Bambino Gesu IRCCS Childrens Hospital

Rome, Italy

Bambino Gesu IRCCS Childrens Hospital

Rome, Italy
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Rossi F.,CNR Institute of Neuroscience | Tatini F.,CNR Institute of Neuroscience | Pini R.,CNR Institute of Neuroscience | Valente P.,Bambino Gesu IRCCS Childrens Hospital | And 6 more authors.
Progress in Biomedical Optics and Imaging - Proceedings of SPIE | Year: 2015

Laser assisted keratoplasty is nowadays largely used to perform minimally invasive surgery and partial thickness keratoplasty [1-3]. The use of the femtosecond laser enables to perform a customized surgery, solving the specific problem of the single patient, designing new graft profiles and partial thickness keratoplasty (PTK). The common characteristics of the PTKs and that make them eligible respect to the standard penetrating keratoplasty, are: the preservation of eyeball integrity, a reduced risk of graft rejection, a controlled postoperative astigmatism. On the other hand, the optimal surgical results after these PTKs are related to a correct comprehension of the deep stroma layers morphology, which can help in the identification of the correct cleavage plane during surgeries. In the last years some studies were published, giving new insights about the posterior stroma morphology in adult subjects [4,5]. In this work we present a study performed on two groups of tissues: one group is from 20 adult subjects aged 59 ± 18 y.o., and the other group is from 15 young subjects, aged 12±5 y.o. The samples were from tissues not suitable for transplant in patients. Confocal microscopy and Environmental Scanning Electron Microscopy (ESEM) were used for the analysis of the deep stroma. The preliminary results of this analysis show the main differences in between young and adult tissues, enabling to improve the knowledge of the morphology and of the biomechanical properties of human cornea, in order to improve the surgical results in partial thickness keratoplasty. © 2015 SPIE.

Tatini F.,CNR Institute of Applied Physics Nello Carrara | Rossi F.,CNR Institute of Applied Physics Nello Carrara | Canovetti A.,Nuovo Ospedale Santo Stefano | Malandrini A.,Nuovo Ospedale Santo Stefano | And 5 more authors.
IET Conference Publications | Year: 2015

Laser assisted keratoplasty is largely used to perform minimally invasive surgery and partial thickness keratoplasty (PTK) [1-3], which can be performed through several different techniques. Such approaches are eligible with respect to the standard penetrating keratoplasty and would benefit a major comprehension of the deep stroma layers morphology, which would be crucial in identifying the correct cleavage planes. In the last years some studies were published, giving new insights about the posterior stroma morphology in adult subjects [4,5]. In this work, confocal microscopy was performed in order to investigate relevant parameters, such as different collagen types distribution. The results of this analysis show some differences in between young and adult tissues and suggest a different pattern of localization of collagen VI and I. Our results indicate the necessity of further analysing the differences between young and adult corneas and between healthy and pathological samples. Our results also suggest a developmental process in the formation of the newly identified Dua's layer, whose presence is proposed to be exploited in order to safely perform deep anterior lamellar keratoplasty (DALK) [6].

Rossi F.,CNR Institute of Applied Physics Nello Carrara | Pini R.,CNR Institute of Applied Physics Nello Carrara | Menabuoni L.,U.O. Oculistica | Malandrini A.,U.O. Oculistica | And 5 more authors.
Progress in Biomedical Optics and Imaging - Proceedings of SPIE | Year: 2013

Diode laser welding of ocular tissues is a procedure that enables minimally invasive closure of a corneal wound. This procedure is based on a photothermal effect: a water solution of Indocyanine Green (ICG) is inserted in the surgical wound, in order to stain the corneal tissue walls. The stained tissue is then irradiated with a low power infrared diode laser, delivering laser light through a 300-μm core diameter optical fiber. This procedure enables an immediate closure of the wounds: it is thus possible to reduce or to substitute the use of surgical threads. This is of particular interest in children, because the immediate closure improves refractive outcome and anti-amblyopic effect; moreover this procedure avoids several general anaesthesia for suture management. In this work, we present the first use of diode laser welding procedure in paediatric patients. 5 selected patients underwent cataract surgery (Group 1), while 4 underwent fs-laserassisted penetrating keratoplasty (Group 2). In Group 1 the conventional surgery procedure was performed, while no stitches were used for the closure of the surgical wounds: these were laser welded and immediately closed. In Group 2 the donor button was sutured upon the recipient by 8 single stitches, instead of 16 single stitches or a running suture. The laser welding procedure was performed in order to join the donor tissue to the recipient bed. Objective observations in the follow up study evidenced a perfect adhesion of the laser welded tissues, no collateral effects and an optimal restoration of the treated tissues. © 2013 Copyright SPIE.

Esposito S.,University of Milan | Marchisio P.,University of Milan | Prada E.,University of Milan | Daleno C.,University of Milan | And 6 more authors.
Vaccine | Year: 2014

It is known that the immunogenicity and efficacy of conventional inactivated influenza vaccines (IIVs) are not completely satisfactory in children. The aim of this prospective, randomised, single-blind study was to compare the immune response to, and the effectiveness and safety of, an IIV (Fluarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) administered to 68 children aged 36-59 months affected by recurrent respiratory tract infections (RRTIs) who were vaccinated with (n= 33) or without (n= 35) the mixed bacterial lysate OM-85 BV (Broncho-vaxom, Vifor Pharma, Geneva, Switzerland). OM-85 BV had no effect on seroconversion or seroprotection rates, geometric mean titres, or dendritic cells, which were not significantly different between the two groups. Moreover, OM-85 BV did not significantly increase the pool of the memory B cells that produce IgG and IgM antibodies against the influenza antigens. However, respiratory morbidity was significantly lower in the children treated with OM-85 BV (p<. 0.05), thus confirming its positive effect on the incidence of RRTIs. There was no difference in the incidence of adverse events between the two groups. These findings show that the immune response of children to influenza vaccine is not significantly influenced by the administration of OM-85 BV. However, the use of OM-85 before and at the same time as IIV seems to reduce respiratory morbidity, and seems to be safe and well tolerated. © 2014 Elsevier Ltd.

Buzzonetti L.,Bambino Gesu IRCCS Childrens Hospital | Buzzonetti L.,Catholic University | Petrocelli G.,Bambino Gesu IRCCS Childrens Hospital | Valente P.,Bambino Gesu IRCCS Childrens Hospital | And 3 more authors.
Cornea | Year: 2015

Purpose: To report the results 15 months after transepithelial corneal cross-linking by iontophoresis of riboflavin performed in pediatric patients affected by keratoconus. Methods: Fourteen eyes of 14 pediatric patients [mean age 13 6 2.4 (SD) years; range, 10-18 years] were treated. Riboflavin solution was administered by iontophoresis for 5 minutes, and then UVA irradiation (10 mW/cm2) was performed for 9 minutes. The corrected distance visual acuity measured as decimal number, spherical equivalent, refractive astigmatism, simulated K, corneal coma, spherical aberration, and high-order aberrations for 5.0-mm pupil and the thinnest point were measured preoperatively and 3, 6, 12, and 15 months postoperatively. The endothelial cell density was evaluated. The paired Student t test was used to compare data during the follow-up. Results: Fifteen months after the procedure, the corrected distance visual acuity improved from 0.7 6 1.7 to 0.8 6 1.8 (P = 0.005). Spherical equivalent and refractive astigmatism as well as topographic and aberrometric data did not show significant changes. Also, the mean thinnest point and the endothelial cell density remained unchanged. The optical coherence tomography showed a nonhomogeneous but deep hyperreflective band with a fading effect extending through the anterior 180 mm of the cornea. No side effects were recorded. Conclusions: Transepithelial collagen cross-linking by iontophoresis, unlike other transepithelial techniques, seems to halt pediatric keratoconus progression over 15 months. However, we did not record significant improvement in higher-order aberrations and topographic indices. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Piastra M.,melli Hospital Catholic University | Onesimo R.,Catholic University | De Luca D.,melli Hospital Catholic University | Lancella L.,Bambino Gesu IRCCS Childrens Hospital | And 5 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2010

Young infants with measles requiring respiratory support have a significant risk for death and long-term complications. Even in developed countries, the occurrence of spontaneous air-leaks and acute respiratory distress syndrome (ARDS) still represent the most severe clinical presentation in early childhood, with a high fatality rate. A clinical series review from a tertiary university paediatric intensive care unit (PICU) was undertaken. During the 2006-2007 outbreak in Rome, Italy, a young infant presented with ARDS/spontaneous air-leak and needed aggressive ventilatory management and haemodynamic support. Both nebulised iloprost and intravenous pentoxifylline were administered during the acute hypoxaemic phase; the role of this pharmacologic approach in critically ill patients is still under debate. We observed four further cases of respiratory impairment requiring a non-invasive approach. Clinical-radiological findings ranged from interstitial pneumonia to bronchiolitis-like pictures. All patients were imported cases, representing an important epidemiological factor and future medical issue, though they were not malnourished nor affected by chronic diseases. We conclude that early respiratory assessment and timely PICU referral is of mainstem importance in the youngest infants with measles-induced respiratory failure. The protean nature of clinical presentation and the possibility of rapid respiratory deterioration should be highlighted, and infants from immigrant families may represent a susceptible high-risk group. © 2009 Springer-Verlag.

Leonardi M.,11 Health | Sattin D.,11 Health | Giovannetti A.M.,11 Health | Pagani M.,11 Health | And 9 more authors.
International Journal of Rehabilitation Research | Year: 2012

Children in a vegetative state (VS) and a minimally conscious state (MCS) experience severe limitations as a consequence of nervous system deficits and require consistent environmental support. However, disability in VS and MCS children has never been described following a model that accounts for the presence of the symptoms, limitations and the support required. Therefore, the aim of this paper is to describe the functioning and disability of children in VS and MCS using the International Classification of Functioning, Disability and Health - version for Children and Youth (ICF-CY). VS and MCS children were enrolled in postacute settings and at home. ICF-CY questionnaires were filled in using information available from clinical documentation, direct observation and from children's parents. ICF-CY categories were considered as relevant if used in at least one-third of the children. In total, 36 children and adolescents (22 in VS, 25 males) were enrolled. The majority developed VS and MCS following a nontraumatic event; the mean age was 114.8 months and the mean duration of condition was 50.1 months. A total of 94 ICF-CY categories were reported as relevant: 26 were from body functions, mostly from mental functions and mobility chapters; nine from body structures, 32 from activities and participation, mostly from learning, mobility and self-care chapters; and 27 from environmental factors. The use of ICF-CY enables to obtain a specific profile of functioning for each child that can be coupled with known issues, such as loss of brain functions and provision of life-sustaining interventions. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Buzzonetti L.,Bambino Gesu IRCCS Childrens Hospital | Buzzonetti L.,Catholic University | Petrocelli G.,Bambino Gesu IRCCS Childrens Hospital | Valente P.,Bambino Gesu IRCCS Childrens Hospital | And 4 more authors.
Journal of Refractive Surgery | Year: 2015

PURPOSE: To describe the big-bubble full femtosecond laser-assisted (BBFF) technique, which could be helpful in standardizing the big-bubble technique in deep anterior lamellar keratoplasty (DALK). METHODS: Ten eyes of 10 consecutive patients affected by keratoconus underwent the BBFF technique using the 150-kHz IntraLase femtosecond laser (Intra-Lase FS Laser; Abbott Medical Optics, Inc., Santa Ana, CA). A 9-mm diameter metal mask with a single fissure 0.7 mm wide oriented at the 12-o'clock position was positioned into the cone, over the laser glass. The laser performed a ring lamellar cut (internal diameter = 3 mm; external diameter = 8 mm) 100 μm above the thinnest point, with the photodisruption effectively occurring only in the corneal stroma corresponding to the fissure to create a deep stromal channel; subsequently, an anterior side cut created an arcuate incision, from the corneal surface to the deep stromal channel on the mask's opening site. The mask was removed and the laser performed a full lamellar cut 200 μm above the thinnest point to create a lamella. After the removal of the lamella, the air needle was inserted into the stromal channel and air was injected to achieve a big bubble. RESULTS: The big bubble was achieved in 9 eyes (all type 1 bubbles) and all procedures were completed as DALK. CONCLUSIONS: Preliminary results suggest that the BBFF technique could help in standardizing the bigbubble technique in DALK, reducing the "learning curve" for surgeons who approach this technique and the risks of intraoperative complications. Copyright © SLACK Incorporated.

Buzzonetti L.,Bambino Gesu Irccs Childrens Hospital | Buzzonetti L.,Catholic University | Ardia R.,University of Rome Tor Vergata | Petroni S.,Bambino Gesu Irccs Childrens Hospital | And 4 more authors.
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2016

Purpose: The purpose was to evaluate indications and clinical outcomes in paediatric corneal keratoplasty. Methods: Fifty-four eyes of 43 patients who underwent corneal keratoplasty from the 1st of January 2010 through the 31st of December 2013 at the Bambino Gesù Children’s Hospital in Rome, Italy, were retrospectively evaluated. To assess the effect of age on graft failure rate, the recipient age was considered as a dichotomous variable (≤5 or >5 years) and a 2X2 table was developed, using the chi-square test for testing the statistical significance. Furthermore, two separate subgroup analyses were conducted on patients of ≤5 years and those of >5 years, to evaluate the effect of penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) on the graft failure rate. The level of statistical significance was set at p < 0.05 Results: Mean recipient age was 8.9 ± 5.7 [SD] years. Mean follow-up time was 22.8 months. Main preoperative diagnoses were keratoconus (37 %) and congenital glaucoma (20 %). Patients ≤5 years showed a higher percentage of graft failure (p = 0.0008). PK and DALK did not show statistically significant differences regarding the graft failure in both subgroups (p = 0.15 for ≤5 years group and p = 0.27 for >5 years group, respectively). However, across groups DALK provided a lower rate of graft failure. Conclusions: Our findings suggest that children older than 5 years show a significantly better graft outcome and that DALK seems to offer greatest benefits in terms of failure risk in paediatric patients. © 2016 Springer-Verlag Berlin Heidelberg

PubMed | Catholic University of the Sacred Heart and Bambino Gesu IRCCS Childrens Hospital
Type: | Journal: Survey of ophthalmology | Year: 2017

The cavernous venous malformation (CVM) of the orbit, previously called cavernous hemangioma, is the most common primary orbital lesion of adults. CVM occurs more often in women and typically presents in the fourth and fifth decades of life. It is a benign vascular malformation characterized by a well-defined capsule and numerous large vascular channels. The most common sign of CVM is progressive axial proptosis from the preferential involvement of the intraconal orbital space. Optic nerve damage and other signs of orbital pathology may be present, with a variable degree of visual impairment. The combination of ultrasound, computed tomography, and magnetic resonance imaging leads to an accurate diagnosis in the vast majority of cases. Surgical and non-surgical treatments are required in case of symptomatic lesions, with a characteristic multidisciplinary management influencing optimal outcome. Orbitotomy represents the traditional surgical approach. Recently, the endoscopic transnasal approach to the orbital cavity has gained interest, representing a feasible and safe, less invasive surgical technique for the management of CVM.

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