Papers by leopoldo spadea
Journal of Refractive Surgery
Therapeutics and Clinical Risk Management
To describe the efficacy and safety of topography-guided trans-epithelial no-touch photorefractiv... more To describe the efficacy and safety of topography-guided trans-epithelial no-touch photorefractive keratectomy (PRK) for the correction of highly irregular astigmatism after penetrating keratoplasty (PK). Patients and Methods: A prospective study was conducted on 12 eyes of 12 patients affected by highly irregular astigmatism after PK for keratoconus. Each patient underwent a single-step topography-guided trans-epithelial ablation (CIPTA ® 2 software, iVis Technologies). Corneal topography data as well as uncorrected (UDVA) and corrected distance visual acuity (CDVA) and spherical equivalent (SEQ) were collected preoperatively (T0) and at 1 (T1), 3 (T2) and 12 (T3) months after surgery. Results: Mean UDVA and CDVA significantly improved, respectively, from 1.22±0.17 and 0.18±0.03LogMAR at T0 to 0.63±0.17 (CI 95%, P<0.001) and 0.04±0.03LogMAR at T3 (CI 95%, P<0.001). Mean SEQ significantly decreased from −3.75±1.32 to-1.60±1.32D (CI 95%, P<0.02). Mean subjective refractive astigmatism (SRAST) and mean keratometry astigmatism (SimK) significantly decreased, respectively, from 7.83±0.98 and 8.10±1.48D to 2.83±0.98 and 5.29±1.48D (CI 95%, P<0.001). Corneal Morphological Irregularity index (CMI) significantly decreased from 62.76±7.26 µm to 23.24±7.26 µm (CI 95%, P<0.001). Apart from a single episode of graft rejection 5 days after ablation, successfully reverted with topical steroids, no other complications were noted. A mild corneal haze was observed in two eyes (16.7%) at 3 months post-PRK, and no regression was observed at 12 months. Conclusion: Our study demonstrates the safety and long-term effectiveness of a transepithelial topography-guided ablation in the treatment of post-PK highly irregular astigmatism.
Journal of Cataract and Refractive Surgery
Journal of Cataract and Refractive Surgery
Journal of Refractive Surgery
UK PubMed Central (UKPMC) is an archive of life sciences journal literature.
European Journal of Ophthalmology
Introduction: Calcific band keratopathy (CBK) is a relatively common chronic corneal degeneration... more Introduction: Calcific band keratopathy (CBK) is a relatively common chronic corneal degeneration and various forms of treatment are mentioned in the literature. Cases description: Two patients (89 and 37 yo, respectively) affected by diffuse long-standing CBK in one eye and complaining of ocular pain, foreign body sensation and decreased visual acuity are reported. An ethylenediaminetetraacetic acid (EDTA) application on the ocular surface was performed associated with a customized no-touch transepithelial phototherapeutic corneal remodeling in one patient and a standard phototherapeutic keratectomy (PTK) in the second patient. Corneal transparency progressively improved in both cases since the early follow-up visits and the cornea became clear 2 weeks after surgery. In both cases, a significant reduction of ocular discomfort was reported. Conclusions: Combining EDTA chelation and excimer laser-assisted PTK represents an useful treatment of band keratopathy even in challenging case...
Clinical Ophthalmology
Fungal endophthalmitis is subsequent to endogenous or exogenous infection and represents an impor... more Fungal endophthalmitis is subsequent to endogenous or exogenous infection and represents an important complication of ocular surgery which may lead to significant visual loss and blindness. The prognosis is poor because of delayed diagnosis and limited availability of effective antifungal drugs with good ocular penetration. Furthermore, the critical issue in diagnosing fungal infection of the eye is microbiological identification of the etiologic agent in clinical samples. Aspergillus is among the most frequent isolated organisms in fungal endophthalmitis. Early diagnosis is essential to prevent severe complications and blindness. Treatments include local, systemic and surgical therapeutic strategies. The purpose of the present review is the analysis of the current procedures adopted to promptly diagnose and treat Aspergillus endophthalmitis.
Case Reports in Ophthalmology
Conjunctivitis, keratoconjunctivitis, and corneal ulcers are common eye disorders frequently diag... more Conjunctivitis, keratoconjunctivitis, and corneal ulcers are common eye disorders frequently diagnosed in both humans and animals, and are currently treated by topical administration of eye drops containing anti-inflammatory and antibacterial agents. The current molecules often lack efficacy because infections in hypoxic tissue contain methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa; thus, new products for the treatment of ocular pain and inflammation are needed. The use of ozone, a molecule stabilized for topical use as an ozonide, could be providential due to its anti-inflammatory and bactericidal activity in certain anterior segment pathologies, in addition to promoting tissue repair properties. Ozonated oils have the same properties as gaseous ozone and are well tolerated by tissues. In the present study the repair and regeneration effect of ozonated oil in liposomes plus hypromellose (Ozodrop ® , FB Vision, Ascoli Piceno, Italy) instilled 3-4 times a day in external ocular spontaneous pathologies both in animals and humans are reported.
Recent Clinical Techniques, Results, and Research in Wounds
Annals of Translational Medicine
International journal of ophthalmology, 2018
To evaluate the efficacy and safety of the excimer laser correction of the residual refractive er... more To evaluate the efficacy and safety of the excimer laser correction of the residual refractive errors after cataract extraction with intraocular lens (IOL) implantation in uncommon cases. Totally 24 patients with high residual refractive error after cataract surgery with IOL implantation were examined. Twenty-two patients had a history of phacoemulsification and IOL implantation, and two had extra-capsular cataract extraction with IOL implantation. Detailed examination of preoperative medical records was done to explain the origin of the post-cataract refractive errors. All patients underwent photorefractire keratectomy (PRK) enhancement. The mean outcome measures were refraction, uncorretted visual acuity (UCVA), best corrected visual acuity (BCVA) and corneal transparency and follow up ranged from 1 to 8y. The principal causes of residual ametropia was inexact IOL calculation in abnormal eyes with high myopia and congenital lens abnormalities, followed by corneal astigmatism both ...
International ophthalmology, 2018
To evaluate by Environmental Scanning Electron Microscopy (ESEM) the corneal incision architectur... more To evaluate by Environmental Scanning Electron Microscopy (ESEM) the corneal incision architecture after intraocular lens (IOL) implantation in pig eyes, using manual, automated injectors or preloaded delivery systems. Twenty-four pig eyes underwent IOL implantation in the anterior chamber using three different injectors: manual (Monarch III) (n = 8), automated (AutoSert) (n = 8), or a preloaded system (UltraSert) (n = 8). Acrysof IQ IOLs, 21 Dioptres (D) (n = 12) and 27D (n = 12), were implanted through 2.2 mm clear corneal incisions. Incision width was measured using corneal calipers. The endothelial side of the incision was analyzed with ESEM. In each group, the final size of the corneal wound after IOL implantation, measured by calipers, was 2.3-2.4 mm. The incision architecture resulted more irregular in the Monarch group compared with the other injectors. In every group the 27D IOL-implanted specimens showed more alterations than in 21D IOL-implanted samples, and this was less...
European journal of ophthalmology, Jan 11, 2017
To compare the long-term results of big-bubble technique and microbubble techniques to complete s... more To compare the long-term results of big-bubble technique and microbubble techniques to complete stroma dissection after failure of achieving a big-bubble. 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. 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...
International Journal of Ophthalmology
• Thecorneaisthetransparentconnectivetissue windowatthefrontoftheeye.Thephysiologicalroleof theco... more • Thecorneaisthetransparentconnectivetissue windowatthefrontoftheeye.Thephysiologicalroleof thecorneaistoconductexternallightintotheeye,focus it,togetherwiththelens,ontotheretina,andtoprovide rigiditytotheentireeyeball.Therefore,goodvision requiresmaintenanceofthetransparencyandproper refractiveshapeofthecornea.Thesurfacestructures irregularities can be associated with wavefront aberrationsandscatteringerrors.Lightscatteringinthe humancorneacausesareductionofvisualquality.In fact,thecorneamustbetransparentandmaintaina smoothandstablecurvaturesinceitcontributestothe majorpartofthefocusingpoweroftheeye.Inmost cases,asimpleexaminationofvisualacuitycannot demonstratethereductionofvisualqualitysecondary lightscattering.Infact,clinicaltechniquesforexamining thehumancornea havegreatlyexpandedoverthe lastfewdecades.Themeasurementofcornealback scatteringqualifiesthedegreeofcornealtransparency. The measurement of corneal forward-scattering quantifiestheamountofvisualimpairmentthat is producedbythealterationoftransparency.Theaimof thisstudywastoreviewscatteringinthehumancornea andmethodsofmeasuringit.
Clinical Ophthalmology, 2016
Collagen cross-linking (CXL) is a relatively new conservative approach for progressive corneal ec... more Collagen cross-linking (CXL) is a relatively new conservative approach for progressive corneal ectasia, which is able to strengthen corneal tissue reforming new covalent bonds. Subjective and objective results following this method seem to be promising. In recent years, newer CXL protocols have been developed to perform more effective and less invasive procedures. The increasing diffusion of CXL in the corneal ectatic disease has increased the need to have actual indices regarding the efficacy of the treatment. Evaluation of demarcation line (DL), a transition zone between the cross-linked anterior corneal stroma and the untreated posterior corneal stroma, is considered a measurement of the depth of CXL treatment into the stroma. Some evidence in the literature emphasize that DL could be a measure of effectiveness of the CXL. On the contrary, some authors believe that the "the deeper, the better" principle is rather a simplistic approach for interpreting the clinical importance of the corneal stromal DL.
Current eye research, Jun 13, 2017
To assess aqueous humor antimicrobial activity in vitro after topical 0.5% chloramphenicol applic... more To assess aqueous humor antimicrobial activity in vitro after topical 0.5% chloramphenicol application. 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. 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. Aqueous humor displayed no bactericidal effect against any of the microorganisms evaluated after topical 0.5% chloramphenicol application.
International Ophthalmology, 2016
Posterior keratoconus is a rare corneal anomaly which is part of the ectatic corneal disorders. W... more Posterior keratoconus is a rare corneal anomaly which is part of the ectatic corneal disorders. We report a clinical presentation of a unilateral posterior keratoconus in a 42-year-old man. At the time of presentation, corrected distance visual acuity (CDVA) was 20/20 with a correction of +2.50 +2.50 × 90° in the right eye and 20/40 with +1 +3.00 × 105° in the left eye. Slit lamp microscopy showed in the left eye an evidence of corneal thinning with a mild anterior protrusion and a remarkable posterior excavation. The intraocular pressure was 19 mmHg in right eye and 16 mmHg in left eye. Ultrasound pachymetry showed a minimum corneal thickness of 556 μ in right eye and 289 μ in left eye. The anterior segment optical coherence tomography (AS-OCT) revealed central corneal thinning and showed a reduced epithelial thickness. Videokeratography showed an increase of the corneal curvature in a defined area with central steepening in the area of the posterior corneal depression with gradual paracentral flattening. The description of this case underlines the importance of this instruments such us AS-OCT and corneal topography in diagnosis of posterior keratoconus. It can also be observed that in the contralateral eye there are no signs of ectasia as in the rare condition of unilateral keratoconus.
Journal of Ophthalmology, 2016
Canaloplasty is a nonpenetrating blebless surgical technique for open-angle glaucoma, in which a ... more Canaloplasty is a nonpenetrating blebless surgical technique for open-angle glaucoma, in which a flexible microcatheter is inserted within Schlemm’s 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.
Graefe S Archive For Clinical and Experimental Ophthalmology, 1997
... Leopoldo Spadea Guido Bianco Tommaso Dragani Emilio Balestrazzi Early detection of P-VEP and ... more ... Leopoldo Spadea Guido Bianco Tommaso Dragani Emilio Balestrazzi Early detection of P-VEP and PERG changes ... Methods: We stud-ied 50 OGD patients who were in a range between class 2 and class 5 ac-cording to the Donaldson-American Thyroid Association ...
J Refract Surg, 2009
To evaluate the usefulness of intraoperative computerized corneal topographic data in excimer las... more To evaluate the usefulness of intraoperative computerized corneal topographic data in excimer laser-assisted lamellar keratoplasty (ELLK) and penetrating keratoplasty (PK). Prospective, comparative, interventional case series. Intra- and postoperative videokeratography (Keratron Scout) evaluation was performed on 30 eyes of 30 consecutive patients affected by keratoconus (16 men and 14 women; mean age 32.63±8.02 years) submitted to ELLK (15 eyes) using 16 interrupted 10-0 nylon stitches or to PK (15 eyes) using a 12-bite 10-0 nylon double-running continuous suture. In the ELLK group, the mean intraoperative keratometric astigmatism was 12.06±4.86 diopters (D), which changed to 5.19±2.51 D after topography-guided intraoperative suture adjustment. In the PK group, intraoperative keratometric astigmatism was 10.18±3.88 D, which changed to 3.49±0.41 D. After 24 months (sutures out), the mean videokeratographic keratometric astigmatism was 3.35±1.96 D in the ELLK group and 3.37±0.92 D in the PK group. The Alpins method of vector analysis showed some significant changes especially in the ELLK group. In keratoplasty surgery, videokeratography is useful for suture adjustment. In the PK group, using a double-running suture technique, the postoperative astigmatism (after all sutures were removed) was similar to the astigmatism measured intraoperatively by videokeratography.
Uploads
Papers by leopoldo spadea