Roberto Ceccuzzi - Academia.edu (original) (raw)

Papers by Roberto Ceccuzzi

Research paper thumbnail of Single-Pass Mikrokeratome and Anterior Chamber Pressurizer for the Ultrathin Descemet-Stripping Automated Endothelial Keratoplasty Graft Preparation

Cornea

PURPOSE To compare the reliability of microkeratome dissection with the anterior chamber pressuri... more PURPOSE To compare the reliability of microkeratome dissection with the anterior chamber pressurizer (ACP) system versus conventional pressurization for ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK) graft preparation. METHODS A retrospective review of a consecutive series of dissected donor corneas processed at Pavia Eye Bank for UT-DSAEK surgery was performed. Grafts were prepared through single-pass microkeratome dissection with artificial anterior chamber internal pressure regulation through either ACP or the conventional method using a water column with tube clamp. The target central graft thickness (CGT) was ≤100 μm. Cutting predictability was determined as the difference between the microkeratome head size and the thickness actually removed. Graft regularity was investigated as central-to-peripheral thickness increase, central-to-peripheral (CP) ratio, and graft thickness uniformity. Thickness was measured with anterior segment optical coherence tomography (horizontal and vertical meridians). RESULTS Of the 265 UT-DSAEK grafts, ACP achieved the target "CGT ≤ 100 μm" in 87 of 120 (72.5%), whereas the conventional technique achieved the same in 85 of 145 (58.6%) (P = 0.018). ACP predictability was -3.9 μm (SD: 2.3), whereas predictability of the conventional technique was -54.6 μm (SD: 3.7) (P < 0.001). Thickness increased similarly (P = 0.212); CP ratio was better with ACP for only 2 mm diameter (P = 0.001); graft thickness uniformity was comparable (P > 0.05). CONCLUSIONS Compared with conventional pressurization, ACP improved microkeratome-assisted preparation reliability of UT-DSAEK grafts, achieving CGT ≤ 100 μm with significantly higher frequency (P = 0.018) and predictability (P < 0.001). ACP improved CP ratio only at 2 mm (P = 0.001); for other graft thickness, the 2 methods proved equivalent.

Research paper thumbnail of A comparison of ultrasound pachymetry vs. rotating Scheimpflug camera, swept-source OCT, spectral-Domain OCT and non-contact specular microscopy

Investigative Ophthalmology & Visual Science, Jun 21, 2021

Research paper thumbnail of Cornea donation: the experience of Morelli District Hospital, Sondalo - Italy

Research paper thumbnail of Human recombinant nerve growth factor (Cenegermin) in a patient affected by primary congenital glaucoma with neurotrophic keratopathy

European Journal of Ophthalmology, 2021

Purpose: To report a case of neurotrophic keratopathy (NK) in a patient affected by primary conge... more Purpose: To report a case of neurotrophic keratopathy (NK) in a patient affected by primary congenital glaucoma (PCG) who undergone glaucoma drainage implant surgery. NK was successfully treated with human recombinant Nerve Growth Factor (Cenegermin) eye drops. Case report description: A 46-years-old patient affected by primary congenital glaucoma underwent Ahmed glaucoma valve implantation in the right eye, after several unsuccessful surgeries to control intraocular pressure (IOP) since the age of three. Surgical intervention was performed without complications, and IOP was well-controlled post-operatively. However, 1 month after surgery, he developed NK with stromal ulceration, initially treated with a topical combination of preservative-free artificial tears and antibiotic ointment. As NK did not resolve, a new treatment with Cenegermin 20 µg/ml eye drops, 6 times daily, was started. Outcome: NK completely resolved after 8 weeks of Cenegermin treatment, with complete restoration ...

Research paper thumbnail of Tecniche anestesiologiche in oftalmologia

L’anestesia generale e utilizzata in minor misura rispetto all’anestesia locale. Essa puo essere ... more L’anestesia generale e utilizzata in minor misura rispetto all’anestesia locale. Essa puo essere realizzata secondo cinque tecniche principali. L’anestesia topica, la piu utilizzata, prevede l’instillazione di alcune gocce sulla cornea o nel sacco congiuntivale. L’anestesia intra-camerulare prevede l’iniezione di alcuni millilitri all’interno della camera anteriore. L’anestesia retro-bulbare prevede l’introduzione di un ago lungo circa 31 mm e l’iniezione di circa 3-5 ml di soluzione anestetica nello spazio intra-conico. L’anestesia peri-bulbare prevede l’introduzione di un ago lungo circa 25 mm e l’iniezione di circa 3-10 ml di soluzione anestetica nello spazio extra-conico. L’anestesia sub-tenoniana, realizzata in due tempi, prevede l’introduzione di una cannula all’interno dello spazio sub-tenoniano.

Research paper thumbnail of Utilizzo della membrana amniotica nelle ulcere corneali

Il caso clinico, da noi riportato, e relativo ad un paziente di sesso maschile giovane di 28 anni... more Il caso clinico, da noi riportato, e relativo ad un paziente di sesso maschile giovane di 28 anni di eta affetto da ulcera corneale recidivante ingravescente. Essa e stata trattata inizialmente con terapia medica e successivamente, in ragione dell’insufficienza della medesima, con terapia chirurgica rappresentata dall’innesto di membrana amniotica. Il quadro clinico con il quale si presentava il paziente, caratterizzato anche da ipoestesia, poteva essere verosimilmente compatibile con cheratite neurotrofica secondaria alla connettivopatia preesistente. La membrana amniotica, se applicata quando sussistono le opportune indicazioni, consente una pressoche completa restituito ad integrum; salvo minimi reliquati che, generalmente, non inficiano significativamente l’acuita visiva.

Research paper thumbnail of La chirurgia del cheratocono: tecnica lamellare anteriore secondo Trimarchi

Scopo: il nostro studio ha lo scopo di valutare il risultato clinico degli interventi chirurgici ... more Scopo: il nostro studio ha lo scopo di valutare il risultato clinico degli interventi chirurgici di cheratoplastica la-mellare anteriore profonda (DALK) secondo Trimarchi eseguiti con il trapano pre-settato. Materiali e metodi: il nostro studio ha valutato 19 pazienti affetti da cheratocono sottoposti a DALK manuale a secco secondo Trimarchi. Nel pre-operatorio sono state eseguite visita oftalmologica completa, topografia corneale e microscopia speculare endoteliale. Nel post-operatorio sono stati realizzati, con le stesse modalita, controlli di follow-up a 1, 3, 6, 12, e 24 mesi. Risultati: rispetto alla fase pre-operatoria la BCVA, per ciascun tempo del follow-up, mostra un notevole e progressivo miglioramento a partire gia dal 1° mese. Infatti, il valore medio dell’acuita visiva passa da 1.31/10±0.90/10 (pre-operatorio) a 7.15/10±1.99/10 (12° mese), con un incremento complessivo di 5.84/10. Il valore cilindrico medio varia da -2.46±2.34 D (pre-operatorio) a -3.26±1.78 D (12° mese...

Research paper thumbnail of Studio delle modificazioni endoteliali post-cheratoplastica in pazienti affetti da cheratocono e pazienti affetti da distrofia endoteliale

Scopo: il nostro studio ha lo scopo di confrontare le modificazioni endoteliali post-cheratoplast... more Scopo: il nostro studio ha lo scopo di confrontare le modificazioni endoteliali post-cheratoplastica tra pazienti affetti da cheratocono e pazienti affetti da distrofia endoteliale. Materiali e metodi: il nostro studio ha valutato 523 pazienti, di cui 296 affetti da cheratocono e 227 affetti da distrofia endoteliale, sottoposti a cheratoplastica perforante o lamellare. Dopo il trapianto e stata effettuata un’analisi retrospettiva delle cartelle sia di ricovero ospedaliero che di controllo ambulatoriale finalizzata alla valutazione dell’ECD misurata tramite microscopia speculare endoteliale. Nel post-operatorio sono stati realizzati controlli di follow-up a 1 e 12 mesi. Risultati: i trapianti corneali eseguiti per patologie con minore densita endoteliale (distrofia endoteliale) hanno mostrato maggiore perdita percentuale endoteliale durante il decorso clinico post-operatorio rispetto a quelli eseguiti per patologie con maggiore densita endoteliale (cheratocono). Discussione: nel nost...

Research paper thumbnail of Considerazioni sulla sindrome di Urrets-Zavalia: rapporto di cinque casi clinici

Research paper thumbnail of Indici topografici e loro significato nella valutazione della refrazione nella patologia corneale e nella cheratoplastica

Scopo: il nostro studio si prefigge due finalita: 1.confrontare i valori di ciascuno di tre indic... more Scopo: il nostro studio si prefigge due finalita: 1.confrontare i valori di ciascuno di tre indici topografici (SAI, SRI, PVA) in tre gruppi di pazienti (normali e patologici, a sua volta ripartiti in affetti da distrofia corneale ectasica e sottoposti a cheratoplastica); 2.valutare la correlazione tra i valori di ciascuno dei tre indici topografici (dato strumentale) e l’acuita visiva corretta (BCVA) (dato clinico) nei due gruppi di pazienti patologici (distrofici e trapiantati). Materiali e metodi: il nostro studio ha valutato 404 occhi di 202 pazienti. Sono stati scartati 220 occhi nei quali erano state riscontrate patologie a carico del cristallino e/o della retina al fine di valutare l’acuita visiva in funzione delle sole caratteristiche refrattive corneali. Tutti i pazienti sono stati sottoposti a visita oftalmologica completa e topografia corneale. Risultati: il SAI ha un valore superiore nei distrofici, intermedio nei trapiantati e inferiore nei sani. Il SRI ha un valore sup...

Research paper thumbnail of La cheratoplastica nella gestione della perforazione corneale periferica

Il caso clinico, da noi riportato, e relativo ad una paziente di sesso femminile anziana di 74 an... more Il caso clinico, da noi riportato, e relativo ad una paziente di sesso femminile anziana di 74 anni di eta affetta da perforazione corneale periferica spontanea associata a contestuale prolasso irideo. Essa e stata trattata con terapia chirurgica rappresentata dalla cheratoplastica lamellare/perforante. Il trapianto di lembo donatore a tutto spessore in un letto ricevente lamellare/perforante puo rimanere, come nel nostro caso, trasparente anche nella porzione sclerale. La sutura a punti staccati minimizza l’effetto astigmatogeno, pur ovviamente presente, purche essi vengano apposti opportunamente rispetto all’asse visivo.

Research paper thumbnail of Corneal sub-basal neural damage pattern in multiple myeloma patients treated with bortezomib: an in vivo confocal study

Leukemia & lymphoma, Jan 18, 2015

Painful sensory peripheral neuropathy represents the main Bortezomib dose-limiting toxicity. Alth... more Painful sensory peripheral neuropathy represents the main Bortezomib dose-limiting toxicity. Although the once-weekly schedule and the sub-cutaneous administration have significantly improved Bortezomib safety profile, peripheral neuropathy (Bor-PN) still remains relatively frequent [1,2]. In addition, at present, there are no tools for its early identification. The main symptoms of Bor-PN are paresthesias, burning dysesthesias, numbness and, in severe cases, neuropathic pain, which is responsible for treatment discontinuation [3–6]. As far as pathogenesis is concerned, Bor-PN especially affects small un-myelinated fibers (C fibers), causing a neural damage pattern similar to that detected in diabetic peripheral neuropathy [7,8]. The cornea is the most innervated tissue in the human body, especially by small sensitive fibers, is a known site of diabetic neural damage and likely could represent a possible target of Bor-PN. Corneal confocal microscopy (CCM) is a novel rapid, diagnostic technique that allows in vivo detailed visualization of all corneal layers. The noninvasive nature of this technique makes tolerable reiterative examinations on the same patients across time, providing information on the evolving pattern of neural damage. At present, CCM is used for early identification and follow-up of diabetic PN [9–11]. Given the similar pathogenesis of Bortezomib and diabetic neuropathy and the known sensitivity and specificity of CCM for identification of diabetic neural damage, we supposed that CCM could be likely used for early identification of Bortezomib-related PN in Multiple Myeloma (MM) patients. In order to test this hypothesis we designed a pilot study on 26 MM patients treated with Bortezomib compared with 20 healthy controls. The study was approved by our local ethic committee; all patients signed informed consent before confocal microscopy evaluation. Control group morphometric findings were similar to data on a healthy population reported by the literature. PN was evaluated by clinical assessment and graded according to NCI-CTCAE toxicity scale. Among MM patients included in the study, Figure 1. Corneal nerve examination with in vivo confocal microscopy. Example of reduction in length and number and increase of tortuosity of corneal sub-basal nerve plexus pattern in one myeloma patients exposed to bortezomib (right image) compared with one healthy control (left image).

Research paper thumbnail of Diagnosis and Treatment of a Rare Complication After Penetrating Keratoplasty: Retained Descemet’s Membrane

Keratoplasties - Surgical techniques and complications, 2012

Research paper thumbnail of Management of recurrent corneal ulcers: use of amniotic membrane

European Journal of Ophthalmology, 2014

Purpose Amniotic membrane (AM), or amnion, is a thin membrane on the inner side of the fetal plac... more Purpose Amniotic membrane (AM), or amnion, is a thin membrane on the inner side of the fetal placenta; it completely surrounds the embryo/fetus and delimits the amniotic cavity, which is filled by amniotic liquid. In recent years, the structure and function of the amnion have been investigated due to its pluripotent properties, which are an attractive source for tissue transplantation and reconstructive surgery. The pioneering use of AM in skin transplantation by Davis dates back to 1910; in 1913, Sabella and Stern employed it in the treatment of burns and superficial scars. Certain characteristics make the AM ideally suited to its application in ocular surface reconstruction. It can be easily obtained and its availability is nearly unlimited. We report a case of AM transplantation to treat ocular surface abnormality. Methods A 28-year-old man came to our attention for persistent foreign body feeling and pain in his right eye. Because of progressive clinical worsening, we decided to...

Research paper thumbnail of Corneal Sensitivity in Keratoconus after Penetrating and Deep Anterior Lamellar Keratoplasty

Ophthalmologica, 2010

Purpose: To evaluate recovery of corneal sensitivity in the graft following penetrating keratopla... more Purpose: To evaluate recovery of corneal sensitivity in the graft following penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. Materials and Methods: 113 eyes of 113 patients (39 females, 74 males) were examined. All eyes had undergone corneal grafting: 39 PK, 74 DALK. Corneal sensitivity tested using the Cochet-Bonnet esthesiometer was evaluated the day before and 3 days, 3, 6, 12 and 24 months after surgery. The corneal sensitivity recovery was associated with surgical techniques (PK or DALK), age and sex of recipient and donor, cadaver time and type of preservation of the cornea. Results: The average percentage of recovery of corneal sensitivity was 91% at 2 years. Surgical techniques and other qualitative and quantitative variables did not affect the statistically significant recovery of corneal sensitivity. Conclusions: In both surgical techniques, PK and DALK, we noticed a good recovery of corneal sensitivity in 2 years.

Research paper thumbnail of Ocular Argyrosis in a Silver Craftsman

Journal of Occupational Health, 2008

Research paper thumbnail of Mydriatic Effect of Ocular Decongestants Studied by Pupillographγ

Ophthalmologica, 1994

The mydriatic effect of three ocular decongestants, containing 0.1% tetrahydrozoline hydrochlorid... more The mydriatic effect of three ocular decongestants, containing 0.1% tetrahydrozoline hydrochloride, 0.3% chlorpheniramine maleate, and 0.05% tetrahydrozoline hydrochloride in combination with 0.3% pheniramine maleate, respectively, was evaluated in 10 healthy volunteers. The study was carried out using a single dose of the tested drug, instilling 2 drops in one eye and 2 drops of a placebo in the other. The papillary diameters were measured by photographic pupillography under basal conditions and 15, 30, 45, 60, 90, and 120 min after each treatment. Near and distance visual acuity and tonometry were evaluated under basal conditions and 50 and 95 min after instillation of drugs. No statistical significant differences between the treated and the control pupil diameters were found after instillation of 0.1% tetrahydrozoline hydrochloride or 0.3% chlorpheniramine maleate. The combination of 0.05% tetrahydrozoline hydrochloride with 0.3% pheniramine maleate caused a significant mydriasis from 30 min up to 120 min (p &lt; 0.01 and p &lt; 0.0005) after instillation, more pronounced in light irides. No local and systemic effects and no effects on visual acuity and ocular pressure were detected. On the basis of our results, it is possible to conclude that the persistent mydriatric action of the two-drug combination is due to a synergism; the use of these eyedrops should be avoided in subjects with narrow-angle glaucoma, light irides, narrow iridocorneal angle, and low anterior chamber for the risk of ocular pressure increase.

Research paper thumbnail of A case report of pediatric neurotrophic keratopathy in pontine tegmental cap dysplasia treated with cenegermin eye drops

Research paper thumbnail of Epidemiology and economic impact of moderate and severe neurotrophic keratopathy in Italy

Global & Regional Health Technology Assessment: Italian; Northern Europe and Spanish

Neurotrophic keratopathy is a rare corneal disease caused by impaired corneal innervation. There ... more Neurotrophic keratopathy is a rare corneal disease caused by impaired corneal innervation. There is a paucity of published evidence on neurotrophic keratopathy with no published studies on the economics of neurotrophic keratopathy in the Italian or international literature. This cost analysis aimed at assessing the economic impact of moderate (persistent epithelial defect) and severe (corneal ulcer without perforation) neurotrophic keratopathy from the perspective of the National Health Service and patients in Italy. Treatment algorithm and health resource use information were collected from a panel of nine experts from Italian centres specialized in ocular/corneal conditions. National ambulatory and inpatient hospital tariffs were applied to units of service, and Agenzia Italiana del Farmaco (AIFA) published prices to pharmaceuticals. Mean annual per patient cost was derived as an average cost weighted by the proportion of patients on each respective treatment and length of the treatment. The National Health Service + patient perspective additionally included patients' out-of-pocket expenses. The mean annual estimated National Health Service cost of treatment was €5167 (persistent epithelial defect) and €10,885 (corneal ulcer without perforation) per patient. Costs were largely driven by ambulatory visits and hospital interventions. The mean annual estimated National Health Service + patient cost was €5731 (persistent epithelial defect) and €11,478 (corneal ulcer without perforation) per patient, including cost of out-of-pocket expenses for pharmaceuticals and therapeutic contact lenses. Mean annual cost of neurotrophic keratopathy in Italy doubles with disease severity. Further research is warranted to provide more insight especially into societal costs.

Research paper thumbnail of Confocal Microscopy Is Useful for Detection of Bortezomib Related Neuropathy (BOR-PN) in Multiple Myeloma (MM) Patients (PTS)

Blood

Background: Bortezomib-related painful sensory peripheral neuropathy (Bor-PN) represents the main... more Background: Bortezomib-related painful sensory peripheral neuropathy (Bor-PN) represents the main dose-limiting toxicity of Bor. Cornea is the most innervated tissue in human body, with the highest density of small sensitive fibers, which are the main target of Bor-PN. Corneal confocal microscopy is a rapid, noninvasive, clinical examination technique that quantifies small nerve fiber damage and is already used for early identification of neural damage in course of diabetic sensory PN. Aims: To evaluate the possible role of confocal microscopy for identification and monitoring of corneal sub-basal neural plexus damage in Multiple Myeloma (MM) patients (pts) treated with Bor and to correlate confocal microscopy findings with Bor-PN. Patients and Methods: Patients underwent corneal examination with corneal confocal microscope (Confoscan 4). Corneal sub-basal fibers were evaluated in terms of the following morphometric measurements used as sign of neural damage: nerve fiber length, ner...

Research paper thumbnail of Single-Pass Mikrokeratome and Anterior Chamber Pressurizer for the Ultrathin Descemet-Stripping Automated Endothelial Keratoplasty Graft Preparation

Cornea

PURPOSE To compare the reliability of microkeratome dissection with the anterior chamber pressuri... more PURPOSE To compare the reliability of microkeratome dissection with the anterior chamber pressurizer (ACP) system versus conventional pressurization for ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK) graft preparation. METHODS A retrospective review of a consecutive series of dissected donor corneas processed at Pavia Eye Bank for UT-DSAEK surgery was performed. Grafts were prepared through single-pass microkeratome dissection with artificial anterior chamber internal pressure regulation through either ACP or the conventional method using a water column with tube clamp. The target central graft thickness (CGT) was ≤100 μm. Cutting predictability was determined as the difference between the microkeratome head size and the thickness actually removed. Graft regularity was investigated as central-to-peripheral thickness increase, central-to-peripheral (CP) ratio, and graft thickness uniformity. Thickness was measured with anterior segment optical coherence tomography (horizontal and vertical meridians). RESULTS Of the 265 UT-DSAEK grafts, ACP achieved the target "CGT ≤ 100 μm" in 87 of 120 (72.5%), whereas the conventional technique achieved the same in 85 of 145 (58.6%) (P = 0.018). ACP predictability was -3.9 μm (SD: 2.3), whereas predictability of the conventional technique was -54.6 μm (SD: 3.7) (P < 0.001). Thickness increased similarly (P = 0.212); CP ratio was better with ACP for only 2 mm diameter (P = 0.001); graft thickness uniformity was comparable (P > 0.05). CONCLUSIONS Compared with conventional pressurization, ACP improved microkeratome-assisted preparation reliability of UT-DSAEK grafts, achieving CGT ≤ 100 μm with significantly higher frequency (P = 0.018) and predictability (P < 0.001). ACP improved CP ratio only at 2 mm (P = 0.001); for other graft thickness, the 2 methods proved equivalent.

Research paper thumbnail of A comparison of ultrasound pachymetry vs. rotating Scheimpflug camera, swept-source OCT, spectral-Domain OCT and non-contact specular microscopy

Investigative Ophthalmology & Visual Science, Jun 21, 2021

Research paper thumbnail of Cornea donation: the experience of Morelli District Hospital, Sondalo - Italy

Research paper thumbnail of Human recombinant nerve growth factor (Cenegermin) in a patient affected by primary congenital glaucoma with neurotrophic keratopathy

European Journal of Ophthalmology, 2021

Purpose: To report a case of neurotrophic keratopathy (NK) in a patient affected by primary conge... more Purpose: To report a case of neurotrophic keratopathy (NK) in a patient affected by primary congenital glaucoma (PCG) who undergone glaucoma drainage implant surgery. NK was successfully treated with human recombinant Nerve Growth Factor (Cenegermin) eye drops. Case report description: A 46-years-old patient affected by primary congenital glaucoma underwent Ahmed glaucoma valve implantation in the right eye, after several unsuccessful surgeries to control intraocular pressure (IOP) since the age of three. Surgical intervention was performed without complications, and IOP was well-controlled post-operatively. However, 1 month after surgery, he developed NK with stromal ulceration, initially treated with a topical combination of preservative-free artificial tears and antibiotic ointment. As NK did not resolve, a new treatment with Cenegermin 20 µg/ml eye drops, 6 times daily, was started. Outcome: NK completely resolved after 8 weeks of Cenegermin treatment, with complete restoration ...

Research paper thumbnail of Tecniche anestesiologiche in oftalmologia

L’anestesia generale e utilizzata in minor misura rispetto all’anestesia locale. Essa puo essere ... more L’anestesia generale e utilizzata in minor misura rispetto all’anestesia locale. Essa puo essere realizzata secondo cinque tecniche principali. L’anestesia topica, la piu utilizzata, prevede l’instillazione di alcune gocce sulla cornea o nel sacco congiuntivale. L’anestesia intra-camerulare prevede l’iniezione di alcuni millilitri all’interno della camera anteriore. L’anestesia retro-bulbare prevede l’introduzione di un ago lungo circa 31 mm e l’iniezione di circa 3-5 ml di soluzione anestetica nello spazio intra-conico. L’anestesia peri-bulbare prevede l’introduzione di un ago lungo circa 25 mm e l’iniezione di circa 3-10 ml di soluzione anestetica nello spazio extra-conico. L’anestesia sub-tenoniana, realizzata in due tempi, prevede l’introduzione di una cannula all’interno dello spazio sub-tenoniano.

Research paper thumbnail of Utilizzo della membrana amniotica nelle ulcere corneali

Il caso clinico, da noi riportato, e relativo ad un paziente di sesso maschile giovane di 28 anni... more Il caso clinico, da noi riportato, e relativo ad un paziente di sesso maschile giovane di 28 anni di eta affetto da ulcera corneale recidivante ingravescente. Essa e stata trattata inizialmente con terapia medica e successivamente, in ragione dell’insufficienza della medesima, con terapia chirurgica rappresentata dall’innesto di membrana amniotica. Il quadro clinico con il quale si presentava il paziente, caratterizzato anche da ipoestesia, poteva essere verosimilmente compatibile con cheratite neurotrofica secondaria alla connettivopatia preesistente. La membrana amniotica, se applicata quando sussistono le opportune indicazioni, consente una pressoche completa restituito ad integrum; salvo minimi reliquati che, generalmente, non inficiano significativamente l’acuita visiva.

Research paper thumbnail of La chirurgia del cheratocono: tecnica lamellare anteriore secondo Trimarchi

Scopo: il nostro studio ha lo scopo di valutare il risultato clinico degli interventi chirurgici ... more Scopo: il nostro studio ha lo scopo di valutare il risultato clinico degli interventi chirurgici di cheratoplastica la-mellare anteriore profonda (DALK) secondo Trimarchi eseguiti con il trapano pre-settato. Materiali e metodi: il nostro studio ha valutato 19 pazienti affetti da cheratocono sottoposti a DALK manuale a secco secondo Trimarchi. Nel pre-operatorio sono state eseguite visita oftalmologica completa, topografia corneale e microscopia speculare endoteliale. Nel post-operatorio sono stati realizzati, con le stesse modalita, controlli di follow-up a 1, 3, 6, 12, e 24 mesi. Risultati: rispetto alla fase pre-operatoria la BCVA, per ciascun tempo del follow-up, mostra un notevole e progressivo miglioramento a partire gia dal 1° mese. Infatti, il valore medio dell’acuita visiva passa da 1.31/10±0.90/10 (pre-operatorio) a 7.15/10±1.99/10 (12° mese), con un incremento complessivo di 5.84/10. Il valore cilindrico medio varia da -2.46±2.34 D (pre-operatorio) a -3.26±1.78 D (12° mese...

Research paper thumbnail of Studio delle modificazioni endoteliali post-cheratoplastica in pazienti affetti da cheratocono e pazienti affetti da distrofia endoteliale

Scopo: il nostro studio ha lo scopo di confrontare le modificazioni endoteliali post-cheratoplast... more Scopo: il nostro studio ha lo scopo di confrontare le modificazioni endoteliali post-cheratoplastica tra pazienti affetti da cheratocono e pazienti affetti da distrofia endoteliale. Materiali e metodi: il nostro studio ha valutato 523 pazienti, di cui 296 affetti da cheratocono e 227 affetti da distrofia endoteliale, sottoposti a cheratoplastica perforante o lamellare. Dopo il trapianto e stata effettuata un’analisi retrospettiva delle cartelle sia di ricovero ospedaliero che di controllo ambulatoriale finalizzata alla valutazione dell’ECD misurata tramite microscopia speculare endoteliale. Nel post-operatorio sono stati realizzati controlli di follow-up a 1 e 12 mesi. Risultati: i trapianti corneali eseguiti per patologie con minore densita endoteliale (distrofia endoteliale) hanno mostrato maggiore perdita percentuale endoteliale durante il decorso clinico post-operatorio rispetto a quelli eseguiti per patologie con maggiore densita endoteliale (cheratocono). Discussione: nel nost...

Research paper thumbnail of Considerazioni sulla sindrome di Urrets-Zavalia: rapporto di cinque casi clinici

Research paper thumbnail of Indici topografici e loro significato nella valutazione della refrazione nella patologia corneale e nella cheratoplastica

Scopo: il nostro studio si prefigge due finalita: 1.confrontare i valori di ciascuno di tre indic... more Scopo: il nostro studio si prefigge due finalita: 1.confrontare i valori di ciascuno di tre indici topografici (SAI, SRI, PVA) in tre gruppi di pazienti (normali e patologici, a sua volta ripartiti in affetti da distrofia corneale ectasica e sottoposti a cheratoplastica); 2.valutare la correlazione tra i valori di ciascuno dei tre indici topografici (dato strumentale) e l’acuita visiva corretta (BCVA) (dato clinico) nei due gruppi di pazienti patologici (distrofici e trapiantati). Materiali e metodi: il nostro studio ha valutato 404 occhi di 202 pazienti. Sono stati scartati 220 occhi nei quali erano state riscontrate patologie a carico del cristallino e/o della retina al fine di valutare l’acuita visiva in funzione delle sole caratteristiche refrattive corneali. Tutti i pazienti sono stati sottoposti a visita oftalmologica completa e topografia corneale. Risultati: il SAI ha un valore superiore nei distrofici, intermedio nei trapiantati e inferiore nei sani. Il SRI ha un valore sup...

Research paper thumbnail of La cheratoplastica nella gestione della perforazione corneale periferica

Il caso clinico, da noi riportato, e relativo ad una paziente di sesso femminile anziana di 74 an... more Il caso clinico, da noi riportato, e relativo ad una paziente di sesso femminile anziana di 74 anni di eta affetta da perforazione corneale periferica spontanea associata a contestuale prolasso irideo. Essa e stata trattata con terapia chirurgica rappresentata dalla cheratoplastica lamellare/perforante. Il trapianto di lembo donatore a tutto spessore in un letto ricevente lamellare/perforante puo rimanere, come nel nostro caso, trasparente anche nella porzione sclerale. La sutura a punti staccati minimizza l’effetto astigmatogeno, pur ovviamente presente, purche essi vengano apposti opportunamente rispetto all’asse visivo.

Research paper thumbnail of Corneal sub-basal neural damage pattern in multiple myeloma patients treated with bortezomib: an in vivo confocal study

Leukemia & lymphoma, Jan 18, 2015

Painful sensory peripheral neuropathy represents the main Bortezomib dose-limiting toxicity. Alth... more Painful sensory peripheral neuropathy represents the main Bortezomib dose-limiting toxicity. Although the once-weekly schedule and the sub-cutaneous administration have significantly improved Bortezomib safety profile, peripheral neuropathy (Bor-PN) still remains relatively frequent [1,2]. In addition, at present, there are no tools for its early identification. The main symptoms of Bor-PN are paresthesias, burning dysesthesias, numbness and, in severe cases, neuropathic pain, which is responsible for treatment discontinuation [3–6]. As far as pathogenesis is concerned, Bor-PN especially affects small un-myelinated fibers (C fibers), causing a neural damage pattern similar to that detected in diabetic peripheral neuropathy [7,8]. The cornea is the most innervated tissue in the human body, especially by small sensitive fibers, is a known site of diabetic neural damage and likely could represent a possible target of Bor-PN. Corneal confocal microscopy (CCM) is a novel rapid, diagnostic technique that allows in vivo detailed visualization of all corneal layers. The noninvasive nature of this technique makes tolerable reiterative examinations on the same patients across time, providing information on the evolving pattern of neural damage. At present, CCM is used for early identification and follow-up of diabetic PN [9–11]. Given the similar pathogenesis of Bortezomib and diabetic neuropathy and the known sensitivity and specificity of CCM for identification of diabetic neural damage, we supposed that CCM could be likely used for early identification of Bortezomib-related PN in Multiple Myeloma (MM) patients. In order to test this hypothesis we designed a pilot study on 26 MM patients treated with Bortezomib compared with 20 healthy controls. The study was approved by our local ethic committee; all patients signed informed consent before confocal microscopy evaluation. Control group morphometric findings were similar to data on a healthy population reported by the literature. PN was evaluated by clinical assessment and graded according to NCI-CTCAE toxicity scale. Among MM patients included in the study, Figure 1. Corneal nerve examination with in vivo confocal microscopy. Example of reduction in length and number and increase of tortuosity of corneal sub-basal nerve plexus pattern in one myeloma patients exposed to bortezomib (right image) compared with one healthy control (left image).

Research paper thumbnail of Diagnosis and Treatment of a Rare Complication After Penetrating Keratoplasty: Retained Descemet’s Membrane

Keratoplasties - Surgical techniques and complications, 2012

Research paper thumbnail of Management of recurrent corneal ulcers: use of amniotic membrane

European Journal of Ophthalmology, 2014

Purpose Amniotic membrane (AM), or amnion, is a thin membrane on the inner side of the fetal plac... more Purpose Amniotic membrane (AM), or amnion, is a thin membrane on the inner side of the fetal placenta; it completely surrounds the embryo/fetus and delimits the amniotic cavity, which is filled by amniotic liquid. In recent years, the structure and function of the amnion have been investigated due to its pluripotent properties, which are an attractive source for tissue transplantation and reconstructive surgery. The pioneering use of AM in skin transplantation by Davis dates back to 1910; in 1913, Sabella and Stern employed it in the treatment of burns and superficial scars. Certain characteristics make the AM ideally suited to its application in ocular surface reconstruction. It can be easily obtained and its availability is nearly unlimited. We report a case of AM transplantation to treat ocular surface abnormality. Methods A 28-year-old man came to our attention for persistent foreign body feeling and pain in his right eye. Because of progressive clinical worsening, we decided to...

Research paper thumbnail of Corneal Sensitivity in Keratoconus after Penetrating and Deep Anterior Lamellar Keratoplasty

Ophthalmologica, 2010

Purpose: To evaluate recovery of corneal sensitivity in the graft following penetrating keratopla... more Purpose: To evaluate recovery of corneal sensitivity in the graft following penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. Materials and Methods: 113 eyes of 113 patients (39 females, 74 males) were examined. All eyes had undergone corneal grafting: 39 PK, 74 DALK. Corneal sensitivity tested using the Cochet-Bonnet esthesiometer was evaluated the day before and 3 days, 3, 6, 12 and 24 months after surgery. The corneal sensitivity recovery was associated with surgical techniques (PK or DALK), age and sex of recipient and donor, cadaver time and type of preservation of the cornea. Results: The average percentage of recovery of corneal sensitivity was 91% at 2 years. Surgical techniques and other qualitative and quantitative variables did not affect the statistically significant recovery of corneal sensitivity. Conclusions: In both surgical techniques, PK and DALK, we noticed a good recovery of corneal sensitivity in 2 years.

Research paper thumbnail of Ocular Argyrosis in a Silver Craftsman

Journal of Occupational Health, 2008

Research paper thumbnail of Mydriatic Effect of Ocular Decongestants Studied by Pupillographγ

Ophthalmologica, 1994

The mydriatic effect of three ocular decongestants, containing 0.1% tetrahydrozoline hydrochlorid... more The mydriatic effect of three ocular decongestants, containing 0.1% tetrahydrozoline hydrochloride, 0.3% chlorpheniramine maleate, and 0.05% tetrahydrozoline hydrochloride in combination with 0.3% pheniramine maleate, respectively, was evaluated in 10 healthy volunteers. The study was carried out using a single dose of the tested drug, instilling 2 drops in one eye and 2 drops of a placebo in the other. The papillary diameters were measured by photographic pupillography under basal conditions and 15, 30, 45, 60, 90, and 120 min after each treatment. Near and distance visual acuity and tonometry were evaluated under basal conditions and 50 and 95 min after instillation of drugs. No statistical significant differences between the treated and the control pupil diameters were found after instillation of 0.1% tetrahydrozoline hydrochloride or 0.3% chlorpheniramine maleate. The combination of 0.05% tetrahydrozoline hydrochloride with 0.3% pheniramine maleate caused a significant mydriasis from 30 min up to 120 min (p &lt; 0.01 and p &lt; 0.0005) after instillation, more pronounced in light irides. No local and systemic effects and no effects on visual acuity and ocular pressure were detected. On the basis of our results, it is possible to conclude that the persistent mydriatric action of the two-drug combination is due to a synergism; the use of these eyedrops should be avoided in subjects with narrow-angle glaucoma, light irides, narrow iridocorneal angle, and low anterior chamber for the risk of ocular pressure increase.

Research paper thumbnail of A case report of pediatric neurotrophic keratopathy in pontine tegmental cap dysplasia treated with cenegermin eye drops

Research paper thumbnail of Epidemiology and economic impact of moderate and severe neurotrophic keratopathy in Italy

Global & Regional Health Technology Assessment: Italian; Northern Europe and Spanish

Neurotrophic keratopathy is a rare corneal disease caused by impaired corneal innervation. There ... more Neurotrophic keratopathy is a rare corneal disease caused by impaired corneal innervation. There is a paucity of published evidence on neurotrophic keratopathy with no published studies on the economics of neurotrophic keratopathy in the Italian or international literature. This cost analysis aimed at assessing the economic impact of moderate (persistent epithelial defect) and severe (corneal ulcer without perforation) neurotrophic keratopathy from the perspective of the National Health Service and patients in Italy. Treatment algorithm and health resource use information were collected from a panel of nine experts from Italian centres specialized in ocular/corneal conditions. National ambulatory and inpatient hospital tariffs were applied to units of service, and Agenzia Italiana del Farmaco (AIFA) published prices to pharmaceuticals. Mean annual per patient cost was derived as an average cost weighted by the proportion of patients on each respective treatment and length of the treatment. The National Health Service + patient perspective additionally included patients' out-of-pocket expenses. The mean annual estimated National Health Service cost of treatment was €5167 (persistent epithelial defect) and €10,885 (corneal ulcer without perforation) per patient. Costs were largely driven by ambulatory visits and hospital interventions. The mean annual estimated National Health Service + patient cost was €5731 (persistent epithelial defect) and €11,478 (corneal ulcer without perforation) per patient, including cost of out-of-pocket expenses for pharmaceuticals and therapeutic contact lenses. Mean annual cost of neurotrophic keratopathy in Italy doubles with disease severity. Further research is warranted to provide more insight especially into societal costs.

Research paper thumbnail of Confocal Microscopy Is Useful for Detection of Bortezomib Related Neuropathy (BOR-PN) in Multiple Myeloma (MM) Patients (PTS)

Blood

Background: Bortezomib-related painful sensory peripheral neuropathy (Bor-PN) represents the main... more Background: Bortezomib-related painful sensory peripheral neuropathy (Bor-PN) represents the main dose-limiting toxicity of Bor. Cornea is the most innervated tissue in human body, with the highest density of small sensitive fibers, which are the main target of Bor-PN. Corneal confocal microscopy is a rapid, noninvasive, clinical examination technique that quantifies small nerve fiber damage and is already used for early identification of neural damage in course of diabetic sensory PN. Aims: To evaluate the possible role of confocal microscopy for identification and monitoring of corneal sub-basal neural plexus damage in Multiple Myeloma (MM) patients (pts) treated with Bor and to correlate confocal microscopy findings with Bor-PN. Patients and Methods: Patients underwent corneal examination with corneal confocal microscope (Confoscan 4). Corneal sub-basal fibers were evaluated in terms of the following morphometric measurements used as sign of neural damage: nerve fiber length, ner...