Francesco Romano

Massachusetts Eye and Ear Infirmary

Purpose To assess the prevalence of foveal neovascularization (FNV) and its associated clinical features in proliferative diabetic retinopathy (PDR) eyes. Methods Cross-sectional observational study. Participants underwent ultra-widefield photography, optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA). FNV was defined a...

Background and Objective A cross-sectional prospective study to examine ergonomic differences in vitreoretinal settings: surgery, clinic, and dedicated procedure clinic. Patients and Methods Three vitreoretinal surgeons, three fellows, and one resident at a tertiary eye care facility. Participants wore an Upright Go 2 posture device and posture wa...

Purpose: To assess corneal sensitivity changes in patients with ocular graft-versus-host disease using a non-contact and Cochet– Bonnet esthesiometer. In addition, we evaluate the association between corneal sensitivity and subbasal nerve changes and epitheliopathy in these patients. Methods: In this retrospective study, the clinical data and image...

Purpose To determine the 10-year morphological outcomes and identify potential risk factors for exudative AMD in the fellow eyes (FE) in patients with naïve exudative AMD. Methods Data from 100 patients were retrospectively reviewed. Baseline macular neovascularization (MNV) type in the exudative AMD eye and presence of drusen, intraretinal hyperr...

A 17-year-old boy presented with a full-thickness macular hole, with 20/20 vision with eccentric fixation in the left eye. Examination of the left eye showed a large macular hole with a base diameter measuring 1,680 μm and temporal macular and mid-peripheral retinal atrophy on ultra-high-definition optical coherence tomography (OCT) scans. Microper...

Introduction: To investigate whether there is visual function impairment in patients with posterior vitreous detachment (PVD) using the active-learning quantitative contrast sensitivity function test. Methods: In this cross-sectional study, contrast sensitivity was measured in eyes with PVD and eyes without PVD using the quantitative contrast sensi...

Purpose: To longitudinally investigate the changes in intraretinal microvascular abnormalities (IRMAs) over time, employing swept-source optical coherence tomography angiography in eyes with diabetic retinopathy. Methods: In this retrospective, longitudinal study, we evaluated 12 × 12-mm swept-source optical coherence tomography angiography cent...

Purpose We investigated the association between inner choroid flow deficit percentage (IC-FD%) using swept-source optical coherence tomography angiography (SS-OCTA) and progression of AMD. Methods Retrospective, observational study including 64 eyes (42 participants) with early or intermediate AMD at baseline. Participants had two or more consecut...

Purpose This study aims to investigate the potential in vivo relationship between macular pigment (MP) and retinal layers thickness in healthy subjects and dry, non-advanced age-related macular degeneration (AMD). Methods An observational, cross-sectional study was conducted. Healthy subjects >40 years and patients with early or intermediate AMD w...

Purpose : To analyze a cohort of individuals diagnosed with age-related macular degeneration (AMD) during treatment with PCSK9 inhibitors (PCSK9i). Methods : A retrospective review of AMD patients who initiated treatment with either alirocumab or evolocumab at Mass General Brigham between 3/1/2016-10/27/2023 was performed. Patients taking a PCSK9i...

Artificial intelligence (AI) has emerged as a transformative tool in the field of ophthalmology, revolutionizing disease diagnosis and management. This paper provides a comprehensive overview of AI applications in various retinal diseases, highlighting its potential to enhance screening efficiency, facilitate early diagnosis, and improve patient ou...

Background and Objective We sought to establish normative quantitative contrast sensitivity function (qCSF) values in healthy adult eyes and investigate the effect of age on qCSF. Patients and Methods Healthy eyes underwent qCSF testing (adaptive sensory technology) and Snellen's visual acuity (VA). Descriptive statistics and mixed-effects multiva...

Purpose The purpose of this study is to investigate test-retest reliability and agreement of the quantitative contrast sensitivity function test (qCSF) in the retina clinic. Methods A total of 121 right eyes of 121 patients were tested and consecutively re-tested with qCSF in the retina clinic. Outcomes included area under the logarithm of contras...

Purpose To describe novel microperimetry and imaging findings in two patients affected by extensive macular atrophy with pseudodrusen-like appearance (EMAP) without signs of retinal pigment epithelium (RPE) atrophy. Methods Case series. Both patients underwent mesopic and dark-adapted two-color scotopic microperimetry, followed by multimodal imagi...

PURPOSE To determine the correlation between microperimetry and imaging findings in extensive macular atrophy with pseudodrusen-like appearance (EMAP). MTHODS This cross-sectional, observational study included 44 consecutive EMAP patients (88 eyes) and 30 healthy subjects (60 eyes). Both groups underwent visual acuity assessment, mesopic and scoto...

Background: To compare the change in lesion area over 4 years of follow-up in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents using either a proactive or a reactive regimen in routine clinical practice. Methods: This was a multicentre, retrospective comparative stud...

Purpose: To report incidence and risk factors for fibrosis at 10 years in a large cohort of neovascular age-related macular degeneration (nAMD). Design: Retrospective, multicenter, cohort study. Methods: We included 225 naïve nAMD eyes who underwent intravitreal anti-vascular endothelial growth factor treatment over 10 years of follow-up at tw...

Retinal vein occlusion represents the second leading cause of retinal vascular disorders, with a uniform sex distribution worldwide. A thorough evaluation of cardiovascular risk factors is required to correct possible comorbidities. The diagnosis and management of retinal vein occlusion have changed tremendously in the last 30 years, but the assess...

Purpose: To describe the imaging characteristics and topographic expansion of retinal pigment epithelium (RPE) and outer retinal atrophy in extensive macular atrophy with pseudodrusen-like appearance (EMAP). Methods: Three-year, prospective, observational study. Nine EMAP patients (17 eyes; 6 females) with no other ocular conditions were annuall...

Purpose: To describe novel imaging findings in a family affected by central areolar choroidal dystrophy (CACD). Methods: Case series with multimodal retinal imaging assessment. Results: A 19-year-old asymptomatic woman was referred for bilateral macular defects of the retinal pigment epithelium (RPE). Blue-light autofluorescence (BAF) of her r...

Retro-mode illumination imaging can provide good visualization of chorio-retinal atrophy and of the retinal pigment epithelial alterations occurring in m.3243A > G associated retinopathy.

Purpose: To report the imaging and functional features of the repair tissue following retinal pigment epithelium (RPE) tears. Methods: This cross-sectional, observational study included patients with RPE tears secondary to neovascular age-related macular degeneration and at least 12 months of follow-up. The following variables were analyzed: bes...

Background: To measure quantitative autofluorescence (qAF) in patients under treatment with hydroxychloroquine (HCQ) and at risk of retinal toxicity but with no apparent signs of retinal toxicity and to compare it with that of untreated subjects. Methods: Consecutive patients at risk for the development of HCQ retinal toxicity (duration of treat...

Purpose: To investigate the course of inherited retinal degenerations (IRD) due to mutations in the RPE65 gene. Methods: This longitudinal multicentric retrospective chart-review study was designed to collect best corrected visual acuity (BCVA), Goldman visual field, optical coherence tomography (OCT), and electroretinography (ERG) measurements....

Purpose To describe a case of combined branch retinal vein and arterial occlusion (CBRVAO) complicated by foveal neovascularization (FNV). Observations A 52-year-old healthy woman presented at the Eye Clinic of Sacco Hospital (Milan, Italy) with a 3-year history of CBRVAO in her right eye. At baseline, her visual acuity was 20/20 Snellen with unre...

Background: To compare four different optical coherence tomography (OCT) devices for visualization of retinal and subretinal layers in highly myopic eyes. Methods: In this prospective, observational, cross-sectional study, consecutive patients with high myopia and control subjects were imaged by four OCT devices: Spectralis OCT2, PlexElite 2.0 1...

To assess the optical coherence tomography (OCT) features of the repair tissue after retinal pigment epithelial (RPE) tear in neovascular age-related macular degeneration. Retrospective, observational study. Medical and imaging records of patients that developed tears after starting anti-VEGF treatment and with at least 12 months of follow-up were...

Background/objectives To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control)....

Purpose: To report the visual outcomes and the rate of retinal pigment epithelium (RPE) atrophy progression in patients with extensive macular atrophy with pseudodrusen (EMAP). Design Retrospective, observational study. Participants Patients with EMAP and symptom onset before 55 years of age, at least 12 months of follow-up using Spectralis blue-...

Background: Syndromic ciliopathies have been variably linked to different retinal dystrophies. However, to date, few reports have characterized by means of multimodal imaging the retinal degeneration occurring in Mainzer-Saldino syndrome (MSS). Methods: Two siblings with history of kidney disease and other systemic abnormalities presented at our e...

Purpose: To assess ellipsoid zone (EZ) alterations in Best vitelliform macular dystrophy (BVMD) using spectral-domain optical coherence tomography (SD-OCT). Methods: Prospective, observational case series. Forty-three patients (43 eyes) underwent complete ophthalmological examination at baseline and at 24 months: best-corrected visual acuity (BC...

Choroidal neovascularization (CNV) represents a possible complication of hereditary chorioretinal dystrophies. Compared to the more common clinical picture of age-related macular degeneration, CNVs associated with hereditary chorioretinal dystrophies occur in younger subjects and increase significantly the risk of severe impairment of the central v...

During early months of Covid-19, significant nonattendance to scheduled appointments was noticed in our tertiary center for nAMD. This resulted in an increased rate of sub-macular hemorrhages in April 2020 compared to two control periods.

Background To assess retinal layer thickness in choroideremia (CHM) and to reveal its correlation with optical coherence tomography (OCT) angiography (OCTA) findings. Methods The study was designed as an observational, cross-sectional clinical series of patients with CHM, which included 14 CHM eyes and 14 age-matched controls. Multimodal imaging i...

Background: To determine the effectiveness of intravitreal ranibizumab (IVR) approach over 1-year follow-up in patients younger than 50 years old with central and branch retinal vein occlusion (RVO) complicated by macular edema (ME). Methods: Prospective, open-label case series. Patients initiating IVR injections from January 2015 to May 2017 we...

Purpose: The main aim was to identify different choroidal patterns in retinitis pigmentosa (RP) and to assess their clinical and anatomical meanings after 1 year of follow-up. Methods: Forty-five patients with RP (29 men; mean age 44.5 ± 11.7 years) and 45 healthy controls (29 men; mean age 44.2 ± 9.8 years) were recruited. Optical coherence tom...

Purpose The vitelliform stage is the typical phenotypic manifestation of Best vitelliform macular dystrophy (BVMD). As yet, no study has focused specifically on the clinical changes occurring in the vitelliform stage over the follow-up. Methods The survey takes the form of a prospective observational study with a 5-year follow-up. Twenty-one eyes...

Purpose: Choroidal neovascularization (CNV) is a common complication of patients affected by age-related macular degeneration, showing a highly variable visual outcome. The main aim of the study was, at baseline, to perform a quantitative optical coherence tomography angiography assessment of CNV secondary to age-related macular degeneration and t...

Purpose: The aim of the present study was to analyze quantitative optical coherence tomography (OCT) and OCT angiography (OCTA) parameters to identify clinically relevant cutoff values able to detect clinically different Stargardt's disease (STGD) subgroups. Methods: Consecutive STGD patients were recruited and underwent complete ophthalmologic...

Background The clinical phenotype of Stargardt disease (STGD) can be extremely heterogeneous, with variable macular and peripheral retinal involvement. The study aim was to correlate peripheral ultrawide field (UWF) involvement with macular alterations, as assessed by structural optical coherence tomography (OCT) and OCT angiography (OCTA), in orde...

Purpose To describe a case of poppers maculopathy by means of multimodal imaging. Methods A 26-year-old male presented to our Department in April 2018 with a history of visual disturbances. He underwent a complete ophthalmologic examination, including optical coherence tomography, fundus autofluorescence, and ultra-widefield fundus photograph. Re...

Purpose: To assess hyperreflective foci (HF) number and distribution in choroideremia (CHM) using spectral domain optical coherence tomography. Methods: Observational, cross-sectional case series. Consecutive patients and matched controls (20 eyes each) underwent best-corrected visual acuity measurement, fundoscopy, blue-light autofluorescence (...

Purpose To study the real-life outcomes of intravitreal anti–vascular endothelial growth factor treatment in patients affected by age-related macular degeneration and diabetic macular edema in an Italian tertiary referral hospital over a 2-year follow-up. Methods Patients with confirmed diagnosis of age-related macular degeneration or diabetic mac...

Background: Retinitis Pigmentosa (RP) represents a retinal dystrophy with an extremely complex pathogenesis further worsened by the impairment of the retinal vascular supply. The main goal of this study was to identify different vascular patterns in RP, by means of optical coherence tomography angiography (OCTA). Methods: A total of 32 RP patien...

Background: To identify different choroidal patterns in Stargardt disease (STGD) and to assess their clinical correlates. Methods: 100 STGD eyes (29 males; mean age 42.6 ± 16.5 years) and 100 control eyes (29 males; mean age 43.2 ± 8.5 years) were included. Optical coherence tomography (OCT) and OCT angiography (OCTA) images were obtained. Four...

Aims To evaluate the effects of neurovascular damage in patients with the typical vitelliform lesion of Best vitelliform macular dystrophy (BVMD) in the attempt to identify different progression patterns. Methods Prospective, observational case series. Patients in the vitelliform stage of BVMD and healthy controls underwent complete ophthalmologic...

To assess hyperreflective foci (HF) number in angioid streaks (AS) by means of spectral-domain optical coherence tomography (SD-OCT). Observational and cross-sectional study. Sixty-two eyes with AS and 62 controls underwent best-corrected visual acuity (BCVA), fundoscopy, and SD-OCT. HF were assessed on the horizontal scan of a six-line radial OCT,...

Purpose: To describe a case of Ellis-van Creveld syndrome with concomitant Usher syndrome. Methods: A 24-year-old lady with a diagnosis of Ellis-van Creveld syndrome came to our attention in 2015 complaining of nyctalopia. She underwent yearly ophthalmologic examinations, including visual acuity, dilated fundoscopy, optical coherence tomography...

Purpose To evaluate the efficacy of intravitreal anti-VEGF injections in choroidal neovascularization (CNV) related to pattern dystrophy-like deposit in pseudoxanthoma elasticum (PXE). Methods One-year prospective, interventional study. Nine eyes were recruited in the ophthalmology departments of San Raffaele University and University of Barcelona...

Purpose To describe the hyperreflective foci (HF) characteristics in eyes affected by Stargardt disease (STGD), correlating HF with the atrophy progression at 1-year follow-up. Methods Prospective observational case series with 1-year follow-up. Twenty-eight eyes (14 patients) affected by STGD and 28 eyes (14 age- and sex-matched healthy patients)...

Torpedo maculopathy is characterized by a congenital, unilateral, and torpedo-shaped chorioretinal lesion with unclear pathogenesis and evolution. Although the optical coherence tomography angiography (OCTA) characteristics have already been defined in literature, the authors describe for the first time the presence of choroidal neovascularization...

Introduction:: Disorders of vitreoretinal interface represent a rare complication of intravitreal dexamethasone implant injection. Our report describes a new mechanism resulting in cystic roof collapse and emphasizes the importance of a strict optical coherence tomography evaluation during therapy with dexamethasone injection in order to prevent t...

Indolent, nonprogressive, multifocal, choroidal lesions represent a newly described, benign, nosological entity that is diagnosed after exclusion of funduscopically similar uveitic and neoplastic processes. Although believed to be a unilateral condition, the authors describe the case of a 63-year-old man presenting with bilateral lesions during a 2...

Purpose: To analyze optical coherence tomography angiography (OCTA) quantitative features in patients affected by new-onset choroidal neovascularization (CNV) in one eye and early/intermediate age-related macular degeneration (AMD) in the fellow eye. Design: Case-control study. Settings: Clinical Practice. Study population: Thirty patients a...

Purpose: To assess the changes in hyperreflective foci (HF) by means of spectral-domain optical coherence tomography (SD-OCT) in patients undergoing anti-VEGF treatment for subfoveal choroidal neovascularization (CNV) secondary to angioid streaks (AS). Methods: Fifteen eyes with diagnosis of AS-related CNV (8 males) and 15 control eyes with unco...

Purpose: To assess foveal and parafoveal vasculature at the superficial capillary plexus, deep capillary plexus, and choriocapillaris of patients with X-linked retinoschisis by means of optical coherence tomography angiography. Methods: Six patients with X-linked retinoschisis (12 eyes) and seven healthy controls (14 eyes) were recruited and und...

Purpose: We compare the fluorescein angiography (FA) patterns with morphologic alterations detectable on spectral-domain OCT (SD-OCT) in myopic choroidal neovascularization (mCNV) and evaluate whether they influence the effects of intravitreal ranibizumab (IVRI) in an as-needed (PRN) regimen. Methods: The 49 patients enrolled in this prospective...

Aim To describe the optical coherence tomography angiography (OCT-A) features of patients affected by acute macular neuroretinopathy (AMN). Methods This is a prospective, observational, cross-sectional study. Multimodal imaging, including spectral domain OCT (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) and 6×6 mm swept source...

Significance: Morning glory disc anomaly is a congenital abnormality of the optic disc. Optical coherence tomography angiography shows vascular rarefaction of the superficial and deep capillary plexuses and increased vascularity of the radial peripapillary capillary plexus. We hypothesize that this congestion represents a compensatory mechanism to...