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Alessio G, Puzo P, Di Pardo C, Sborgia A, D'Oria F. Remote Topography-Guided Transepithelial Photorefractive Combined Phototherapeutic Keratectomy Telesurgery. Cornea 2024:00003226-990000000-00546. [PMID: 38692706 DOI: 10.1097/ico.0000000000003564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The purpose of this study was to report the first remote telesurgery in a case of epithelial basement membrane disease with recurrent corneal erosions. METHODS Topography-guided transepithelial photorefractive combined phototherapeutic keratectomy (PRK-PTK) is a surgical option that treats corneal irregularities and prevents the recurrences of erosions while treating the refractive error. RESULTS We performed for the first time a remote transepithelial topography-guided combined PRK-PTK using the iRes®2 excimer laser platform (iVIS Technologies, Taranto, Italy), with the surgeon sitting in his own room and controlling the excimer laser in remote with 5G connection through the Remote Control Station and the patient in the operating room. At one-month post-operative, visual acuity was 20/20 and the patient's symptoms subsided. CONCLUSIONS Our surgery opens the era of telesurgery in the corneal panorama.
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Affiliation(s)
- Giovanni Alessio
- Section of Ophthalmology, Department of Translational Biomedicine Neuroscience, University of Bari, Bari, Italy
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D'Oria F, Alio JL. Methods of refractive surgical correction of keratoconus. Arch Soc Esp Oftalmol (Engl Ed) 2024:S2173-5794(24)00057-4. [PMID: 38589000 DOI: 10.1016/j.oftale.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 04/10/2024]
Affiliation(s)
- F D'Oria
- Sección de Oftalmología, Departamento de Ciencias Médicas, Neurociencias y Órganos Sensoriales, Universidad de Bari, Bari, Italy
| | - J L Alio
- Vissum Miranza, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain.
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D'Oria F, Bagaglia SA, Alio Del Barrio JL, Alessio G, Alio JL, Mazzotta C. Refractive surgical correction and treatment of keratoconus. Surv Ophthalmol 2024; 69:122-139. [PMID: 37774800 DOI: 10.1016/j.survophthal.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Keratoconus is an ectatic corneal disorder that causes severe vision loss. Surgical options allow us to correct, partially or totally, the induced refractive error. Intracorneal ring segments (ICRS) implantation represents a minimally invasive surgical option that improves visual acuity, with a high success rate and a low overall complication rate. Corneal allogenic ICRS consists of ring segments derived from allogenic eye bank-processed donor corneas. Selective topography-guided transepithelial photorefractive or phototherapeutic keratectomy combined with CXL is another way in selected cases to improve spectacles corrected distance visual acuity. The microphotoablative remodeling of the central corneal profile is generally planned by optimizing the optical zones and minimizing tissue consumption. Phakic intraocular lens (PIOL) implant is considered in patients with stable disease and acceptable anatomical requirements. The two types of pIOLs, depending on their implantation inside the eye, are anterior chamber-pIOLs, which fixate to the anterior surface of the iris by using a polymethomethacrolate claw at the two haptics, and posterior chamber-pIOLs. In patients with both cataracts and keratoconus, the correct IOL power is difficult to obtain due to the irregular corneal shape and K values. Toric IOL is recommended, but carefully judging the topography and the possible need of subsequent keratoplasties.
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Affiliation(s)
- Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
| | - Simone A Bagaglia
- Departmental Ophthalmology Unit, Sant' Andrea Hospital, USL Toscana Sud-Est, Massa Marittima, Italy
| | - Jorge L Alio Del Barrio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Jorge L Alio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
| | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, AUSL Toscana Sud Est, Campostaggia, Siena, Italy; Department of Medicine, Surgery and Neurosciences, Postgraduate Ophthalmology School, Siena University, Siena, Italy; Siena Crosslinking Center, Siena, Italy
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Incandela C, D'Oria F, Lapenna L, Acquaviva A. Penetrating keratoplasty in brittle Cornea syndrome: Case series and review of the literature. Eur J Ophthalmol 2024; 34:11-17. [PMID: 37073081 DOI: 10.1177/11206721231171426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
It concerns three siblings (two 28 year old twin boys and a 25 year old woman) who presented a previous history of rupture of eyeball in one eye and very poor vision in the other. At the first ophthalmoscopic and instrumental evaluation, three patients presented with bluish sclera and keratoglobus in the intact eye. A genetic analysis with whole exome sequencing was then performed on the three siblings, identifying a biallelic variant of the PRDM5 gene that led to the diagnosis of Brittle Cornea Syndrome (BCS), a rare autosomal recessive disorder characterized by corneal thinning and blue sclera. To preserve the only intact eye from possible breakage, the three siblings were trained in using protective measures (polycarbonate goggles etc.) to carry out close monitoring of symptoms and were asked to continue with follow-up visits for ocular and systemic diseases associated with BCS. Given the poor best corrected visual acuity achievable with glasses and contact lenses, penetrating keratoplasty was performed, achieving good visual acuity maintained in the 2-year follow-up in two of the three patients. Knowledge of this pathology and its clinical manifestations is essential for early diagnosis and correct management of this rare but very debilitating pathology. To our knowledge, this is the first case series of BCS reported in an Albanian population.
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Affiliation(s)
- Cosimo Incandela
- Department of Ophthalmology, Di Venere's Hospital of Bari, Bari City, Italy
| | - Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Lucia Lapenna
- Department of Ophthalmology, Di Venere's Hospital of Bari, Bari City, Italy
| | - Antonio Acquaviva
- Department of Ophthalmology, Di Venere's Hospital of Bari, Bari City, Italy
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Nowrouzi A, D'Oria F, Alió Del Barrio JL, Alió JL. Phakic intraocular Lens implantation in keratoconus patients. Eur J Ophthalmol 2023:11206721231199780. [PMID: 37661651 DOI: 10.1177/11206721231199780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases. AIM To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards). RESULTS No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1. CONCLUSION pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA.
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Affiliation(s)
- Ali Nowrouzi
- Cornea, Cataract and Refractive Surgery Unit, Department of Ophthalmology, Hospital Quironsalud Marbella, Spain
- Clinical research fellow at VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Francesco D'Oria
- Clinical research fellow at VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Nowrouzi A, Alió Del Barrio JL, D'Oria F, Kamel NR, Alió JL. Visual Performance After Unilateral Implantation of an Extended Depth-of-Focus Intraocular Lens in Patients With Unilateral Cataract. J Refract Surg 2023; 39:518-523. [PMID: 37578177 DOI: 10.3928/1081597x-20230710-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
PURPOSE To investigate the visual performance after unilateral implantation of an extended depth-of-focus intraocular lens (IOL) in patients with unilateral cataracts. METHODS In this prospective study, uneventful phacoemulsification with LuxSmart IOL (Bausch & Lomb) implantation was performed in 25 eyes of 25 patients with unilateral cataracts. At postoperative 1, 4, 12, and 24 weeks, uncorrected and corrected visual acuity at far, intermediate, and near distances and the spherical equivalent in manifest refraction were measured. A Visual Function Index and modified Visual Function Index questionnaire were used to investigate glare, spectacle dependence, and satisfaction at 24 weeks in the eye that had surgery. RESULTS At 6 months postoperatively, uncorrected distance visual acuity was 20/20 (0.0 logMAR) in 96% of cases, distance corrected intermediate visual acuity was 20/32 (0.2 logMAR) in all cases (60 cm), and distance corrected near visual acuity was 20/32 (0.2 logMAR) in 60% of cases (40 cm). The patient satisfaction score was 100% based on the Visual Function Index questionnaire for far and intermediate distance, respectively. No patients complained of the permanent photic phenomenon. No patients reported bilateral imbalance. All of the patients became spectacle independent for most of their intermediate activities at 60 cm. A total of 96% of the patients reported 100% contrast sensitivity in the Pelli-Robson test. CONCLUSIONS The unilateral implantation of this EDOF IOL seems to be tolerated and effective in improving the visual function of patients with unilateral cataract with limited optical side effects such as halos or glare, providing spectacle-independent vision from far to intermediate object distances. [J Refract Surg. 2023;39(8):518-523.].
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Al-Amri SAJ, Alió JL, Milán-Castillo R, D'Oria F, Martinez-Abad A, Yebana P, Subirana N, Al-Harbi Z, Plaza-Puche AB, Alió Del Barrio JL. Clinical Retinal Image Quality of a Non-diffractive Wavefront-Shaping Extended Depth of Focus (Vivity) Intraocular Lens. J Refract Surg 2023; 39:103-110. [PMID: 36779465 DOI: 10.3928/1081597x-20221130-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE To evaluate clinical retinal optical image quality following implantation of an extended depth of focus intraocular lens (EDOF IOL) (Vivity; Alcon Laboratories, Inc), and to compare it with a monofocal and a trifocal IOL. METHODS This prospective, comparative, case-control study included 88 eyes implanted with: (1) 19 monofocal IOLs (AcrySof SA60AT; Alcon Laboratories, Inc); (2) 38 EDOF IOLs (AcrySof IQ Vivity); and (3) 31 trifocal IOLs (AT LISA tri 839MP; Carl Zeiss Meditec AG). Total root mean square, ocular lower (LOA) and higher (HOA) order aberrations, point spread function (PSF) Strehl ratio (PSF with LOA), and PSF Strehl ratio excluding LOA (PSF without LOA) were analyzed using a Pyramidal WaveFront-based sensor aberrometer Osiris (Costruzione Strumenti Oftalmici) at two different pupil sizes (3 and 4 mm). RESULTS The trifocal IOL showed the highest PSF without LOA at both pupil sizes (0.52 ± 0.12 and 0.31 ± 0.07, respectively), followed by the AcrySof SA60AT (0.39 ± 0.10 and 0.27 ± 0.07) and AcrySof IQ Vivity (0.34 ± 0.11 and 0.24 ± 0.09) (P < .001). The AcrySof IQ Vivity and monofocal IOLs were comparable (P > .05). Despite the comparable postoperative low spherical equivalent among the IOL groups, the AT LISA tri 839MP retinal image quality (PSF with LOA) was the most severely affected by such residual refractive errors (dropped to 0.26 ± 0.06 at 3 mm; P < .001) compared to the monofocal AcrySof SA60AT (0.24 ± 0.07 at 3 mm) and EDOF Acrysof IQ Vivity (0.23 ± 0.06 at 3 mm) groups. The PSF with LOA was comparable (P > .05) among the three groups at both the 3-and 4-mm pupil size. CONCLUSIONS Although trifocal IOLs provided significantly better retinal image quality if influence of LOA is excluded, they also demonstrated to be the most sensitive to residual refractive errors. Both the EDOF Acrysof IQ Vivity and mono-focal AcrySof SA60AT IOLs showed a comparable retinal image quality, and they are also comparable with trifocal IOLs when considering the clinically real PSF (PSF with LOA). [J Refract Surg. 2023;39(2):103-110.].
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D'Oria F, Buonamassa R, Rizzo T, Boscia F, Alessio G, Guerriero S. Bacterial isolates and antimicrobial susceptibility pattern of ocular infection at a tertiary referral hospital in the South of Italy. Eur J Ophthalmol 2023; 33:370-376. [PMID: 35642247 DOI: 10.1177/11206721221106139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The present study aimed to determine the prevalence of bacterial and fungal infections of the eye and also to assess the antibiotic susceptibility pattern of bacterial isolates at a tertiary referral eye care hospital in Bari, Italy. METHODS Two hundred seventy three samples collected during a 2-year observation period. Culture, Gram's stain, potassium hydroxide mount and occasionally Giemsa staining was done for the clinical specimens. Antibiotic susceptibility testing was performed for bacterial growth. RESULTS Out of 273 samples processed, 236 (86.4%) yielded growth: of them, 183 (77,5%) were bacterial, 26 (11%) fungal, and 23 (9,7%) specimens showed the presence of Acanthamoeba. Among bacterial infections, 99 (54.5%) bacterial isolates were Gram-positives, and 82 (44.8%) were Gram-negatives. Among Gram positives, Tigecycline showed the greatest susceptibility (93.8%), followed by Linezolid (97%) and Daptomycin (95.18%). Gram negative bacteria strains were susceptible to Imipenem (95%), Meropenem (98,5%) and Amikacin (91%) Multidrug in vitro resistance (resistance >3 classes of antibiotics) was found in 45 Gram positive (63%). and 33 Gram negative (44%). CONCLUSION Conjunctival specimens yielded mainly bacterial growth with Staphylococcus species being the predominant isolate followed by Pseudomonas species. Findings from the current analysis evidence a substantial level of in vitro resistance to ≥3 antibiotics.
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Affiliation(s)
- Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Rosa Buonamassa
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Tiziana Rizzo
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Francesco Boscia
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Silvana Guerriero
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
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Puzo P, D'Oria F, Imburgia A, Incandela C, Sborgia A, Marchegiani EB, Rania L, Mularoni A, Alessio G. Live surgery outcomes in cataract surgery. Eur J Ophthalmol 2022; 32:3444-3450. [PMID: 35322704 DOI: 10.1177/11206721221089172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate and compare the outcomes of live surgery (LS) and no-live surgery (NLS) on cataract surgery with implantation of different types of intraocular lenses (IOLs). METHODS Retrospective, contralateral eye, case series of patients that underwent cataract surgery in live or non-live view during two consecutive editions of national meetings. Both eyes of the same patients were implanted with the same IOL, one in LS and the other in NLS. RESULTS 108 eyes of 54 patients, aged between 50 and 82 (72 ± 8.2) and implanted with different types of IOLs, were reviewed. Both eyes in each patient were well matched at baseline in terms of intraocular biometric characteristics, corneal curvature and endothelial cell density (ECD) (p > 0.05). There are no statistically significant differences between the biometric and topographic parameters, aberrometric data and the loss of ECD in the post-operative outcomes (p > 0.05). However, comparing the different types of IOLs, there is a significant loss of ECD in eyes implanted with a toric IOL during LS (p = 0.0014 and p = 0.04, in 2017 and 2018 edition respectively). CONCLUSIONS In this series of live cataract surgery, eyes operated in LS or NLS have comparable outcomes, underlying the importance and the benefits of live view in terms of medical education and the low-risk of complications. Nevertheless, we have found a significant increase in ECD loss in patients implanted with toric IOLs during LS.
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Affiliation(s)
- Pasquale Puzo
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Aurelio Imburgia
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Cosimo Incandela
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Alessandra Sborgia
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Eleonora B Marchegiani
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Laura Rania
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Alessandro Mularoni
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
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D'Oria F, Alio JL. Are the epi-on and epi-off CXL protocols equivalent in the treatment of keratoconus? Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:121-123. [PMID: 35248392 DOI: 10.1016/j.oftale.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Affiliation(s)
- F D'Oria
- Vissum Miranza, Alicante, Spain; Department of Basic Medical Science, Neuroscience and Sense Organs, Universidad de Bari, Bari, Italy
| | - J L Alio
- Vissum Miranza, Alicante, Spain; División de Oftalmología, Universidad Miguel Hernández, Alicante, Spain.
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D'Oria F, Barraquer R, Alio JL. Crystalline lens alterations in congenital aniridia. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96 Suppl 1:38-51. [PMID: 34836587 DOI: 10.1016/j.oftale.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/15/2020] [Indexed: 06/13/2023]
Abstract
Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.
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Affiliation(s)
- F D'Oria
- Vissum Innovation, Alicante, Spain; Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - R Barraquer
- Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J L Alio
- Vissum Innovation, Alicante, Spain; División de Oftalmología, Universidad Miguel Hernández, Alicante, Spain.
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Alio JL, D'Oria F, Toto F, Balgos J, Palazon A, Versaci F, Del Barrio JLA. Retinal image quality with multifocal, EDoF, and accommodative intraocular lenses as studied by pyramidal aberrometry. Eye Vis (Lond) 2021; 8:37. [PMID: 34615549 PMCID: PMC8496005 DOI: 10.1186/s40662-021-00258-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/06/2021] [Indexed: 11/10/2022]
Abstract
Background To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer. Methods This study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group); (b) 19 Miniwell; (c) 24 LENTIS Mplus LS-313 MF30; d) 33 LENTIS Mplus LS-313 MF15; (e) 17 AkkoLens Lumina; (f) 31 AT LISA Tri 839MP; (g) 20 Precizon Presbyopic; (h) 20 AcrySof IQ PanOptix; (i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer. Results AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10; P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001). Conclusions Far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.
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Affiliation(s)
- Jorge L Alio
- Vissum Innovation, Alicante, Spain. .,Division of Ophthalmology, Universidad Miguel Hernández, Vissum Miranza, c/ Cabañal, 1, 03016, Alicante, Spain.
| | - Francesco D'Oria
- Vissum Innovation, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Vissum Miranza, c/ Cabañal, 1, 03016, Alicante, Spain.,Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | | | - Antonio Palazon
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Francesco Versaci
- R&D Department, Costruzione Strumenti Oftalmici (CSO), Florence, Italy
| | - Jorge L Alio Del Barrio
- Vissum Innovation, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Vissum Miranza, c/ Cabañal, 1, 03016, Alicante, Spain
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D'Oria F, Palazón A, Alio JL. Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis. Eye Vis (Lond) 2021; 8:34. [PMID: 34565473 PMCID: PMC8465763 DOI: 10.1186/s40662-021-00256-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/08/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking (CXL) techniques compared with standard epi-off CXL. METHODS We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) and we evaluated the selected papers according to the Cochrane risk of bias tool. We considered, as primary outcomes, average Kmax flattening, changes in uncorrected and corrected distance visual acuity (UDVA and CDVA); as secondary outcomes, we considered changes in pachymetry values and endothelial cell density (ECD). We also investigated adverse events related to the treatments and treatment failure. Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference (MD) with 95% confidence interval (CI) as the effect size. RESULTS A total of 15 studies were included and among these 15 trials, 9 were RCTs and 6 were NRSIs, but only 4 studies showed no high risk of bias and were included in this meta-analysis. Our analysis revealed significant postoperative differences in CDVA (MD = 0.07; 95% CI 0.04 to 0.10; P < 0.001), and no significative differences in UDVA, Kmax, central corneal thickness (CCT) and ECD (P > 0.05). Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing (P = 0.035) and persistent stromal haze (P = 0.026). CONCLUSION Epi-on CXL is as effective as epi-off CXL. Except for a higher significant improvement in CDVA with current epi-on protocols, our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual, topographic, pachymetric, and endothelial parameters. Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.
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Affiliation(s)
- Francesco D'Oria
- Vissum Innovation, c/ Cabañal, 1, 03016, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Antonio Palazón
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Jorge L Alio
- Vissum Innovation, c/ Cabañal, 1, 03016, Alicante, Spain.
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
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D'Oria F, Barraquer R, Alio JL. Crystalline lens alterations in congenital aniridia. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:S0365-6691(21)00028-9. [PMID: 33612366 DOI: 10.1016/j.oftal.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
Congenital aniridia is a rare genetic disease associated with mutations in the PAX6 gene. Changes in the lens in aniridia can be alterations of size and shape, of position - which generally reveal zonular weakness and determines subluxation of the lens - and mainly changes in transparency, cataracts, with variable morphology of polar, cortical, subcapsular, lamellar, and more rarely, nuclear cataract. Visual acuity and quality of vision in patients with congenital aniridia complicated by cataracts can be improved by carefully planned surgery, when lack of media transparency justifies surgical indication. Most patients have some improvement in visual acuity and quality of retinal image. Cataract surgery with aniridia is complicated by pathological changes due to the underlying cause of the aniridia. Challenges include corneal opacification, friable capsule and, above all, iris and pupil reconstruction. It can also determine late complications, such as secondary glaucoma or deterioration of pre-existent glaucoma, and corneal endothelial decompensation. After crystalline lens surgery in these patients, either by cataract or dislocation, for visual rehabilitation there are various techniques such as keratopigmentation, prosthetic iris devices or Morcher intraocular lenses with a black diaphragm. An appropriate individualised surgical plan should be selected depending on patient and surgical experience, in order to minimise complications and give the best chance of postoperative success.
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Affiliation(s)
- F D'Oria
- Vissum Innovation, Alicante, España; Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italia
| | - R Barraquer
- Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, España
| | - J L Alio
- Vissum Innovation, Alicante, España; División de Oftalmología, Universidad Miguel Hernández, Alicante, España.
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D'Oria F, Abdelghany AA, Ledo N, Barraquer RI, Alio JL. Incidence and Reasons for Intrastromal Corneal Ring Segment Explantation. Am J Ophthalmol 2021; 222:351-358. [PMID: 33011155 DOI: 10.1016/j.ajo.2020.09.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the main causes of intrastromal corneal ring segment (ICRS) explantation and define the incidence rate. DESIGN Multicenter, observational consecutive case series. METHODS Consecutive cases of ICRSs explanted in the last 10 years were reviewed. Clinical data included age of the patients at explantation, reasons for implantation and explantation, date of implantation and explantation, tunnel creation technique, and ICRS type. Main outcomes measures were the reasons for ICRS removal and the incidence rate. RESULTS During the study period, 121 ICRSs (119 patients) were explanted, with an explantation rate of 5.60%. Functional failure (74 eyes, 61.16%) represents the main cause for ICRS removal: of them, 48 (39.67%) ICRSs were removed for refractive failure and 26 (21.49%) in the setting of a keratoplasty related to poor visual performance of the implanted eye. In addition, 47 eyes (38.84%) had ICRS removal for anatomic failure: among them, 36 (29.75%) were explanted for spontaneous extrusion (overall extrusion rate: 1.58%), 7 (5.79%) for suspected infectious keratitis, 3 (2.48%) for corneal melting, and 1 (0.83%) for corneal perforation. Mild cases of keratoconus were more prone to be explanted because of a loss of the initial improved visual acuity, whereas spontaneous extrusion happened often in advanced cases of keratoconus. CONCLUSIONS We report the largest series of ICRS explantation as of this writing. The main cause of explantation was functional refractive failure followed by spontaneous extrusion of the ICRS, that is, correlated to an anatomic failure at the site of implantation in an advanced disease.
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Affiliation(s)
- Francesco D'Oria
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Ahmed A Abdelghany
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Ophthalmology department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Natalia Ledo
- Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael I Barraquer
- Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge L Alio
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
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Abdelghany AA, D'Oria F, Alio JL. Surgery for glaucoma in modern corneal graft procedures. Surv Ophthalmol 2020; 66:276-289. [PMID: 32827497 DOI: 10.1016/j.survophthal.2020.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
Glaucoma is a common cause of vision loss after corneal transplantion and is considered a major risk factor for graft failure. Glaucoma may be present before corneal transplant surgery, or increased intraocular pressure may develop after keratoplasty in up to one-third of patients. Pre-existing glaucoma should be controlled before keratoplasty, either medically or surgically. For postkeratoplasty increase in intraocular pressure; identifying the risk factors allows appropiate follow-up and management. Patients undergoing anterior lamellar keratoplasty may take advantage of reduced rates of postkeratoplasty glaucoma. Glaucoma also complicates eyes with endothelial keratoplasties, mostly related to management of intraocular pressure spikes derived from anterior chamber air bubbles. Nevertheless, the severity is less, and the intraocular pressure is more easily controlled when compared with penetrating keratoplasty. Adequate management of glaucoma that develops before or after keratoplasty may save eyes from irreversible damage to the optic nerve and increase graft survival.
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Affiliation(s)
- Ahmed A Abdelghany
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Faculty of Medicine, Ophthalmology Department, Minia University, Minia, Egypt
| | - Francesco D'Oria
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Jorge L Alio
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
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Sborgia L, Niro A, D'Oria F, Sborgia G, Sborgia A, Furino C, Giuliani G, Ferrari LM, Boscia F, Recchimurzo N, Alessio G. Perfluorocarbon liquid-assisted inverted inner limiting membrane-flap for large macular hole after recurrent rhegmatogenous retinal detachment. Taiwan J Ophthalmol 2020; 11:193-196. [PMID: 34295629 PMCID: PMC8259532 DOI: 10.4103/tjo.tjo_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/23/2020] [Indexed: 11/27/2022] Open
Abstract
A 45-year-old Caucasian myopic woman with a severe vision impairment (20/320) in the left eye due to a macula-off rhegmatogenous retinal detachment (RRD) underwent vitrectomy with silicone oil tamponade followed by an inferior relaxing retinectomy with heavy silicone oil tamponade during the second procedure for recurrence of RRD due to proliferative vitreoretinopathy. Four weeks after the second surgery, visual acuity was 20/200 and the patient complained metamorphopsia in the same eye due to a large full-thickness macular hole. A perfluorocarbon liquid-assisted inverted inner limiting membrane-flap technique was performed. Visual acuity improved to 20/80 after closing of macular hole and partial recovery of outer retinal layers at 3 months from the last surgery.
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Affiliation(s)
- Luigi Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. Moscati", ASL TA, Taranto, Italy
| | - Francesco D'Oria
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | | | - Claudio Furino
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Luisa Micelli Ferrari
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Nicola Recchimurzo
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Bari, Italy
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Guerriero S, D'Oria F, Rossetti G, Favale RA, Zoccolella S, Alessio G, Petruzzella V. CMT2A Harboring Mitofusin 2 Mutation with Optic Nerve Atrophy and Normal Visual Acuity. Int Med Case Rep J 2020; 13:41-45. [PMID: 32110117 PMCID: PMC7039061 DOI: 10.2147/imcrj.s237620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/17/2020] [Indexed: 01/20/2023] Open
Abstract
Charcot-Marie-Tooth (CMT) constitutes a group of heterogeneous hereditary motor and sensor neuropathies. Mutations in mitofusin-2 (MFN2) cause CMT type 2A by altering mitochondrial fusion and trafficking along with the axonal microtubule system. In literature patients presenting with CMT2A are reported as having a subacute onset of optic atrophy associated with central scotoma and color vision defects. We report on the clinical and genetic findings in a 40 years-old Caucasian woman presenting with CMT type 2A and MFN2 mutation (c.2258duplT/p.Leu753fs) who presented bilateral progressive optic atrophy with bilateral severe concentric narrowing of the visual field but normal visual acuity and color vision. This is the first report that describes such phenotypical manifestation of an MFN2 mutation suggesting that the molecular mechanisms underlying the mitofusin-2 function alteration at optic nerve need to be investigated further.
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Affiliation(s)
- Silvana Guerriero
- Department of Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco D'Oria
- Department of Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giacomo Rossetti
- Department of Molecular Biology, University of Geneva, Geneva, Switzerland
| | - Rosa Anna Favale
- Department of Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefano Zoccolella
- Department of Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vittoria Petruzzella
- Department of Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Sborgia G, Niro A, Coassin M, Sborgia L, D'Oria F, Pastore V, Albano V, Tritto T, Sborgia A, Boscia F, Alessio G. Inverted internal limiting membrane-flap technique to treat a full-thickness macular hole complicating idiopathic macular telangiectasia type 2. Eur J Ophthalmol 2019; 31:NP81-NP85. [PMID: 31690102 DOI: 10.1177/1120672119886177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Full-thickness macular hole is a complication of idiopathic macular telangiectasia type 2 with a low surgical closure rate and a poor functional recovery. We analyze morphologic and functional outcomes after an inverted internal limiting membrane-flap technique for full-thickness macular hole complicating idiopathic macular telangiectasia type 2 using optical coherence tomography and microperimetry. CASE REPORT A 77-year-old man presented us complaining visual impairment in the left eye (20/40) due to a full-thickness macular hole complicating idiopathic macular telangiectasia type 2. The patient underwent vitrectomy with an inverted internal limiting membrane-flap technique and injection of 22% SF6 gas. Optical coherence tomography and functional analysis, including visual acuity test and microperimetry, were performed before surgery and over 3 months. Optical coherence tomography scans revealed macular hole closure at 1-month follow-up. Visual acuity and retinal sensitivity improved from 20/40 to 20/20 and from 13.1 to 14.9 dB, respectively. Fixation stability (bivariate contour ellipse area) improved from 2.02 to 1.58 deg2, from 5.44 to 4.24 deg2 and from 9.72 to 7.58 deg2, at 68%, 95%, and 99% of fixation points, respectively. CONCLUSION Inverted internal limiting membrane-flap technique may be an alternative approach in patients with full-thickness macular hole complicating diopathic macular telangiectasia type 2, and microperimetry may be a useful tool to analyze related functional changes.
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Affiliation(s)
- Giancarlo Sborgia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. MOSCATI," ASL TA, Statte, Italy
| | - Marco Coassin
- Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Luigi Sborgia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Francesco D'Oria
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Valentina Pastore
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Valeria Albano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Tiziana Tritto
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Alessandra Sborgia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy.,Eye Clinic, Hospital "S. G. MOSCATI," ASL TA, Statte, Italy
| | - Francesco Boscia
- Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
| | - Giovanni Alessio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
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Briatico-Vangosa F, Rink M, D'Oria F, Verzelli A. Deformational behavior of polyolefins at high temperature and strain rate: Experimental analysis and constitutive laws. POLYM ENG SCI 2004. [DOI: 10.1002/pen.11285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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