Background: The corneal coating gel reduces corneal injury and improve patient comfort. In the present study we monitored inflammation and epithelial remodelling parameters in coating gel- and BSS-treated eyes up to 30 days postop.

Purpose: To study the effects on corneal surface and discomfort syndrome after cataract surgery using intraoperative tripolymeric coating gel.

Methods: 25 eyes received the corneal coating gel during surgery; 25 eyes were irrigated with BSS (control). Anterior segment optical coherence tomography (central corneal thickness (CCT), epithelial thickness (ET), confocal microscopy, and ocular surface disease index (OSDI) were administered preoperatively (baseline), 1, 5, and 14 days postoperatively.

Results: In the BSS-irrigated eyes, all the parameters changed in postop period and came back to the baseline values after 30 days. In the gel-coated eyes, only CCT and ET increased significantly 1 day postop, whereas all the parameters remained similar to the baseline at all follow-up intervals. OSDI was better in the coating gel group.

Conclusion: The use of intraoperative coating gel reduced the effects of surgically induced trauma and improved ocular comfort.

Methods: Serial dilutions of perfluorooctanoid acid, 1H,1H,7H-dodecafluoro-1- heptanol, 1H,1H,1H,2H,2H-Perfluorooctane, 1H perfluorooctan; ethylbenzene, paraxylene, perfluotobutyfurane, and hexafluoro-1,2,3,4-tetrachlorobutane were tested by direct contact cytotoxicity test using BALB3T3 and ARPE19 cell lines, after application on 59% of the area for 24 h.

Results: Traces of paraxylene, ethylbenzene, and PFOA (≤30ppm) induced severe toxicity in both cell lines. Hexafluoro-1,2,3,4-tetrachlorobutane and H,1H,7H-Dodecafluoro-1-heptanol were cytotoxic at approximately 10000 ppm. 1H perfluorooctan was cytotoxic at approximately 60000 ppm. High concentrations of 1H,1H,1H,2H,2H-Perfluorooctane and perfluotobutyfurane were not cytotoxic.

Conclusions: Six out of eight perfluorocarbon manufacturing process residuals showed cytotoxicity in the direct contact test according to ISO 10993-5. Paraxylene, ethylbenzene, and PFOA were the most cytotoxic compounds. 1H,1H,1H,2H,2H-Perfluorooctane and perfluotobutyfurane were not cytotoxic.

Methods: BALB3T3 and ARPE19 cell lines were cultured in 96-well plates for direct contact cytotoxicity test of 22%, 59%, and 83% contact areas and 2.5, 12, and 24 h contact times. Cell morphology was graded by light microscopy. Cell viability was quantified by MTT assay in ARPE19 cells and neutral red uptake viability assay for BALB3T3. 1-H perfluorooctane (1H PFO) and purified perfluoro-n-octane (PFO) were used as positive and negative controls, respectively.

Results: Qualitative evaluation showed that positive control induced the presence of severe reactivity zones, resulting in 2.2 to 3.0 grading score, and cytotoxicity according to ISO 10993-5 in all tested conditions. Quantitative evaluation of 1H PFO applied on 22%, 59%, and 83% contact areas corresponded to 14–26%, 84–96%, and 86–99% cell mortality ranges, respectively. No cytotoxicity according to ISO 10993-5 was detected in tested cell lines, when 1H PFO was applied on a 22% area at the tested time intervals. The negative control was not cytotoxic with both approaches in all tested conditions.

Conclusions: Direct contact cytotoxicity test according to ISO 10993-5 of PFCLs was validated quantitatively and qualitatively, using ARPE19 and BALB 3T3 cell lines and covering 59% of the cell surface areas for 24 h of contact time. Test conditions using a smaller contact area could not be validated.

Purpose: To compare the protective properties and ease of manipulation during cataract surgery of corneal coating with a gel (eyeDRO; AL.CHI.MI.A. S.R.L, Italy) and corneal irrigation with balanced salt solution (BSS).

Methods: We analyzed the data of 51 patients receiving either eyeDRO or BSS during routine cataract surgery performed within a 20-day period in 2016. The selected parameters were intraoperative clarity and ease of manipulation; postoperative epithelial integrity; and patient discomfort.

Results: Compared with BSS irrigation, eyeDRO coating significantly increased intraoperative clarity and ease of manipulation (P < 0.01). Single application was required in eyeDRO-treated eyes, whereas BSS was applied 5.3 ± 0.4 times on average (P < 0.01). Two hours postoperatively, a normal epithelium was observed in 90.0% and 60.0% of eyeDRO-coated and BSS-irrigated eyes, respectively; punctate epithelial damage was observed in 9.7% and 40.0% (P < 0.05) of eyeDRO-coated and BSS-irrigated eyes, respectively; eye irritation and foreign body sensation were experienced by 13.0% and 37.0% of eyeDRO-treated patients and by 65.0% and 100% of BSS-treated patients, respectively (P < 0.01). Twenty-four hours postoperatively, 80.0% of BSS-treated patients versus 19.0% of eyeDRO-treated patients still experienced foreign body sensation (P < 0.01).

Conclusions: eyeDRO coating was shown to be a safer and more effective option than BSS irrigation in cataract surgery because single application provided optimal hydration and intraoperative clarity during the entire surgery, better preserved the corneal epithelium, and offered postoperative comfort to the patient.

Purpose: The vitreous cortex, epiretinal membrane (ERM), and inner limiting membrane (ILM) are transparent tissues and are then difficult to visualize. Staining these structures can increase the efficiency of a nontraumatic removal.

Methods: The surgeon performs a partial core vitrectomy and induces a posterior vitreous detachment. The vital dye is then injected into the retrohyaloid space in balanced salt solution (BSS). The dyes used are TWIN (AL.CHI.MI.A. Srl, Padova, Italy), MembraneBlue-Dual (DORC International, Zuidland, The Netherlands), and Doubledyne (Alfa Intes, Casoria, Italy). The surgeon can complete the vitrectomy and gradually aspirate the dye with a probe. Once the vitrectomy is complete, the surgeon can perform the peeling of the ERM without the need to reinject the vital dye over the macula.

Results: The presence of the dye over the macula facilitates the visualization of the vitreous cortex by blocking the red reflex and increasing the contrast power of the coaxial light probe during the vitrectomy. This allows a negative staining of the vitreous because the dye acts by increasing the visibility of the surrounding BSS and not the vitreous itself.

Conclusions: We describe a new chromovitrectomy technique using the same dye to increase the visualization of the vitreous, posterior hyaloid, ERM, and ILM.

Purpose: Standardization of dropless cataract surgery consisting in minimal preoperative preparation and elimination of intraoperative BSS irrigation.

Setting: POLIVISUS, via A Moro 34, Brescia, Italy, Private Ophthalmology Clinic.

Methods: Sixty cataract patients were enrolled in a prospective study. “Dropless Surgery group” included forty eyes receiving Mydriasert ophthalmic insert (Laboratories Thea, France) and single application of eyeDRO corneal coating (Alchimia, Italy), before surgery. Control group included 20 eyes receiving topical mydriatics (Visufarma, Italy) preoperatively and irrigation with BSS (Alcon, USA) during surgery. All patients underwent phacoemulsification cataract surgery using Infinity equipment (Alcon, USA). Surgeon scored clarity of operative field and ease of manipulation at different intervals. Eye transparency was examined by slit lamp (Nikon, Japan), and epithelial damage by fluorescein staining, 2 hours postoperatively. All patients filled a self-assessment questionnaire.

Results: Corneal transparency and operative field clarity were significantly better in “Dropless Surgery group” than in Control group at each time interval. No eyes in “Dropless Surgery group” required further application of eyeDRO during surgery. Six irrigations were required on average in Control group with use of 13,6ml BSS per procedure. Frequency and volume of irrigation were increased in eyes with reduced transparency. Two hours postoperatively, 10% and 57% of patients showed moderate fluorescein staining in Dropless Surgery and Control group, respectively. 20% of patients in “Dropless Surgery group” reported foreign body sensation 24h postop compared to 86% in control group.

Conclusions: Dropless cataract surgery allowed to increase significantly the clarity of the operative field, facilitated surgical manipulation and improved patient comfort as compared to BSS irrigation procedure. Dropless cataract surgery permitted to minimize the variability related to preoperative preparation and intraoperative irrigation, and then resulted in simplification and standardization of the outcome of the phacoemulsification cataract surgery.

Purpose: To report the cases of cataract patients characterized by poor visibility of the operative field which was significantly improved with use of eyeDRO gel.

Setting: POLIVISUS, private ophthalmology clinic, via A Moro 34, Brescia, Italy.

Methods: Cataract patients with poor visibility of the operative field due to severe dry eye syndrome, corneal epithelium damage, cloudy/opaque cornea, deep set eyes and iatrogenic corneal abrasions are described. All patients received topical anesthetics and Mydriasert ophthalmic insert (Laboratories Thea, France) preoperatively and continuous 2-mm layer of eyeDRO gel (Alchimia, Italy) as corneal surface coating before surgery. All patients underwent phacoemulsification cataract surgery using Infinity equipment (Alcon, USA). Surgeon scored intraoperative clarity of operative field at different intervals and all the surgeries were filmed.

Results: In patients with severe dry eye, corneal epithelium damage, iatrogenic corneal abrasions, the application of the eyeDRo coating completely reestablished the transparency and visibility of the operative field. In deep set eyes the single application of the gel protected the corneal surface during all the surgery and facilitated the manipulation. Pseudoexfoliation syndrome was clearly detected in eyeDRO treated eye thank to the excellent intraocular visibility.

Conclusions: In patients characterized by poor visibility of the operative field during phacoemulsification cataract surgery, the single eyeDRO gel application restored visibility and protection of corneal surface significantly better than BSS irrigation.

Purpose: To report the surgical results of primary pseudophakic  rhegmatogenous retinal detachment (RRD) with only inferior retinal breaks (IRBs) repaired by pars plana vitrectomy (PPV) alone and complete drainage of subretinal fluid.

Design: Prospective, interventional cohort study.

Participants: A total of 147 consecutive pseudophakic eyes of 147 patients with primary RRD with causative inferior breaks.

Methods: All eyes underwent PPV alone and complete drainage of subretinal fluid, with air, 20% sulfur hexafluoride (SF6), or 12% perfluoropropane (C3F8) as tamponade and with no face-down position in the postoperative period.

Main Outcome Measures: Postoperative primary and final anatomic outcome, visual acuity, and complications.

Results: The patient population consisted of 44 women (30%) and 103 men (70%) with a mean age of 60.8
12.9 years. The mean follow-up period was 24.9
19.4 months. The mean number of quadrants affected was 2.4 (range, 1e4). A single break was present in 90 cases (61.2%), and 2 to 4 breaks were present in 57 cases (38.8%). The macula was found to be detached in 118 cases (80.3%) and attached in 29 cases (19.7%) intraoperatively.
Of 152 breaks located between 5 and 7 clock-hours, 124 breaks (81.6%) were located outside the limits of the gas bubble on the first or third day postoperatively. Initial reattachment was achieved in 139 cases (94.5%; 95% confidence interval, 89.5e97.6). Final reattachment was achieved in 147 cases (100%). Two cases (1.3%) redetached because of new or missed retinal breaks. Six cases (4.1%) redetached because of incomplete retinal adhesion of the treated break(s). Mean preoperative best-corrected visual acuity (BCVA) was 1.11
0.59 logarithm of the minimum angle of resolution (logMAR). The mean final postoperative BCVA was 0.42
0.33 logMAR.

Conclusions: Pars plana vitrectomy alone with complete drainage of subretinal fluid achieves a high reattachment rate in the management of primary pseudophakic RRD due to IRBs.