Leopoldo Spadea

Corneal wound healing after laser vision correction

Any trauma can trigger a cascade of responses in tissues, with the purpose of safeguarding the integrity of the organ affected by the trauma and of preventing possible damage to nearby organs. Subsequently, the body tries to restore the function of the organ affected. The introduction of the excimer laser for keratorefractive surgery has changed the treatment landscape for correcting refractive errors, such as myopia, hyperopia, and astigmatism. In recent years, with the increased understanding of the basic science of refractive errors, higher-order aberrations, biomechanics, and the biology of corneal wound healing, a reduction in the surgical complications of keratorefractive surgery has been achieved. The understanding of the cascade of events involved in the corneal wound healing process and the examination of how corneal wound healing influences corneal biomechanics and optics are crucial to improving the efficacy and safety of laser vision correction.

Corneal Sensitivity in Keratoconus: A Review of the Literature

Corneal sensitivity has recently received much attention given the crucial role the corneal nerves play in maintaining normal corneal structure and function. An increased understanding of the corneal sensitivity and dry eye disease in keratoconus, including alterations of the conjunctival cells, may help explain the pathogenesis of this disorder. There is histological evidence of the involvement of corneal nerves in the pathology of keratoconus and it has been suggested that this plays a role in the pathophysiological features and progression of the disease. In this review, the impaired corneal sensitivity found on keratoconus and corneal sensitivity changes after cross-linking performed in patients with keratoconus are reported.

Recovery of corneal sensitivity after collagen crosslinking with and without epithelial debridement in eyes with keratoconus.

Purpose To evaluate the changes in corneal sensitivity after corneal collagen crosslinking (CXL) with the epithelium off (epi‐off) and with the epithelium on (epi‐on) in eyes with keratoconus. Design Prospective interventional case series. Setting Eye Clinic, A. Fiorini Hospital, Terracina (Latina), Rome, Italy. Methods On the basis of the corneal pachymetry at the area of topographic steepening, eyes treated with CXL were divided in 2 groups: those with a corneal thickness of 400 &mgr;m or more (epi‐off) and those with a corneal thickness of less than 400 &mgr;m (epi‐on). Corneal sensitivity was measured using a contact esthesiometer (Cochet‐Bonnet) before treatment and 1 and 7 days and 1, 3, 6, 9, and 12 months after treatment. Results The study evaluated 50 CXL‐treated eyes in 50 patients (25 epi‐on and 25 epi‐off) from January 7, 2012, to December 15, 2012. In the epi‐off group, corneal sensitivity was statistically significantly reduced for up to 3 months after CXL and gradually returned to normal levels. In the epi‐on group, corneal sensitivity was statistically significantly reduced for up to 7 days but was not statistically significantly different from preoperative values at other measurement times. At 7 days, the corneal sensitivity was statistically significantly lower in the epi‐off eyes than in the epi‐on eyes. Conclusions Epi‐off and epi‐on CXL both caused hypoesthesia, but corneal sensitivity subsequently recovered completely. The corneal hypoesthesia was more pronounced in eyes in which the epi‐off technique was used, and the recovery time was shorter for eyes treated using epi‐on CXL. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Microincision Vitrectomy Surgery in Vitreomacular Traction Syndrome of Retinitis Pigmentosa Patients

Purpose. To investigate long-term retinal changes after microincision pars plana vitrectomy surgery (MIVS) and internal limiting membrane (ILM) peeling outcome in retinitis pigmentosa (RP) patients affected by vitreomacular traction syndrome (VMT) with higher vitreous surface adhesion or coexisting epiretinal membrane (ERM). Methods. Eight RP patients suffering from VMT were evaluated by means of best corrected visual acuity (BCVA), anterior and posterior binocular examination, spectral-domain optical coherence tomography (SD-OCT), MP-1 microperimetry (MP-1), and full-field electroretinogram (ERG), before MIVS and ILM peeling and during the 36-month follow-up. Patients were hospitalized for two days after the surgery. Surgical procedure was performed following this schedule: surgical removal of crystalline lens (MICS), MIVS with 23-gauge sutureless system trocars, core vitreous body removal, and balanced-sterile-salin-solution- (BSS-) air-gas (SF6) exchange. Results. All patients presented visual acuity (VA) increase after MIVS. None of the patients developed ocular hypertension or vitreomacular adhesions during the 3-year follow-up. MP-1 bivariate contour ellipse area (BCEA) was reduced in its dimensions and improved in all patients demonstrating a better fixation. Conclusions. MIVS could be the gold standard therapy in RP patients with VMT and higher vitreous surface adhesion or coexisting ERM if medical therapy is not applicable or not effective.

Canaloplasty: Current Value in the Management of Glaucoma

Canaloplasty is a nonpenetrating blebless surgical technique for open-angle glaucoma, in which a flexible microcatheter is inserted within Schlemms canal for the entire 360 degrees. When the microcatheter exits the opposite end, a 10-0 prolene suture is tied and it is then withdrawn, by pulling microcatheter back through the canal in the opposite direction. Ligation of prolene suture provides tension on the canal and facilitates aqueous outflow. The main advantage of canaloplasty is that this technique avoids the major complications of fistulating surgery related to blebs and hypotony. Currently, canaloplasty is performed in glaucoma patients with early to moderate disease and combination with cataract surgery is a suitable option in patients with clinically significant lens opacities.

Ocular Manifestations of Ebola Virus Disease: An Ophthalmologist’s Guide to Prevent Infection and Panic

Ebola virus disease (EVD—formerly known as Ebola hemorrhagic fever) is a severe hemorrhagic fever caused by lipid-enveloped, nonsegmented, negative-stranded RNA viruses belonging to the genus Ebolavirus. Case fatality rates may reach up to 76% of infected individuals, making this infection a deadly health problem in the sub-Saharan population. At the moment, there are still no indications on ophthalmological clinical signs and security suggestions for healthcare professionals (doctors and nurses or cooperative persons). This paper provides a short but complete guide to reduce infection risks.

Microbubble technique in failed deep anterior lamellar keratoplasty: 2-year outcomes

Purpose: To compare the long-term results of big-bubble technique and microbubble techniques to complete stroma dissection after failure of achieving a big-bubble. Methods: A total of 35 eyes with keratoconus underwent lamellar keratoplasty with the big-bubble technique (15 eyes) or the microbubble technique (15 eyes). Conversion to penetrating keratoplasty was performed in 3 eyes of the big-bubble group and in 2 eyes of the microbubble group. Best-corrected visual acuity, corneal thickness, corneal astigmatism, and endothelial cell count were assessed preoperatively and at 12 and 24 months after surgery. Results: Mean preoperative visual acuity was 0.29 ± 0.18 in the big-bubble group and 0.25 ± 0.15 in the microbubble group. Postoperatively, all patients showed a regular interface between donor and recipient tissue. At 24 months, mean best-corrected visual acuity was 0.84 ± 0.16 in the big-bubble group and 0.68 ± 0.17 in the microbubble group (p = 0.013), and mean central corneal thickness was 530 ± 39 µm in the big-bubble group and 545 ± 30 µm in the microbubble group. Astigmatism was 2.41 ± 1.29 D and 3.59 ± 1.48 D (p = 0.036), respectively, while endothelial cell density was 1,671 ± 371 in the big-bubble group and 1,567 ± 275 in the microbubble group. Conclusions: The microbubble technique appears to be a valid alternative as it was safe and provided good functional results.

Aqueous Humor Antimicrobial Activity: In Vitro Analysis after Topical 0.5% Chloramphenicol Application.

ABSTRACT Purpose: To assess aqueous humor antimicrobial activity in vitro after topical 0.5% chloramphenicol application. Materials and methods: This investigation included 63 eyes from 65 cataract surgery patients. The study group of 48 eyes received preoperatively four topical applications of 0.5% chloramphenicol. The control group of 15 eyes was given no topical applications. Aqueous humor samples were collected for in vitro antimicrobial analysis using Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Pasteurella multocida organisms by means of disk diffusion test. Results: No inhibition halo was observed around all aqueous humor samples from all chloramphenicol-treated patients, irrespective of the sample quantity added to the paper disks, with no significant difference from aqueous humor from untreated control patients. Conclusions: Aqueous humor displayed no bactericidal effect against any of the microorganisms evaluated after topical 0.5% chloramphenicol application.

Current techniques of lamellar keratoplasty for keratoconus

In recent years, there has been a considerable interest regarding the concept of lamellar keratoplasty (LK), which contributed in spreading the use of this procedure in the treatment of keratoconus. This is a new frontier in corneal surgery that minimizes trauma on the recipient patient since it works on a “closed bulb”. The LK surgery, in fact, aims to selectively replace diseased corneal stroma, leaving the healthy endothelium. The main advantage of LK is to avoid major causes of failure of penetrating keratoplasty as immunological rejection, and the late mismatch in the transplanted cornea, thus increasing the life of transplantation. In the last decade, several techniques of LK have been proposed, depending on how the anterior portion of the recipient cornea is removed. This article, through a literary research reviews the various emerging techniques of anterior lamellar surgery for the management of keratoconus, analyzing their indications, visual outcomes, and rate of complications.

Sliding Keratoplasty Followed by Transepithelial Iontophoresis Collagen Cross-linking for Pellucid Marginal Degeneration.

PURPOSE To describe the changes in visual acuity and topographic analysis in a patient affected by advanced pellucid marginal degeneration (PMD). METHODS A 59-year-old woman with bilateral PMD who was contact lens intolerant was treated by sliding keratoplasty before and 3 months after transepithelial (epi-on) iontophoresis collagen cross-linking (I-CXL) in one eye. Corrected distance visual acuity (CDVA), spherical equivalent and cylinder refraction, corneal topography, ultrasound pachymetry, and endothelial cell count were assessed at baseline and up to 12 months postoperatively. RESULTS After 1 year of follow-up, CDVA increased from 20/200 to 20/50 and the videokeratographic patterns significantly improved. Endothelial cell counts did not change significantly (P > .05). CONCLUSIONS Sliding keratoplasty combined with I-CXL was safe and effective in the treatment of advanced PMD.