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorMartina Mussi MD, Corresponding Author Martina Mussi MD [email protected] orcid.org/0000-0003-0955-6112 Dermatology – IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorMatilde Roda MD, Matilde Roda MD Unit of Ophthalmology, IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorFrancesca Pepe MD, Francesca Pepe MD orcid.org/0000-0001-7993-2473 Dermatology – IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorCostantino Schiavi MD, Costantino Schiavi MD Unit of Ophthalmology, IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this author Sabina Vaccari MD, Sabina Vaccari MD Dermatology – IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorMartina Mussi MD, Corresponding Author Martina Mussi MD [email protected] orcid.org/0000-0003-0955-6112 Dermatology – IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorMatilde Roda MD, Matilde Roda MD Unit of Ophthalmology, IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorFrancesca Pepe MD, Francesca Pepe MD orcid.org/0000-0001-7993-2473 Dermatology – IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this authorCostantino Schiavi MD, Costantino Schiavi MD Unit of Ophthalmology, IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, ItalySearch for more papers by this author First published: 02 February 2023 https://doi.org/10.1111/ijd.16609 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

The present study aims to investigate the choroidal morphology and microvascular structure in eyes of patients with idiopathic normal pressure hydrocephalus (iNPH) compared with the eyes of healthy age-matched individuals, and to assess the choroidal structure in eyes of iNPH patients before and after shunt surgery using Optical Coherence Tomography (OCT). The primary objective was to assess the choroidal morphology in eyes of iNPH patients before and after ventriculo-peritoneal (VP) surgery compared to age and sex-matched healthy individuals. The secondary objective was to compare the choroidal morphology of iNPH patients before and after a mean of 56 days from shunt surgery. Eighteen consecutive patients diagnosed with iNPH and 18 healthy controls were prospectively recruited between November 2021 and October 2022. Spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) was conducted before and within 4 months after shunt surgery. Images were binarized using the ImageJ software, and the choroidal vascular index (CVI) was calculated. Sub-foveal choroidal thickness (SFCT), total choroidal area (TCA), luminal choroidal area (LCA), and stromal choroidal area (SCA) were significantly increased in iNPH patients before surgery compared to the control group ( p < 0.05). SFCT, TCA, and SCA were significantly increased in iNPH patients after surgery compared to the control group ( p < 0.05). There were no differences in the CVI between iNPH patients and controls. No statistical differences in the choroidal structure were observed before and after VP shunt surgery ( p > 0.05). In conclusion, the choroid was thicker in iNPH patients before and after VP shunt compared to age-matched healthy individuals. However, there were no difference in the choroidal microstructure in the eyes of iNPH patients before and after a mean of 3 months from VP shunt surgery.

Myopia is a condition widely spread throughout the world, and it is expected to affect almost half of the population within 2050. Its correlation with many ocular pathologies, such as retinal detachment, retinal degeneration, maculopathy, glaucoma and cataract, is already well known. Strabismus associated with myopia is more likely to develop as exotropia; however it can also show different clinical features, and thus therapeutic needs, which often make it a challenge for the ophthalmologist to be detected and treated. Heavy eye syndrome is a pathology related to high degenerative myopia, and it is characterized by a wide range of deviation, which goes from a small angle esotropia to a large angle of eso-hypodeviation. Bielschowsky esotropia, ore AACE type III esotropia, is a condition spreading rapidly among population, mainly in association with the use of electronic devices. It is characterized by onset of diplopia for distance vision, followed by the involvement of near vision, and for the preservation of binocular vision. Treatment options include prisms and botulinum toxin therapy; however surgery remains the best curative alternative. Myopia is a predisposing factor for rhegmatogenous retinal detachment, which often can be treated with the positioning of scleral buckling. This surgery is related to the development of strabismus, due to the extraocular motility restriction and subsequent diplopia. Finally, refractive surgery for the treatment of myopia may result in different type of strabismus and diplopia, through many different mechanisms. This review aims to describe clinical features and therapeutic approaches for all these conditions.

Purpose To evaluate changes in peripapillary vascular blood flow indices (PVBFI) in patients with thyroid-associated ophthalmopathy (TAO) using OCT angiography (OCTA) technology. Methods Patients with TAO and control subjects matched for age and sex were included in the study. Eye examination, Clinical Activity Score (CAS) evaluation and OCTA scan analysis (Topcon ImageNet 6; DRI OCT Triton, Topcon Corporation) were performed. In particular, PVBFI of the superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR) and choriocapillaris (CC) layers were obtained by OCTA and extracted from 8-bit greyscale OCT images using the ImageJ software package. Results Twenty-six patients with TAO (19 females, mean age 54.7 ± 5.2 and 7 males, mean age 51.4 ± 16.3) were compared with 26 healthy subjects (15 females, mean age 48.2 ± 14.1 and 11 males, mean age 53.1 ± 15.2). Both DCP-PVBF and CC-PVBFI were significantly reduced in TAO patients compared to control eyes (28.6 ± 2.1 vs. 29.7 ± 0.93, p = 0.002; 46.5 ± 1.72 vs. 47.2 ± 1.2, p = 0.019 respectively); on the other hand, no statistically significant differences were found in SCP-PVBFI and OR-PVBFI in TAO patients compared to healthy subjects ( p > 0.05). Also, CC-PVBFI was associated with elevated values of CAS ( p = 0.018) and ROC curve showed that patients with elevated CC-PVBFI were correlated with active TAO (CAS > 3) ( p = 0.012). Conclusions TAO disease may be associated with changes in DCP-PVBFI and CC-PVBFI; also, CC-PVBFI seems to correlate with disease activity.

A 41-year-old man presented to the emergency department complaining of decrease of vision in his left eye. Initial examination was consistent with retrobulbar optic neuritis, and an intravenous drip of methylprednisolone was started. On the third day, the fundus examination revealed the appearance of multiple Purtscher-like cotton-wool spots in the posterior pole and nasally to the optic disc, slight retinal whitening around the fovea, and cherry-red spot. The patient reported flu-like symptoms, and he tested positive at PCR (polymerase chain reaction) test for 2019-nCoV (2019 novel coronavirus) infection. Assuming possible 2019-nCoV-related vascular damage, we prescribed low-molecular-weight heparin. The lesions were regressing at follow-up, and we registered a complete visual recovery.

In recent years, the role of artificial intelligence (AI) and deep learning (DL) models is attracting increasing global interest in the field of ophthalmology. DL models are considered the current state-of-art among the AI technologies. In fact, DL systems have the capability to recognize, quantify and describe pathological clinical features. Their role is currently being investigated for the early diagnosis and management of several retinal diseases and glaucoma. The application of DL models to fundus photographs, visual fields and optical coherence tomography (OCT) imaging has provided promising results in the early detection of diabetic retinopathy (DR), wet age-related macular degeneration (w-AMD), retinopathy of prematurity (ROP) and glaucoma. In this review we analyze the current evidence of AI applied to these ocular diseases, as well as discuss the possible future developments and potential clinical implications, without neglecting the present limitations and challenges in order to adopt AI and DL models as powerful tools in the everyday routine clinical practice.