Cornea and Ocular Surface Unit

Milano, Italy

Cornea and Ocular Surface Unit

Milano, Italy
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Knutsson K.A.,San Raffaele Scientific Institute | Rama P.,Cornea and Ocular Surface Unit | Paganoni G.,Cornea and Ocular Surface Unit
Acta Ophthalmologica | Year: 2015

Purpose To evaluate the clinical findings and results of manual dissection deep anterior lamellar keratoplasty (DALK) compared to a modified big-bubble DALK technique in eyes affected by keratoconus. Methods Sixty eyes of 60 patients with keratoconus were treated with one of the two surgical techniques manual DALK (n = 30); big-bubble DALK (n = 30). The main outcomes measured were visual acuity, corneal topographic parameters, thickness of residual stroma and endothelial cell density (ECD). Patients were examined postoperatively at 1 month, 6 months, 1 year and 1 month after suture removal. Results Final best spectacle-corrected visual acuity (BSCVA) measured 1 month after suture removal was 0.11 ± 0.08 LogMAR in the big-bubble group compared to 0.13 ± 0.08 in the manual DALK group (p = 0.227). In patients treated with the big-bubble technique without complications (Descemet's membrane completely bared), the stromal residue was not measureable. Mean stromal residual thickness in the manual DALK group was 30.50 ± 27.60 μm. Data analysis of the manual DALK group demonstrated a significant correlation between BSCVA and residual stromal thickness; lower residual stromal thickness correlated with better BSCVA values (Spearman ρ = 0.509, p = 0.018). Postoperative ECD was similar in both groups at all intervals, with no statistically significant differences. In both groups, ECD loss was only significant during the 1- to 6-month interval (p = 0.001 and p < 0.001 in the big-bubble DALK and manual DALK groups, respectively). Conclusion Manual DALK provides comparable results to big-bubble DALK. Big-bubble DALK permits faster visual recovery and is a surgical technique, which can be easily converted to manual DALK in cases of unsuccessful 'big-bubble' formation. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.


Sacchetti M.,Cornea and Ocular Surface Unit | Mantelli F.,GB Bietti Eye Foudation | Lambiase A.,Biomedical University of Rome | Mastropasqua A.,Biomedical University of Rome | And 2 more authors.
British Journal of Ophthalmology | Year: 2014

Aims: Topical ciclosporin A (CsA) is a therapeutic option for dry eye disease (DED) to control ocular surface inflammation and improve tear function. The aim of this study is to systematically review data from randomised clinical trials (RCTs) evaluating efficacy and safety of topical CsA treatment for DED. Methods: Articles published up to December 2012 were identified from Medline, Embase and the Cochrane Controlled Trials Register. A total of 18 RCTs that evaluated the efficacy and safety of different topical CsA formulations for the treatment of DED were selected according to the set criteria. The Jadad score was calculated to assess RCT quality. Results: The mean Jadad score of the included RCTs was 2.8±0.6. All CsA formulations proved safe for the treatment of DED. Symptoms improved in 100% (9/9) RCTs, tear function improved in 72% (13/18) RCTs and ocular surface damage was ameliorated in 53% (9/17) RCTs in patients with DED. No improvements with CsA treatment versus control were observed in DED resulting from surgical procedures, contact lens use and thyroid orbitopathy. Statistical comparison of CsA efficacy through a meta-analysis of data was not possible due to a lack of standardised criteria and comparable outcomes among studies. Conclusions: Although topical CsA appears to be a safe treatment for DED, evidence emerging from RCTs is limited, and this affects the strength of recommendations to healthcare providers and policymakers for optimal management. Standardised diagnostic criteria to assess the efficacy of topical CsA are recommended to improve the design of future RCTs in DED.


PubMed | University of Rome La Sapienza, Temple University, Cornea and Ocular Surface Unit and Biomedical University of Rome
Type: | Journal: BioMed research international | Year: 2015

The iridocorneal endothelial (ICE) syndrome is a rare ocular disorder that includes a group of conditions characterized by structural and proliferative abnormalities of the corneal endothelium, the anterior chamber angle, and the iris. Common clinical features include corneal edema, secondary glaucoma, iris atrophy, and pupillary anomalies, ranging from distortion to polycoria. The main subtypes of this syndrome are the progressive iris atrophy, the Cogan-Reese syndrome, and the Chandler syndrome. ICE syndrome is usually diagnosed in women in the adult age. Clinical history and complete eye examination including tonometry and gonioscopy are necessary to reach a diagnosis. Imaging techniques, such as in vivo confocal microscopy and ultrasound biomicroscopy, are used to confirm the diagnosis by revealing the presence of ICE-cells on the corneal endothelium and the structural changes of the anterior chamber angle. An early diagnosis is helpful to better manage the most challenging complications such as secondary glaucoma and corneal edema. Treatment of ICE-related glaucoma often requires glaucoma filtering surgery with antifibrotic agents and the use of glaucoma drainage implants should be considered early in the management of these patients. Visual impairment and pain associated with corneal edema can be successfully managed with endothelial keratoplasty.


PubMed | Cornea and Ocular Surface Unit, GB Bietti Eye Foudation IRCCS, Biomedical University of Rome and Instituto Superiore Of Sanita Of Rome
Type: Journal Article | Journal: The British journal of ophthalmology | Year: 2014

Topical ciclosporin A (CsA) is a therapeutic option for dry eye disease (DED) to control ocular surface inflammation and improve tear function. The aim of this study is to systematically review data from randomised clinical trials (RCTs) evaluating efficacy and safety of topical CsA treatment for DED.Articles published up to December 2012 were identified from Medline, Embase and the Cochrane Controlled Trials Register. A total of 18 RCTs that evaluated the efficacy and safety of different topical CsA formulations for the treatment of DED were selected according to the set criteria. The Jadad score was calculated to assess RCT quality.The mean Jadad score of the included RCTs was 2.80.6. All CsA formulations proved safe for the treatment of DED. Symptoms improved in 100% (9/9) RCTs, tear function improved in 72% (13/18) RCTs and ocular surface damage was ameliorated in 53% (9/17) RCTs in patients with DED. No improvements with CsA treatment versus control were observed in DED resulting from surgical procedures, contact lens use and thyroid orbitopathy. Statistical comparison of CsA efficacy through a meta-analysis of data was not possible due to a lack of standardised criteria and comparable outcomes among studies.Although topical CsA appears to be a safe treatment for DED, evidence emerging from RCTs is limited, and this affects the strength of recommendations to healthcare providers and policymakers for optimal management. Standardised diagnostic criteria to assess the efficacy of topical CsA are recommended to improve the design of future RCTs in DED.


PubMed | University of Rome La Sapienza, University of Pennsylvania, Cornea and Ocular Surface Unit and Biomedical University of Rome
Type: Journal Article | Journal: Journal of cellular physiology | Year: 2015

Corneal dystrophies are a heterogeneous group of bilateral, inherited, rare diseases characterized by slowly progressive corneal opacities, that lead to visual impairment. Most of them have an autosomal dominant pattern of inheritance with variable expressivity, but new mutations have been described. Many corneal dystrophies have been genetically characterized and the specific gene mutations identified, such as for the epithelial-stromal TGFBI dystrophies. Current classification systems identified four main groups of corneal dystrophies based on clinical, histologic, and genetic information. Diagnosis is performed during a routine ophthalmic examination that shows typical cellular abnormalities of the corneal epithelium, stroma, or endothelium. Disease progression should be carefully monitored to decide the proper clinical management. The treatment of corneal dystrophies is variable, depending on symptoms, clinical course, severity, and type of dystrophy. Management aimed to reduce symptoms and to improve vision, includes different surgical approaches. Novel cellular and genetic therapeutic approaches are under evaluation. J. Cell. Physiol. 231: 261-269, 2016. 2015 Wiley Periodicals, Inc.


Gabriele Mainetti, Direktor von „They Call Me Jeeg”, ist derjenige, der die Notlage von all jenen Personen portraitiert, die an seltenen Augenerkrankungen leiden. Für diese Personen gestaltet sich der Weg „zurück zum Licht” sehr schwierig und kompliziert. Er führt sie oftmals in eine verkehrte Richtung und ist mit Unbehagen, Müdigkeit und Schwierigkeiten behaftet. Genau wie der Protagonist des Films, der mit Not, Müdigkeit und dem Gefühl des Verlorenseins auf unbekanntem Terrain bei seiner Suche nach dem Licht zu kämpfen hat. Die Hoffnungsstrahlen im Leben aller von diesen Erkrankungen betroffenen Personen werden in der Szene vom folgenden Tag durch das in Licht getauchte Gesicht des Protagonisten metaphorisch dargestellt.„Jeder wissenschaftliche Fortschritt bietet einen Hoffnungsstrahl”: das Video endet mit dieser Botschaft, um uns daran zu erinnern, dass Forschung eine Waffe gegen die Dunkelheit der Erkrankungen sein kann. „Wenn wir die Erfahrung gemacht haben, dass die Natur keinesfalls immer gerecht ist, bleibt dennoch der Wunsch, dass jeder von uns dieselbe Lebensqualität besitzen sollte, tief in uns verwurzelt”, so Gabriele Mainetti bei der Veröffentlichung seiner Interpretation dieser Filmsequenzen. „Ich glaube an die Forschung und an ihren Erfolg bei der Unterstützung derjenigen, die beim Versuch sich gegen diese Erkrankungen zur Wehr zu setzen sonst verloren wären.” „Mithilfe dieser Kampagne möchten wir den Prozess unterstützen, Licht auf die Welt der von seltenen Erkrankungen betroffenen Patienten zu werfen, und das Bewusstsein für ihre gesundheitlichen Bedürfnisse schärfen”, erklärte Eugenio Aringhieri, CEO von Dompé. „Die Suche nach neuen Behandlungsoptionen ist ein wichtiges Anliegen in allen Teilen dieser Welt. Dies ist eine langwierige und komplexe Herausforderung, die oftmals dem Weg des Protagonisten in dem Video gleicht und von der ich überzeugt bin, dass wir sie nur durch die Zusammenarbeit in einem Team bewältigen können, in dem unterschiedliche Perspektiven rund um dasselbe Ziel zusammengeführt werden: das Wohl des Patienten.” „Als Zeichen eines großen Verantwortungsbewusstseins hat unser Unternehmen den Forschungspfad eingeschlagen, um seltenen Erkrankungen zu begegnen, und mit dem gleichen Engagement unterstützen und fördern wir Initiativen, um das Bewusstsein auf diesem Gebiet zu schärfen”, so Sergio Dompé, President der Dompé Group. „Wir leben in einer Welt, die immer noch nicht sehr gut erforscht wurde. Aus diesem Grund ist es unerlässlich, die Forschung fortzuführen und niemals nachzulassen in dem Streben, über den Wert und den Nutzen für das Leben vieler Menschen zu informieren.” „Seltene Augenerkrankungen gehören zu einem Bereich, in dem noch immer eine Reihe von Fragen unbeantwortet bleiben”, so Paolo Rama, Cornea and Ocular Surface Unit Director am San Raffaele Research Hospital. „Die italienische Forschung profitiert noch immer in besonderem Maße von den Studien, die von der Nobelpreisträgerin Rita Levi Montalcini im Bereich NGF durchgeführt wurden. Hierbei handelt es sich um ein auf natürlichem Weg im menschlichen Körper erzeugtes Protein, das für die Entwicklung, den Erhalt und das Überleben von Nervenzellen verantwortlich ist. Daher erwarten wir nun mit Spannung die Ergebnisse der bereits durchgeführten klinischen Studien, von denen wir erwarten, dass sie tatsächliche Innovationen auf dem Gebiet der Ophtalmologie zu Tage fördern werden.” Der Kurzfilm, der von dem Hashtag #fightforlight begleitet wird, um im Internet und in den sozialen Medien geteilt zu werden, kann auf dem Dompé YouTube Kanal in Verbindung mit anderem mit der Kampagne in Zusammenhang stehendem Backstage-Material eingesehen werden. Verwenden Sie den folgenden Link, um „In the Woods” einsehen und teilen zu können: https://youtu.be/YIOA9ajZ0Gw


MILAN--(BUSINESS WIRE)--A man finds himself lost in a wood, as night is falling. He finds a torch that shines a dim light and helps him move through the trees, looking for a way out of the blackness closing in on him. This is the opening scene of “In the Woods”, the short film commissioned by biopharmaceutical company Dompé to mark World Rare Disease Day, and presented today as part of the #fightforlight social media campaign. Gabriele Mainetti, director of “They Call Me Jeeg”, is the man portraying the plight of people suffering from rare eye diseases. For these people, finding their way “back to the light” is complicated, sometimes leading down the wrong path and involving discomfort, tiredness and difficulties. Just like the protagonist, battling with distress, fatigue and being lost in an unfamiliar forest, searching for the light. The rays of hope are metaphorically represented by the protagonist waking up the next day with his face bathed in light. “Any advance in research is a ray of hope”: the video ends with this message, to remind us that research can be a weapon to defeat the darkness of disease. “Considering that nature is anything but democratic, the objective to guarantee the same quality of life for everyone is deeply human”, said Gabriele Mainetti when speaking about his interpretation. “I believe in research and in its fight to help those who are lost in the darkness”. Created by Saatchi & Saatchi, directed by Roberto Saku Cinardi and produced by Think Cattleya, the video is part of a constant commitment by Dompé to focus its research on identifying innovative treatments for rare diseases. “With this campaign, we want to continue with the process of helping to shed light on the world of patients affected by rare diseases and their health needs”, explains Dompé CEO Eugenio Aringhieri. “The search for new treatment options is an important part of this world. This is a long and complex challenge, which in some ways evokes the experience of the protagonist in the video and which I am convinced we must pursue as a team, bringing together different perspectives around a single goal: the patient”. “It is with great sense of responsibility that our company has embarked on the path of research for rare diseases and it is with this very spirit that we support and promote initiatives to raise awareness around this field”, said Sergio Dompé, President of the Dompé Group. “This is a world that is still not very well known today, which is why it is imperative that we continue to carry out research and inform on the value and benefits that this can have on people’s lives”. In the field of rare eye diseases, Dompé is involved in research and development with the recombinant version of the human nerve growth factor (NGF), a biotech ophthalmic solution being studied in collaboration with clinical centres of excellence in Europe and the USA. “Rare eye diseases are an area where patients are still waiting for many answers”, says Paolo Rama, Cornea and Ocular Surface Unit Director at the San Raffaele Research Hospital. “Italian research still owes a lot to studies conducted by Nobel Prize winner Rita Levi Montalcini on NGF, a protein naturally produced by the human body and responsible for the development, maintenance and survival of nerve cells, so we are waiting for the results of clinical trials we have conducted, which are expected to bring real innovation to certain areas of ophthalmology.” “Progress in research and access to innovation are essential for people suffering from a rare disease and represent a real hope to fight and overcome the disease. As a civic movement aimed at protecting the rights of citizens and vulnerable people, Cittadinanzattiva encourages awareness-raising projects such as this. Being aimed at the general public, it can contribute to a greater awareness of rare diseases, which must become an increasingly key issue for public health”, explains Francesca Moccia, Deputy General Secretary of Cittadinanzattiva, who attended the preview of the video. The short film, which is accompanied by the hashtag #fightforlight to allow sharing online and on social media, can be viewed on the Dompé YouTube channel, together with other backstage content related to the campaign. To view and share “In the Woods”: https://youtu.be/YIOA9ajZ0Gw For further information, please visit: www.dompe.com


PubMed | University of Rome La Sapienza, Cornea and Ocular Surface Unit, Catholic University of the Sacred Heart and Temple University
Type: | Journal: BioMed research international | Year: 2015

Neurotrophic keratitis (NK) is a rare degenerative disease of the cornea caused by an impairment of corneal sensory innervation, characterized by decreased or absent corneal sensitivity resulting in epithelial keratopathy, ulceration, and perforation. The aetiopathogenesis of corneal sensory innervation impairment in children recognizes the same range of causes as adults, although they are much less frequent in the pediatric population. Some extremely rare congenital diseases could be considered in the aetiopathogenesis of NK in children. Congenital corneal anesthesia is an extremely rare condition that carries considerable diagnostic and therapeutic problems. Typically the onset is up to 3 years of age and the cornea may be affected in isolation or the sensory deficit may exist as a component of a congenital syndrome, or it may be associated with systemic somatic anomalies. Accurate diagnosis and recognition of risk factors is important for lessening long-term sequelae of this condition. Treatment should include frequent topical lubrication and bandage corneal or scleral contact lenses. Surgery may be needed in refractory cases. The purpose of this review is to summarize and update data available on congenital causes and treatment of corneal hypo/anesthesia and, in turn, on congenital NK.


Sacchetti M.,Cornea and Ocular Surface Unit | Lambiase A.,University of Rome La Sapienza
Clinical Ophthalmology | Year: 2014

Neurotrophic keratitis (NK) is a degenerative disease characterized by corneal sensitivity reduction, spontaneous epithelium breakdown, and impairment of corneal healing. Several causes of NK, including herpetic keratitis, diabetes, and ophthalmic and neurosurgical procedures, share the common mechanism of trigeminal damage. Diagnosis of NK requires accurate investigation of clinical ocular and systemic history, complete eye examination, and assessment of corneal sensitivity. All diagnostic procedures to achieve correct diagnosis and classification of NK, including additional examinations such as in vivo confocal microscopy, are reviewed. NK can be classified according to severity of corneal damage, ie, epithelial alterations (stage 1), persistent epithelial defect (stage 2), and corneal ulcer (stage 3). Management of NK should be based on clinical severity, and aimed at promoting corneal healing and preventing progression of the disease to stromal melting and perforation. Concomitant ocular diseases, such as exposure keratitis, dry eye, and limbal stem cell deficiency, negatively influence the outcome of NK and should be treated. Currently, no specific medical treatment exists, and surgical approaches, such as amniotic membrane transplantation and conjunctival flap, are effective in preserving eye integrity, without ameliorating corneal sensitivity or visual function. This review describes experimental and clinical reports showing several novel and potential therapies for NK, including growth factors and metalloprotease inhibitors, as well as three ongoing Phase II clinical trials. © 2014 Sacchetti and Lambiase.


PubMed | University of Rome La Sapienza and Cornea and Ocular Surface Unit
Type: | Journal: Clinical ophthalmology (Auckland, N.Z.) | Year: 2014

Neurotrophic keratitis (NK) is a degenerative disease characterized by corneal sensitivity reduction, spontaneous epithelium breakdown, and impairment of corneal healing. Several causes of NK, including herpetic keratitis, diabetes, and ophthalmic and neurosurgical procedures, share the common mechanism of trigeminal damage. Diagnosis of NK requires accurate investigation of clinical ocular and systemic history, complete eye examination, and assessment of corneal sensitivity. All diagnostic procedures to achieve correct diagnosis and classification of NK, including additional examinations such as in vivo confocal microscopy, are reviewed. NK can be classified according to severity of corneal damage, ie, epithelial alterations (stage 1), persistent epithelial defect (stage 2), and corneal ulcer (stage 3). Management of NK should be based on clinical severity, and aimed at promoting corneal healing and preventing progression of the disease to stromal melting and perforation. Concomitant ocular diseases, such as exposure keratitis, dry eye, and limbal stem cell deficiency, negatively influence the outcome of NK and should be treated. Currently, no specific medical treatment exists, and surgical approaches, such as amniotic membrane transplantation and conjunctival flap, are effective in preserving eye integrity, without ameliorating corneal sensitivity or visual function. This review describes experimental and clinical reports showing several novel and potential therapies for NK, including growth factors and metalloprotease inhibitors, as well as three ongoing Phase II clinical trials.

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