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1. Effect of COVID-19-related lockdown on ophthalmic practice in Italy: A report from 39 institutional centers

Author

Roberto dell’Omo, Mariaelena Filippelli, Gianni Virgili, Francesco Bandello, Giuseppe Querques, Paolo Lanzetta, Teresio Avitabile, Francesco Viola, Michele Reibaldi, Francesco Semeraro, Luciano Quaranta, Stanislao Rizzo, Edoardo Midena, Giuseppe Campagna, Ciro Costagliola, Paola Marolo, Carlo Enrico Traverso, Michele Iester, Carlo Alberto Cutolo, Claudio Azzolini, Simone Donati, Elias Premi, Paolo Nucci, Stela Vujosevic, Giovanni Staurenghi, Ferdinando Bottoni, Francesco Romano, Domenico Grosso, Enrico Borrelli, Riccardo Sacconi, Paolo Milella, Simone Ganci, Mario R. Romano, Gabriella Ricciardelli, Davide Allegrini, Marco Casaluci, Davide Romano, Giorgio Marchini, Francesca Chemello, Camilla Amantea, Rino Frisina, Elisabetta Pilotto, Raffaele Parrozzani, Daniele Veritti, Valentina Sarao, Tognetto Daniele, Massimo Busin, Francesco Parmeggiani, Katia De Nadai, Luca Furiosi, Rodolfo Mastropasqua, Bruno Battaglia, Matteo Gironi, Stefano Gandolfi, Enrico Luciani, Paolo Mora, Costantino Schiavi, Patrizia Bertaccini, Alessandro Finzi, Matilde Roda, Carlo Cagini, Marco Lupidi, Fabrizio Giansanti, Daniela Bacherini, Gianmarco Tosi, Elena De Benedetto, Marco Nardi, Michele Figus, Chiara Posarelli, Cesare Mariotti, Vittorio Pirani, Michele Nicolai, Stefano Bonini, Marco Coassin, Antonio Di Zazzo, Mariacristina Savastano, Alfonso Savastano, Gloria Gambini, Umberto De Vico, Leopoldo Spadea, Andrea Iannaccone, Carlo Nucci, Federico Ricci, Francesco Aiello, Gabriele Gallo Afflitto, Leonardo Mastropasqua, Giada D’Onofio, Federica Evangelista, Lorenza Brescia, Pasquale Napolitano, Paolo Polisena, Nicolina Gianfrancesco, Domenico Trivisonno, Francesco Petti, Francesca Simonelli, Settimio Rossi, Antonio Tartaglione, Nicola Rosa, Maddalena De Bernardo, Cristiana Iaculli, Anna Valeria Bux, Giulia Maggiore, Francesco Boscia, Giancarlo Sborgia, Maria Oliva Grassi, Vincenzo Scorcia, Giuseppe Giannaccare, Guglielmo Parisi, Salvatore Cillino, Francesco Alaimo, Pasquale Aragona, Alessandro Meduri, Antonio Pinna, Andrea Sollazzo, Enrico Peiretti, Emanuele Siotto, dell’Omo, Roberto, Filippelli, Mariaelena, Virgili, Gianni, Bandello, Francesco, Querques, Giuseppe, Lanzetta, Paolo, Avitabile, Teresio, Viola, Francesco, Reibaldi, Michele, Semeraro, Francesco, Quaranta, Luciano, Rizzo, Stanislao, Midena, Edoardo, Campagna, Giuseppe, Costagliola, Ciro, Marolo, Paola, Traverso, Carlo Enrico, Iester, Michele, Cutolo, Carlo Alberto, Azzolini, Claudio, Donati, Simone, Premi, Elia, Nucci, Paolo, Vujosevic, Stela, Staurenghi, Giovanni, Bottoni, Ferdinando, Romano, Francesco, Grosso, Domenico, Borrelli, Enrico, Sacconi, Riccardo, Milella, Paolo, Ganci, Simone, Romano, Mario R., Ricciardelli, Gabriella, Allegrini, Davide, Casaluci, Marco, Romano, Davide, Marchini, Giorgio, Chemello, Francesca, Amantea, Camilla, Frisina, Rino, Pilotto, Elisabetta, Parrozzani, Raffaele, Veritti, Daniele, Sarao, Valentina, Daniele, Tognetto, Busin, Massimo, Parmeggiani, Francesco, De Nadai, Katia, Furiosi, Luca, Mastropasqua, Rodolfo, Battaglia, Bruno, Gironi, Matteo, Gandolfi, Stefano, Luciani, Enrico, Mora, Paolo, Schiavi, Costantino, Bertaccini, Patrizia, Finzi, Alessandro, Roda, Matilde, Cagini, Carlo, Lupidi, Marco, Giansanti, Fabrizio, Bacherini, Daniela, Tosi, Gianmarco, De Benedetto, Elena, Nardi, Marco, Figus, Michele, Posarelli, Chiara, Mariotti, Cesare, Pirani, Vittorio, Nicolai, Michele, Bonini, Stefano, Coassin, Marco, Di Zazzo, Antonio, Savastano, Mariacristina, Savastano, Alfonso, Gambini, Gloria, Vico, Umberto De, Spadea, Leopoldo, Iannaccone, Andrea, Nucci, Carlo, Ricci, Federico, Aiello, Francesco, Afflitto, Gabriele Gallo, Mastropasqua, Leonardo, D’Onofio, Giada, Evangelista, Federica, Brescia, Lorenza, Napolitano, Pasquale, Polisena, Paolo, Gianfrancesco, Nicolina, Trivisonno, Domenico, Petti, Francesco, Simonelli, Francesca, Rossi, Settimio, Tartaglione, Antonio, Rosa, Nicola, Bernardo, Maddalena De, Iaculli, Cristiana, Valeria Bux, Anna, Maggiore, Giulia, Boscia, Francesco, Sborgia, Giancarlo, Grassi, Maria Oliva, Scorcia, Vincenzo, Giannaccare, Giuseppe, Parisi, Guglielmo, Cillino, Salvatore, Alaimo, Francesco, Aragona, Pasquale, Meduri, Alessandro, Pinna, Antonio, Sollazzo, Andrea, Peiretti, Enrico, Siotto, Emanuele, Dell'Omo, R., Filippelli, M., Virgili, G., Bandello, F., Querques, G., Lanzetta, P., Avitabile, T., Viola, F., Reibaldi, M., Semeraro, F., Quaranta, L., Rizzo, S., Midena, E., Campagna, G., Costagliola, C., Marolo, P., Traverso, C. E., Iester, M., Cutolo, C. A., Azzolini, C., Donati, S., Premi, E., Nucci, P., Vujosevic, S., Staurenghi, G., Bottoni, F., Romano, F., Grosso, D., Borrelli, E., Sacconi, R., Milella, P., Ganci, S., Romano, M. R., Ricciardelli, G., Allegrini, D., Casaluci, M., Romano, D., Marchini, G., Chemello, F., Amantea, C., Frisina, R., Pilotto, E., Parrozzani, R., Veritti, D., Sarao, V., Daniele, T., Busin, M., Parmeggiani, F., De Nadai, K., Furiosi, L., Mastropasqua, R., Battaglia, B., Gironi, M., Gandolfi, S., Luciani, E., Mora, P., Schiavi, C., Bertaccini, P., Finzi, A., Roda, M., Cagini, C., Lupidi, M., Giansanti, F., Bacherini, D., Tosi, G., De Benedetto, E., Nardi, M., Figus, M., Posarelli, C., Mariotti, C., Pirani, V., Nicolai, M., Bonini, S., Coassin, M., Di Zazzo, A., Savastano, M., Savastano, A., Gambini, G., Vico, U. D., Spadea, L., Iannaccone, A., Nucci, C., Ricci, F., Aiello, F., Afflitto, G. G., Mastropasqua, L., D'Onofio, G., Evangelista, F., Brescia, L., Napolitano, P., Polisena, P., Gianfrancesco, N., Trivisonno, D., Petti, F., Simonelli, F., Rossi, S., Tartaglione, A., Rosa, N., Bernardo, M. D., Iaculli, C., Valeria Bux, A., Maggiore, G., Boscia, F., Sborgia, G., Grassi, M. O., Scorcia, V., Giannaccare, G., Parisi, G., Cillino, S., Alaimo, F., Aragona, P., Meduri, A., Pinna, A., Sollazzo, A., Peiretti, E., and Siotto, E.

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Trauma, phacoemulsification, glaucoma, retinal detachment, choroidal neovascular membranes, venous occlusive disease, corneal transplantation, Trauma, choroidal neovascular membranes, retinal detachment, Retrospective Studie, Settore MED/30, medicine, Retrospective analysis, choroidal neovascular membrane, Humans, venous occlusive disease, Retrospective Studies, corneal transplantation, glaucoma, phacoemulsification, Communicable Disease Control, SARS-CoV-2, COVID-19, Retinal Detachment, Settore MED/30 - Malattie Apparato Visivo, business.industry, Retinal detachment, General Medicine, Phacoemulsification, Surgical procedures, medicine.disease, Surgery, Ophthalmology, business, trauma, Human
Abstract

Background/objectives: To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control). Methods: Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value Results: A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65–0.80 and 0.61–0.75, respectively, p Conclusion: This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.

Published
2022

2. One week of levofloxacin plus dexamethasone eye drops for cataract surgery: an innovative and rational therapeutic strategy

Author

Bandello, Francesco, Coassin, Marco, Di Zazzo, Antonio, Rizzo, Stanislao, Biagini, Ilaria, Pozdeyeva, Nadezhda, Sinitsyn, Maksim, Verzin, Alexander, De Rosa, Pasquale, Calabrò, Francesco, Avitabile, Teresio, Bonfiglio, Vincenza, Fasce, Francesco, Barraquer, Rafael, Mateu, Josè Lamarca, Kohnen, Thomas, Carnovali, Marino, Malyugin, Boris, Pasquale, Aragona, Paolo, Arvedi, Carlo, Cagini, Luigi, Caretti, Gian Maria Cavallini, Salvatore, Cillino, Innocente, Figini, Livio Marco Franco, Alberto La Mantia, Antonio, Laborante, Paolo, Lanzetta, Mattia, Marcigaglia, Cesare, Mariotti, Enrico, Martini, Leonardo, Mastropasqua, Simonetta, Morselli, Franco, Passani, Alfredo, Pece, Grazia, Pertile, Antonino, Pioppo, Cesare, Pirondini, Marcello, Prantera, Antonio, Rapisarda, Romano, Mario R., Giuseppe, Scarpa, Domenico, Schiano-Lomoriello, Vincenzo, Scorcia, Gianluca, Scuderi, Francesco, Semeraro, Franco, Spedale, Giovanni, Staurenghi, Tognetto, Daniele, Marco, Tosi, Giuseppe, Trabucchi, Fausto, Trivella, Edoardo, Villani, Andrea, Vento, Paolo, Vinciguerra, Alió, Jorge L., Alfonso Sanchez, Josè F., Francisco Arnalich Montiel, Katrin, Lorenz, Irina, Panova, Alena, Eremina, Giorgio, Ciprandi, Bandello F., Coassin M., Di Zazzo A., Rizzo S., Biagini I., Pozdeyeva N., Sinitsyn M., Verzin A., De Rosa P., Calabro F., Avitabile T., Bonfiglio V., Fasce F., Barraquer R., Mateu J.L., Kohnen T., Carnovali M., Malyugin B., Aragona P., Arvedi P., Cagini C., Caretti L., Cavallini G.M., Cillino S., Figini I., Franco L.M., La Mantia A., Laborante A., Lanzetta P., Marcigaglia M., Mariotti C., Martini E., Mastropasqua L., Morselli S., Passani F., Pece A., Pertile G., Pioppo A., Pirondini C., Prantera M., Rapisarda A., Romano M.R., Scarpa G., Schiano-Lomoriello D., Scorcia V., Scuderi G., Semeraro F., Spedale F., Staurenghi G., Tognetto D., Tosi M., Trabucchi G., Trivella F., Villani E., Vento A., Vinciguerra P., Alio J.L., Alfonso Sanchez J.F., Montiel F.A., Lorenz K., Panova I., Eremina A., Ciprandi G., Francesco, Bandello, Marco, Coassin, Antonio, Di Zazzo, Stanislao, Rizzo, Ilaria, Biagini, Nadezhda, Pozdeyeva, Maksim, Sinitsyn, Alexander, Verzin, Pasquale, De Rosa, Francesco, Calabrò, Teresio, Avitabile, Vincenza, Bonfiglio, Francesco, Fasce, Rafael, Barraquer, Josè Lamarca, Mateu, Thomas, Kohnen, Marino, Carnovali, Boris, Malyugin, Aragona, Pasquale, Arvedi, Paolo, Cagini, Carlo, Caretti, Luigi, Maria Cavallini, Gian, Cillino, Salvatore, Figini, Innocente, Marco Franco, Livio, La Mantia, Alberto, Laborante, Antonio, Lanzetta, Paolo, Marcigaglia, Mattia, Mariotti, Cesare, Martini, Enrico, Mastropasqua, Leonardo, Morselli, Simonetta, Passani, Franco, Pece, Alfredo, Pertile, Grazia, Pioppo, Antonino, Pirondini, Cesare, Prantera, Marcello, Rapisarda, Antonio, Romano, Mario R., Scarpa, Giuseppe, Schiano-Lomoriello, Domenico, Scorcia, Vincenzo, Scuderi, Gianluca, Semeraro, Francesco, Spedale, Franco, Staurenghi, Giovanni, Tognetto, Daniele, Tosi, Marco, Trabucchi, Giuseppe, Trivella, Fausto, Villani, Edoardo, Vento, Andrea, Vinciguerra, Paolo, Alió, Jorge L., Alfonso Sanchez, Josè F., Arnalich Montiel, Francisco, Lorenz, Katrin, Panova, Irina, Eremina, Alena, Ciprandi, Giorgio, Bandello, F., Coassin, M., Di Zazzo, A., Rizzo, S., Biagini, I., Pozdeyeva, N., Sinitsyn, M., Verzin, A., De Rosa, P., Calabro, F., Avitabile, T., Bonfiglio, V., Fasce, F., Barraquer, R., Mateu, J. L., Kohnen, T., Carnovali, M., Malyugin, B., Aragona, P., Arvedi, P., Cagini, C., Caretti, L., Cavallini, G. M., Cillino, S., Figini, I., Franco, L. M., La Mantia, A., Laborante, A., Lanzetta, P., Marcigaglia, M., Mariotti, C., Martini, E., Mastropasqua, L., Morselli, S., Passani, F., Pece, A., Pertile, G., Pioppo, A., Pirondini, C., Prantera, M., Rapisarda, A., Romano, M. R., Scarpa, G., Schiano-Lomoriello, D., Scorcia, V., Scuderi, G., Semeraro, F., Spedale, F., Staurenghi, G., Tognetto, D., Tosi, M., Trabucchi, G., Trivella, F., Villani, E., Vento, A., Vinciguerra, P., Alio, J. L., Alfonso Sanchez, J. F., Montiel, F. A., Lorenz, K., Panova, I., Eremina, A., and Ciprandi, G.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Levofloxacin, Article, Dexamethasone, Cataract, 03 medical and health sciences, 0302 clinical medicine, Endophthalmitis, Pharmacotherapy, Postoperative Complications, Internal medicine, medicine, Tobramycin, Clinical endpoint, Humans, Endophthalmitis, Cataract, Intracameral cefuroxime, Adverse effect, business.industry, Cataract surgery, Intracameral cefuroxime, medicine.disease, not applicable, Anti-Bacterial Agents, Ophthalmology, Italy, Spain, 030221 ophthalmology & optometry, Ophthalmic Solutions, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background: Cataract surgery is the most common operation performed worldwide. A fixed topical corticosteroid-antibiotic combination is usually prescribed in clinical practice for 2 or more weeks to treat post surgical inflammation and prevent infection. However, this protracted schedule may increase the incidence of corticosteroid-related adverse events and notably promote antibiotic resistance. Methods: This International, multicentre, randomized, blinded-assessor, parallel-group clinical study evaluated the non-inferiority of 1-week levofloxacin/dexamethasone eye drops, followed by 1-week dexamethasone alone, vs. 2-week gold-standard tobramycin/dexamethasone (one drop QID for all schedules) to prevent and treat ocular inflammation and prevent infection after uncomplicated cataract surgery. Non-inferiority was defined as the lower limit of the 95% confidence interval (CI) around a treatment difference >–10%. The study randomized 808 patients enrolled in 53 centres (Italy, Germany, Spain and Russia). The primary endpoint was the proportion of patients without anterior chamber inflammation on day 15 defined as the end of treatment. Endophthalmitis was the key secondary endpoint. This study is registered with EudraCT code: 2018-000286-36. Results: After the end of treatment, 95.2% of the patients in the test arm vs. 94.9% of the control arm had no signs of inflammation in the anterior chamber (difference between proportions of patients = 0.028; 95% CI: −0.0275/0.0331). No case of endophthalmitis was reported. No statistically significant difference was evident in any of the other secondary endpoints. Both treatments were well tolerated. Conclusions: Non-inferiority of the new short pharmacological strategy was proven. One week of levofloxacin/dexamethasone prevents infection, ensures complete control of inflammation in almost all patients and may contain antibiotic resistance.

Published
2020

3. Macular peeling-induced retinal damage: clinical and histopathological evaluation after using different dyes

Author

Cesare Mariotti, Mario R. Romano, Mariantonia Ferrara, Giovanni Cennamo, Gilda Cennamo, Stefania Staibano, Gennaro Ilardi, Barbara Parolini, Romano, Mario R., Ilardi, Gennaro, Ferrara, Mariantonia, Cennamo, Gilda, Parolini, Barbara, Mariotti, Cesare, Staibano, Stefania, and Cennamo, Giovanni

Subjects
Male, Retinal Ganglion Cells, Time Factors, Visual acuity, genetic structures, Basement Membrane, chemistry.chemical_compound, 0302 clinical medicine, Vitrectomy, Prospective Studies, Fluorescein Angiography, Coloring Agents, Intraoperative Complications, Aged, 80 and over, Glial fibrillary acidic protein, biology, Inner limiting membrane, Middle Aged, Immunohistochemistry, Sensory Systems, medicine.anatomical_structure, Female, Trypan blue, Epiretinal membrane, medicine.symptom, Pars plana, medicine.medical_specialty, Neurofilament, Dye, Fundus Oculi, Ependymoglial Cells, 03 medical and health sciences, Cellular and Molecular Neuroscience, Ophthalmology, medicine, Humans, Neurofilament protein, Aged, business.industry, Müller cell, Pars plana vitrectomy, Macular peeling, medicine.disease, eye diseases, chemistry, 030221 ophthalmology & optometry, biology.protein, sense organs, Sensory System, business, Indocyanine green, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

Purpose: To describe functional and histopathological findings after macular peeling using different dyes. Methods: Prospective, randomized, comparative, interventional, and immunohistochemical study. Forty-five eyes from 45 patients with idiopathic epiretinal membrane (ERM) underwent pars plana chromovitrectomy with ERM and inner limiting membrane (ILM) using trypan blue 0.15% + brilliant blue 0.05% + lutein 2% in group 1 (15 eyes), trypan blue 0.15% + brilliant blue 0.025% + polyethylene glycol 3350 4% in group 2 (15 eyes), and indocyanine green 0.05% in group 3 (15 eyes). We evaluated visual acuity (VA) and macular sensitivity (MS) preoperatively, 1, 3, and 6 months after surgery. The expression of glial fibrillary acidic protein (GFAP) and neurofilament protein (NF) was assessed immunohistochemically on the ILMs peeled as markers of glial and neuronal cells. Results: In group 1, both mean VA and MS were significantly better at 1 and 3 months after surgery (P < 0.05), whereas no significant difference was found after 6 months. GFAP and NF expression was significantly lower in group 1 (P < 0.05). Conclusions: The ERM/ILM peeling is thought to rip off the intraretinal tissue, based on the amounts of GFAP and NF in the specimens. The use of lutein dyes reduces iatrogenic stress to the retinal tissue and allows a faster functional recovery in the first 3 months after surgery, suggesting a less iatrogenic adhesion to the retinal tissue

Published
2018

4. Multilayer Microstructure of Idiopathic Epiretinal Macular Membranes

Author

Simona Maria Caprani, Jennifer Cattaneo, Petra Rita Basso, Claudio Azzolini, Riccardo Vinciguerra, Eliana Piantanida, Terenzio Congiu, Simone Donati, Cesare Mariotti, Alberto Passi, Francesco Testa, Azzolini, Claudio, Congiu, Terenzio, Donati, Simone, Passi, Alberto, Basso, Petra, Piantanida, Eliana, Mariotti, Cesare, Testa, Francesco, Caprani, Simona M., Cattaneo, Jennifer, and Vinciguerra, Riccardo

Subjects
Male, 0301 basic medicine, Collagen, Epiretinal membrane, Gliosis, Scanning electron microscopy, Microscope, Materials science, Scanning electron microscope, Basement Membrane, Retina, law.invention, 03 medical and health sciences, 0302 clinical medicine, Epiretinal membrane, law, Vitrectomy, Stereo microscope, medicine, Humans, Gliosis, Aged, Basement membrane, Gliosi, Soft tissue, Inner limiting membrane, General Medicine, Middle Aged, medicine.disease, Ophthalmology, 030104 developmental biology, medicine.anatomical_structure, Membrane, Microscopy, Electron, Scanning, 030221 ophthalmology & optometry, Female, Collagen, Scanning electron microscopy, Biomedical engineering
Abstract

Purpose: To identify the ultramicroscopic structure of idiopathic epiretinal macular membranes (iEMMs) by scanning electron microscopy (SEM). Methods: We examined 28 iEMMs surgically removed from 28 eyes of 28 patients. All specimens, previously observed at stereomicroscope, were treated with an osmium maceration technique. Fine resolution of iEMMs’ 3D architecture and their interaction with the retina were studied using a Philips SEM-FEG XL-30 microscope. Results: The specimens appeared as laminar connective structures partially or completely adherent to the inner limiting membrane (ILM). We identified 4 types of structures: (1) distinct layers of thin sheets of woven fibers; (2) folded layers of inhomogeneous thickness of fibrous material more consistent; (3) thicker and more rigid layers recognizable as collagen fibrils with typical 64-nm period, collagen fibrils isolated or intermingled between them; (4) lacunar structures with inflammatory and/or necrotic material. The first 3 types of structures appear to thicken towards a centripetal direction from the ILM to the vitreous in order from 1 to 3. The interface of ILM-iEMM tissue shows particular small bridges of connection. Cells are rarely found, especially in the tissue near the ILM. Conclusions: Layers of various materials follow one another in iEMMs. Cells are rarely found. The interface ILMiEMM tissue shows particular small bridges of connection. The dynamic modeling of bended layers begins in soft tissue. Purpose: To identify the ultramicroscopic structure of idiopathic epiretinal macular membranes (iEMMs) by scanning electron microscopy (SEM). Methods: We examined 28 iEMMs surgically removed from 28 eyes of 28 patients. All specimens, previously observed at stereomicroscope, were treated with an osmium maceration technique. Fine resolution of iEMMs’ 3D architecture and their interaction with the retina were studied using a Philips SEM-FEG XL-30 microscope. Results: The specimens appeared as laminar connective structures partially or completely adherent to the inner limiting membrane (ILM). We identified 4 types of structures: (1) distinct layers of thin sheets of woven fibers; (2) folded layers of inhomogeneous thickness of fibrous material more consistent; (3) thicker and more rigid layers recognizable as collagen fibrils with typical 64-nm period, collagen fibrils isolated or intermingled between them; (4) lacunar structures with inflammatory and/or necrotic material. The first 3 types of structures appear to thicken towards a centripetal direction from the ILM to the vitreous in order from 1 to 3. The interface of ILM-iEMM tissue shows particular small bridges of connection. Cells are rarely found, especially in the tissue near the ILM. Conclusions: Layers of various materials follow one another in iEMMs. Cells are rarely found. The interface ILMiEMM tissue shows particular small bridges of connection. The dynamic modeling of bended layers begins in soft tissue.

Published
2017

5. Optical Coherence Tomography Angiography Findings in X-Linked Retinoschisis

Author

Rodolfo Mastropasqua, Lisa Toto, Luca Di Antonio, Ivana Antonucci, Luca Sorino, Maurizio Battaglia Parodi, Cesare Mariotti, Liborio Stuppia, Marta Di Nicola, Mastropasqua, Rodolfo, Toto, Lisa, Di Antonio, Luca, Parodi, Maurizio Battaglia, Sorino, Luca, Antonucci, Ivana, Stuppia, Liborio, Di Nicola, Marta, and Mariotti, Cesare

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Visual acuity, Adolescent, Fundus Oculi, Retinoschisis, Visual Acuity, Retina, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Ophthalmology, Electroretinography, medicine, Humans, Fluorescein Angiography, Child, medicine.diagnostic_test, business.industry, Healthy subjects, Retinal, Optical coherence tomography angiography, Female, Middle Aged, Pedigree, Tomography, Optical Coherence, 030104 developmental biology, medicine.anatomical_structure, chemistry, 030221 ophthalmology & optometry, Surgery, X-linked retinoschisis, Retinoschisi, medicine.symptom, Acetazolamide, business, Tomography, Optical Coherence, Human, medicine.drug
Abstract

BACKGROUND AND OBJECTIVE: The aim of the study was to determine optical coherence tomography angiography (OCTA) findings and to identify mutations in the RS1 gene in a three-generation family with X-linked juvenile retinoschisis (XLRS). PATIENTS AND METHODS: Clinical and genetic assessments were performed in 12 family members. OCTA was performed at baseline (12 members including cases and carriers) and after acetazolamide administration (three cases). Twenty healthy subjects (20 eyes, controls) were chosen for comparison. Molecular genetic analysis of the RS1 gene was performed in all family members. RESULTS: Deep capillary plexus density was reduced in cases compared with controls ( P < .01) and was negatively related with retinal thickness ( P < .05). After treatment, retinal thickness decreased ( P < .05) and deep capillary plexus density increased ( P < .05) in cases. In three cases and in four carriers, p.Arg197 His mutation was found. CONCLUSION: OCTA shows reduced macular deep vessel density in patients with XLRS probably related to vessel displacement and disruption due to schitic cysts. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:e20–e31.]

Published
2018

6. LATE-ONSET OCULAR HYPERTENSION AFTER VITRECTOMY: A Multicenter Study of 6,048 Eyes

Author

Francesco Boscia, Antonio Longo, Matteo Fallico, Cesare Mariotti, Gilda Cennamo, Teresio Avitabile, Giovanni Li Volti, Andrea Russo, Vincenza Bonfiglio, Guglielmo Parisi, Claudio Bucolo, Mario R. Romano, Niccolò Castellino, Michele Reibaldi, Reibaldi, Michele, Avitabile, Teresio, Russo, Andrea, Bonfiglio, Vincenza, Mariotti, Cesare, Romano, Mario R, Boscia, Francesco, Cennamo, Gilda, Fallico, Matteo, Parisi, Guglielmo, Castellino, Niccolò, Bucolo, Claudio, Li Volti, Giovanni, Longo, Antonio, Reibaldi M., Avitabile T., Russo A., Bonfiglio V., Mariotti C., Romano M.R., Boscia F., Cennamo G., Fallico M., Parisi G., Castellino N., Bucolo C., Li Volti G., and Longo A.

Subjects
Male, Pediatrics, medicine.medical_specialty, Time Factors, medicine.medical_treatment, MEDLINE, Ocular hypertension, Vitrectomy, Late onset, 01 natural sciences, 03 medical and health sciences, 0302 clinical medicine, Retinal Diseases, Risk Factors, Humans, Medicine, Intraocular Pressure, Aged, Retrospective Studies, business.industry, Incidence, Medical record, Incidence (epidemiology), Retrospective cohort study, General Medicine, medicine.disease, 0104 chemical sciences, 010404 medicinal & biomolecular chemistry, Ophthalmology, Italy, Multicenter study, 030221 ophthalmology & optometry, Female, Ocular Hypertension, business, late-onset ocular hypertension, Follow-Up Studies
Abstract

Purpose: To determine the incidence and risk factors for late-onset ocular hypertension (LOH) after vitrectomy. Methods: From the electronic medical records of consecutive patients who underwent primary vitrectomy, from January 2010 to December 2015, at 5 tertiary vitreoretinal centers in Italy, patient demographics, systemic, ophthalmic, operative, and postoperative data were drawn. Main outcome measure was the presence of LOH, defined as intraocular pressure >21 mmHg detected more than 2 months after vitrectomy on at least 2 consecutive visits. Results: Among 6,048 patients, LOH was found in 294 (4.9%) vitrectomized eyes and in 87 (1.4%) fellow eyes, (chi square; P < 0.001). Multivariable logistic regression showed that significant risk factors for developing LOH included intraoperative triamcinolone use (odds ratio [OR], 7.62; P < 0.001), longer axial length (OR, 1.55; P = 3.023), preoperative higher intraocular pressure (OR, 1.81; P = 0.003), and postvitrectomy pseudophakic/aphakic status (OR, 2.04; P < 0.001). Decision-tree analysis showed that the stronger predictor of LOH was intraoperative triamcinolone use (P < 0.001). Secondary predictors were a preoperative intraocular pressure more than 15 mmHg (P < 0.001) in eyes that use triamcinolone, and postvitrectomy pseudophakic/aphakic status (P = 0.007) in eyes that did not use triamcinolone. Conclusion: Late-onset ocular hypertension occurred in 4.9% of vitrectomized eyes. The main risk factors were intraoperative use of triamcinolone and postvitrectomy pseudophakic/aphakic status.

Published
2018

7. miRNAs in the vitreous humor of patients affected by idiopathic epiretinal membrane and macular hole

Author

Russo A, Ragusa M, Barbagallo C, Longo A, Avitabile T, Uva MG, Bonfiglio V, Toro M, Caltabiano R, Mariotti C, Boscia F, Romano MR, Di Pietro C, Barbagallo D, Purrello M, Reibaldi M, Russo, Andrea, Ragusa, Marco, Barbagallo, Cristina, Longo, Antonio, Avitabile, Teresio, Uva, Maurizio G, Bonfiglio, Vincenza, Toro, Mario D, Caltabiano, Rosario, Mariotti, Cesare, Boscia, Francesco, Romano, Mario R, Di Pietro, Cinzia, Barbagallo, Davide, Purrello, Michele, Reibaldi, Michele, Russo, A, Ragusa, M, Barbagallo, C, Longo, A, Avitabile, T, Uva, Mg, Bonfiglio, V, Toro, M, Caltabiano, R, Mariotti, C, Boscia, F, Romano, Mr, Di Pietro, C, Barbagallo, D, Purrello, M, and Reibaldi, M

Subjects
Male, Multidisciplinary, lcsh:R, lcsh:Medicine, Correction, Down-Regulation, Epiretinal Membrane, Middle Aged, Retinal Perforations, Vitreous Body, MicroRNAs, Vitrectomy, Humans, lcsh:Q, Female, Prospective Studies, lcsh:Science, Transcriptome, miRNA, macular hole
Abstract

The aim of the present study was to assess the expression of miRNAs in the Vitreous Humor (VH) of patients with Macular Hole (MH) and Epiretinal Membrane (ERM) compared to a control group.In this prospective, comparative study, 2-ml of VH was extracted from the core of the vitreous chamber in consecutive patients who underwent standard vitrectomy for ERM and MH. RNA was extracted and TaqMan® Low Density Arrays (TLDAs) were used to profile the transcriptome of 754 miRNAs. Results were validated by single TaqMan® assays. Finally, we created a biological network of differentially expressed miRNA targets and their nearest neighbors.Overall 10 eyes with MH, 16 eyes with idiopathic ERM and 6 controls were enrolled in the study. Profiling data identified 5 miRNAs differentially expressed in patients affected by MH and ERM with respect to controls. Four were downregulated (miR-19b, miR-24, miR-155, miR-451) and 1 was downregulated (miR-29a); TaqMan® assays of the VH of patients affected by MH and ERM, with respect to controls, showed that the most differentially expressed were miR-19b (FC -9.13, p:0.00004), mir-24 (FC -7.52, p:0.004) and miR-142-3p (FC -5.32, p:0.011). Our network data showed that deregulation of differentially expressed miRNAs induces an alteration of several pathways associated with genes involved in both MH and ERM.The present study suggests that disregulation of miR-19b, miR-24 and miR-142-3p, might be related to the alterations that characterize patients affected by MH and ERM.

Published
2017

8. Macular hole surgery: The healing process of outer retinal layers to visual acuity recovery

Author

Riccardo Vinciguerra, Simone Donati, Luigi Bartalena, Cesare Mariotti, Simona Maria Caprani, Giovanni Porta, Francesco Testa, Claudio Azzolini, Caprani, Simona M., Donati, Simone, Bartalena, Luigi, Vinciguerra, Riccardo, Mariotti, Cesare, Testa, Francesco, Porta, Giovanni, and Azzolini, Claudio

Subjects
Male, Visual acuity, genetic structures, Visual Acuity, Retinal Pigment Epithelium, Idiopathic macular hole, chemistry.chemical_compound, 0302 clinical medicine, Vitrectomy, 80 and over, Postoperative Period, Prospective Studies, Prospective cohort study, Macular hole, Tomography, Aged, 80 and over, medicine.diagnostic_test, Medicine (all), Inner limiting membrane, Epiretinal Membrane, General Medicine, Middle Aged, Macular surgery, medicine.anatomical_structure, Female, Tamponade, medicine.symptom, Tomography, Optical Coherence, medicine.medical_specialty, 03 medical and health sciences, Optical coherence tomography, Ophthalmology, medicine, Outer retinal layers, Aged, Humans, Recovery of Function, Retinal Perforations, Retinal Photoreceptor Cell Inner Segment, Retinal Photoreceptor Cell Outer Segment, Retina, business.industry, Retinal, medicine.disease, Outer retinal layer, eye diseases, Surgery, chemistry, Optical Coherence, 030221 ophthalmology & optometry, sense organs, business, 030217 neurology & neurosurgery
Abstract

Purpose: To evaluate optical coherence tomography (OCT) modifications of outer retinal layers as determinants for functional recovery after surgery for idiopathic macular hole (IMH). Methods: This prospective study included 23 eyes of 23 consecutive patients who underwent vitreoretinal surgery for IMH. We excluded patients with other retinal diseases. Baseline and follow-up evaluations at months 3 and 6 included complete ophthalmologic and instrumental evaluations. Functional evaluation was performed by Best Corrected Visual Acuity (BCVA) and Amsler test. Morphologic evaluation was performed by spectral-domain 3D-OCT (Topcon, Tokyo, Japan) for a deep analysis of retinal layers as well as central retinal thickness evaluation. A standard 23-G or 25-G vitreoretinal surgery was performed, completed by posterior hyaloid and inner limiting membrane peeling by means of vital dyes and gas tamponade. Statistical analysis was performed on collected data. Results: The mean BCVA increased significantly from 0.57 ± 0.25 logMAR at baseline to 0.34 ± 0.22 logMAR at month 6. Intraretinal layers modification showed a progressive recomposition of inner segment/outer segment layer in 91% of patients at month 6. Retinal layers recomposition showed a progressive increase in all patients during follow-up from the immediate postoperative control to the last 6-month visit. Conclusions: Optical coherence tomography examination appears useful to investigate visual recovery after macular hole surgery. To ensure postsurgical functional increase, recomposition of all retinal layers, in particular in the outer retina, is mandatory. This process could be slow and not immediately observable during follow-up examinations. Purpose: To evaluate optical coherence tomography (OCT) modifications of outer retinal layers as determinants for functional recovery after surgery for idiopathic macular hole (IMH). Methods: This prospective study included 23 eyes of 23 consecutive patients who underwent vitreoretinal surgery for IMH. We excluded patients with other retinal diseases. Baseline and follow-up evaluations at months 3 and 6 included complete ophthalmologic and instrumental evaluations. Functional evaluation was performed by Best Corrected Visual Acuity (BCVA) and Amsler test. Morphologic evaluation was performed by spectral-domain 3D-OCT (Topcon, Tokyo, Japan) for a deep analysis of retinal layers as well as central retinal thickness evaluation. A standard 23-G or 25-G vitreoretinal surgery was performed, completed by posterior hyaloid and inner limiting membrane peeling by means of vital dyes and gas tamponade. Statistical analysis was performed on collected data. Results: The mean BCVA increased significantly from 0.57 ± 0.25 logMAR at baseline to 0.34 ± 0.22 logMAR at month 6. Intraretinal layers modification showed a progressive recomposition of inner segment/outer segment layer in 91% of patients at month 6. Retinal layers recomposition showed a progressive increase in all patients during follow-up from the immediate postoperative control to the last 6-month visit. Conclusions: Optical coherence tomography examination appears useful to investigate visual recovery after macular hole surgery. To ensure postsurgical functional increase, recomposition of all retinal layers, in particular in the outer retina, is mandatory. This process could be slow and not immediately observable during follow-up examinations.

Published
2017

9. Correlation of Preoperative Retinal Pigment Epithelium Status with Foveal Microstructure in Repaired Macular Holes

Author

Santo Stella, Caterina Gagliano, Michele Reibaldi, Maurizio G. Uva, Vincenza Bonfiglio, Teresio Avitabile, Alfonso Giovannini, Andrea Saitta, Andrea Russo, Mario Damiano Toro, Antonio Longo, Michele Nicolai, Francesca Viti, Gilda Cennamo, Cesare Mariotti, Reibaldi, M, Avitabile, T, Longo, A, Uva, Mg, Bonfiglio, V, Russo, A., Toro, Md, Stella, S, Giovannini, A, Viti, F, Nicolai, M., Saitta, A, Cennamo, Gilda, Gagliano, C, Mariotti, C., Reibaldi, Michele, Avitabile, Teresio, Longo, Antonio, Giacinto Uva, Maurizio, Bonfiglio, Vincenza, Russo, Andrea, D Toro, Mario, Stella, Santo, Giovannini, Alfonso, Viti, Francesca, Nicolai, Michele, Saitta, Andrea, Gagliano, Caterina, and Mariotti, Cesare

Subjects
Male, Fovea Centralis, medicine.medical_specialty, Visual acuity, genetic structures, medicine.medical_treatment, Visual Acuity, Vitrectomy, Retinal Pigment Epithelium, Optical coherence tomography, Foveal, Ophthalmology, medicine, Humans, Macular hole, Aged, Retrospective Studies, Retinal pigment epithelium, medicine.diagnostic_test, business.industry, Follow up studies, General Medicine, Retinal Perforations, medicine.disease, eye diseases, Sensory Systems, medicine.anatomical_structure, Preoperative Period, Female, sense organs, Tomography, medicine.symptom, business, Tomography, Optical Coherence, Follow-Up Studies
Abstract

Purpose: To investigate, with spectral-domain optical coherence tomography, if the preoperative status of the retinal pigment epithelium (RPE) affects the postoperative foveal morphology and visual outcomes in eyes with surgically closed macular holes (MHs). Methods: In 52 eyes with surgically closed MHs, preoperative RPE morphology was evaluated and graded based on the measurement of the largest hyperreflective protrusions above the RPE line. Foveal microstructural features and best-corrected visual acuity (BCVA) were evaluated 12 months after surgery. Results: At 12 months, a significant correlation was found between postoperative degree of integrity of the photoreceptors with preoperative RPE morphology, and base diameter of the hole (p = 0.003 and p = 0.028, respectively); mean BCVA at 12 months in eyes with diffuse RPE alteration was significantly lower than in eyes with small or no RPE alteration (p < 0.05). Conclusions: Preoperative RPE integrity may be indicative of good photoreceptor restoration and visual recovery in patients with surgically closed MHs.

Published
2014

10. Delayed Suprachoroidal Hemorrhage After Pars Plana Vitrectomy: Five-Year Results of a Retrospective Multicenter Cohort Study

Author

Cesare Mariotti, Antonio Longo, Vincenza Bonfiglio, Teresio Avitabile, Francesco Boscia, Michele Reibaldi, Gilda Cennamo, Mario R. Romano, Reibaldi, Michele, Longo, Antonio, Romano, Mario, Cennamo, Gilda, Mariotti, Cesare, Boscia, Francesco, Bonfiglio, Vincenza, Avitabile, Teresio, Reibaldi M., Longo A., Romano M.R., Cennamo G., Mariotti C., Boscia F., Bonfiglio V., and Avitabile T.

Subjects
Pars plana, Choroid Hemorrhage, Male, medicine.medical_specialty, Time Factors, Time Factor, Fundus Oculi, medicine.medical_treatment, Vitrectomy, Postoperative Hemorrhage, Choroid hemorrhage, Follow-Up Studie, Retrospective Studie, Risk Factors, Ophthalmology, medicine, Humans, Fluorescein Angiography, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Risk Factor, Retinal Detachment, Retinal detachment, Retrospective cohort study, Odds ratio, Middle Aged, Fluorescein angiography, medicine.disease, Surgery, medicine.anatomical_structure, Female, business, Human, Cohort study, Follow-Up Studies
Abstract

Purpose To determine the incidence, risk factors, and outcomes of delayed suprachoroidal hemorrhage after vitrectomy. Design Retrospective multicenter cohort study. Methods All consecutive patients who underwent primary vitrectomy, from January 2009 to December 2014, at 4 tertiary vitreoretinal centers in Italy were enrolled. Patient demographics and systemic, ophthalmic, operative, and postoperative data from all centers were extracted from the electronic record system using standardized data collection forms. All eyes that developed delayed suprachoroidal hemorrhage within 48 hours of the end of the vitrectomy were identified as the delayed suprachoroidal hemorrhage group; all other eyes that underwent vitrectomy in the same period, without delayed suprachoroidal hemorrhage, were considered the control group. Results From a total of 4852 vitrectomy procedures, 39 cases of delayed suprachoroidal hemorrhage (0.8%) were identified. Multivariable logistic regression showed that significant risk factors for developing delayed suprachoroidal hemorrhage included advancing age (odds ratio [OR], 2.22; P

Published
2015

11. Treatment of persistent serous retinal detachment in Vogt-Koyanagi-Harada syndrome with intravitreal bevacizumab during the systemic steroid treatment

Author

Gilda Cennamo, Livio Giulio Marco Franco, Nicola Delle Noci, Andrea Russo, Michele Reibaldi, Cesare Mariotti, Teresio Avitabile, V. Russo, Maurizio G. Uva, Piergiorgio Neri, Antonio Longo, Mario Damiano Toro, Reibaldi, Michele, Russo, Andrea, Avitabile, Teresio, G Uva, Maurizio, Franco, Livio, Longo, Antonio, Toro, mario damiano, Cennamo, Gilda, Mariotti, Cesare, Neri, Piergiorgio, D Noci, Nicola, Russo, Vincenzo, Reibaldi, M, Russo, A, Avitabile, T, Uva, Mg, Franco, L, Longo, A, Toro, Md, Mariotti, C, Neri, P, Noci, Nd, and Russo, V.

Subjects
Adult, Male, medicine.medical_specialty, Visual acuity, genetic structures, Bevacizumab, Systemic steroid, Visual Acuity, Angiogenesis Inhibitors, Antibodies, Monoclonal, Humanized, Serous Retinal Detachment, chemistry.chemical_compound, Ophthalmology, medicine, Humans, Stage (cooking), Intravitreal bevacizumab, Vogt-Koyanagi-Harada syndrome, Analysis of Variance, business.industry, Retinal Detachment, Retinal, General Medicine, Middle Aged, eye diseases, chemistry, Intravitreal Injections, Female, Steroids, medicine.symptom, business, Uveomeningoencephalitic Syndrome, medicine.drug
Abstract

PURPOSE To report the use of bevacizumab in patients with Vogt-Koyanagi-Harada disease and persistent serous retinal detachment during the systemic steroid treatment. METHODS Four patients with bilateral Vogt-Koyanagi-Harada disease with the resolution of ocular inflammation presenting a serous retinal detachment involving the fovea that persisted for at least 1 month, despite systemic corticosteroid treatment, received an intravitreal injection of bevacizumab during the steroid tapering stage. Best-corrected visual acuity, central retinal thickness, and macular sensitivity were evaluated. RESULTS Of 8 eyes, 7 (87%) had complete resolution of subretinal fluid within 1 month following the treatment. After the treatment, the mean best-corrected visual acuity and macular sensitivity improved significantly (P < 0.001, analysis of variance). Compared with baseline, at all measurements, central retinal thickness decreased significantly (P < 0.01, Tukey-Kramer test). At 6 months, a significant correlation was found between best-corrected visual acuity and macular sensitivity in the central 8° (linear regression, r = -0.73; P = 0.03), whereas no correlation was found between central retinal thickness and both best-corrected visual acuity and macular sensitivity. CONCLUSION Intravitreal injection of bevacizumab during the corticosteroid therapy may be a treatment option for patients with decreased visual function because of persistent serous retinal detachment associated with Vogt-Koyanagi-Harada syndrome.

Published
2014

12. Vitreous Substitutes: The Present and the Future

Author

Luigi Bartalena, Francesca Simonelli, Claudio Azzolini, Simone Donati, Cesare Mariotti, Giovanni Porta, Simona Maria Caprani, Giulia Airaghi, Riccardo Vinciguerra, Francesco Testa, Donati, Simone, Caprani, Simona Maria, Airaghi, Giulia, Vinciguerra, Riccardo, Bartalena, Luigi, Testa, Francesco, Mariotti, Cesare, Porta, Giovanni, Simonelli, Francesca, and Azzolini, Claudio

Subjects
medicine.medical_specialty, Materials science, genetic structures, Prostheses and Implant, Immunology and Microbiology (all), medicine.medical_treatment, lcsh:Medicine, Vitrectomy, Biocompatible Materials, Review Article, General Biochemistry, Genetics and Molecular Biology, Vitreous cavity, Smart hydrogels, medicine, Animals, Humans, Biocompatible Material, Biochemistry, Genetics and Molecular Biology (all), General Immunology and Microbiology, Animal, Medicine (all), lcsh:R, General Medicine, Vitreoretinal surgery, Prostheses and Implants, Biocompatible material, eye diseases, Surgery, Vitreous Body, sense organs, Biomedical engineering, Human
Abstract

Vitreoretinal surgery has advanced in numerous directions during recent years. The removal of the vitreous body is one of the main characteristics of this surgical procedure. Several molecules have been tested in the past to fill the vitreous cavity and to mimic its functions. We here review the currently available vitreous substitutes, focusing on their molecular properties and functions, together with their adverse effects. Afterwards we describe the characteristics of the ideal vitreous substitute. The challenges facing every ophthalmology researcher are to reach a long-term intraocular permanence of vitreous substitute with total inertness of the molecule injected and the control of inflammatory reactions. We report new polymers with gelification characteristics and smart hydrogels representing the future of vitreoretinal surgery. Finally, we describe the current studies on vitreous regeneration and cell cultures to create new intraocular gels with optimal biocompatibility and rheological properties. © 2014 Simone Donati et al.

Published
2014

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