Dr Barbara Parolini, born in Italy on April 17th, 1968.Vitreoretinal surgeon. Myopia, trauma, PVR PDR Address: EYECARE CLINIC Via Cefalonia 70, Crystal Palace, BRESCIA ITALY
Journal of refractive surgery (Thorofare, N.J.: 1995)
The HydroBlade and the HydroBrush keratomes are waterjet-based devices for corneal surgery that o... more The HydroBlade and the HydroBrush keratomes are waterjet-based devices for corneal surgery that operate at normal intraocular pressure in two different modes: removal of parallel or shaped lenticules or hinged flaps with a small diameter, high speed waterjet; and removal of the epithelium with a waterjet sheet. The operating principles as well as histology of the cut surfaces are described. A flap was made in one cadaver eye with a Chiron ACS keratome and in the second eye with the HydroBlade keratome. The epithelium was removed in one cadaver eye with a surgical blade and in the second eye by the HydroBrush keratome. Scanning and transmission electron microscopy and light microscopy was obtained. The HydroBlade keratome cleaved only cross-linking fibrils and left intact keratocytes. Shape and dimensions of the flap were accurate. There was no observable hydration or significant heating of the tissue. Mechanical forces on the cornea were small. The HydroBrush keratome removed the ep...
Journal of refractive surgery (Thorofare, N.J.: 1995)
Corneal epithelial removal finds multiple applications in ophthalmic surgery (epithelial herpes i... more Corneal epithelial removal finds multiple applications in ophthalmic surgery (epithelial herpes infections, recurrent epithelial erosion, corneal ulcers and plaques, and intraoperative epithelial clouding). Photorefractive keratectomy is initiated by removal of the epithelium. Current techniques for epithelial removal are suboptimal. We studied the safety and effectiveness of a new technique, hydroepithelial keratectomy, performed with the HydroBrush keratome on live rabbits. Eighteen rabbits (18 eyes) underwent hydroepithelial keratectomy and 18 rabbits (18 eyes) underwent epithelial removal with a surgical blade (blade group). Twelve rabbits were euthanized immediately after the procedure. Twenty-four rabbits were followed for up to 120 hours after treatment. Ultrastructural analysis was performed with light and electron microscopy. The hydroepithelial keratectomy group healed a mean 53 hours after treatment; the blade group healed a mean 78 hours after treatment. The HydroBrush k...
The efficacy of a macular buckle in treating myopic traction maculopathy was studied. Fifty eyes ... more The efficacy of a macular buckle in treating myopic traction maculopathy was studied. Fifty eyes with myopic traction maculopathy, in the form of macular detachment with macular hole (MHMD), or without macular hole (MD) and macular foveoschisis (MF), were treated with vitrectomy combined with macular buckle or with a macular buckle without vitrectomy. Combined group: The combined group comprised 10 eyes with MHMD, 6 eyes with MD, and 4 eyes with MF. The retina was attached in 100% of MD and MHMD and the MF was improved in 100% of cases. The hole was closed in 60% of MHMD. The mean initial and final Snellen best-corrected visual acuity was 20/500 and 20/100 for MHMD, 20/200 and 20/60 for MD, and 20/200 and 20/50 for MF. The mean surgical time was 80 ± 35 minutes. Fundus angiography or indocyanine green revealed no alteration of the chorioretinal blood flow. Buckle shortening was required in 6/20 (30% of cases) patients for lateral extrusion of the sponge through the conjunctiva with the first sponge model. This complication was overcome by changing the arm of the buckle. Buckle group: The buckle group comprised 5 eyes with MHMD, 11 with MD, and 14 with MF. The retina was attached in 100% of MHMD, MD, and MF. The macular hole was closed in 60%. The mean initial and final Snellen best-corrected visual acuity was 20/800 and 20/60 for MHMD, 20/125 and 20/50 for MD, and 20/200 and 20/63 for MF. The mean postoperative decrement in axial length was 1.21 mm. The mean surgical time was 35 ± 15 minutes. Fundus angiography or indocyanine green revealed no alteration of the chorioretinal blood flow. Complications included conjunctiva erosion (15%), diplopia (7.7%), and pain (3.8%). Magnetic resonance imaging showed flattening of the posterior staphyloma. Considering the possible complications and technical difficulties of vitrectomy, we suggest that the macular buckle alone should be the first treatment of myopic traction maculopathy. Vitrectomy should be reserved only for cases of tangential tractions.
The aim is to describe 5 cases of unexplained visual impairment after uneventful episcleral surge... more The aim is to describe 5 cases of unexplained visual impairment after uneventful episcleral surgery associated with submacular lesions occurring post-operatively (bleb-like syndrome). The 5 cases were followed with biomicroscopy and OCT for up to 6 months. At biomicroscopy the 5 eyes presented no visible abnormalities or a yellow subfoveal dot. OCT demonstrated the presence of isolated or multiple subfoveal or submacular blebs. Some cases experienced partial or total slow spontaneous resolution, while other blebs remained stable for months or slightly enlarged. In conclusion, OCT can play an important role in the follow up of patients with unexplained visual impairment after episcleral surgery and diagnose the presence of small subfoveal shallow retinal detachments persistent for months after surgery. We think that OCT should be routinely considered in the follow-up of these patients.
Journal of refractive surgery (Thorofare, N.J. : 1995)
To report four cases of corneal interface complications that occurred after excimer laser in situ... more To report four cases of corneal interface complications that occurred after excimer laser in situ keratomileusis (LASIK). Four eyes of three patients underwent technically uneventful LASIK. One day after LASIK, patients presented with severe pain, blurred vision, conjunctival infection, and diffuse opacity at the interface. Two days after LASIK, significant features were central opacity, striae in the flap, loss of uncorrected and best spectacle-corrected visual acuity, and corneal sensitivity. The findings did not improve by using drugs or by lifting the flap and irrigating the bed. The central opacity partially resolved over 8 to 12 months, leaving a hyperopic shift (one patient), striae (one patient), and loss of two or more lines of best spectacle-corrected visual acuity (three patients). This severe central inflammation after LASIK could be an extreme manifestation of diffuse lamellar keratitis.
A slight difference in brightness between objects close to each other and with no clear-cut outli... more A slight difference in brightness between objects close to each other and with no clear-cut outlines separating them can be recognized by the visual function called contrast sensitivity. This function is particularly developed in the radiologist, whose task is to analyze images in many shades of grey and with no clear-cut outlines, due to kinetic and radiogeometrical shading. Assuming that professional habit might develop this function, the authors compared contrast sensitivity in a group of 26 radiologists with contrast sensitivity in a control group (30 non-radiologists). The Vistech VTCS 6500 test was chosen for the task because of its practicality and reliability. The test consists in the recognition of the orientation of 5 series of alternate bright and dark lines differencing in thickness and contrast. The results obtained in the two groups were studied and compared with the statistical test of the analysis of variance, the T-test by Student and the U-test by Mann-Whitney. Con...
To determine the effectiveness and safety of diode laser, pars plana vitrectomy (PPV) with gas ta... more To determine the effectiveness and safety of diode laser, pars plana vitrectomy (PPV) with gas tamponade, and intravitreal triamcinolone (IVT) as possible treatments for diffuse diabetic macular edema (dDME). To determine whether the new macular edema Classification previously proposed by some of the authors may help as a guide in the choice of treatment. A retrospective, comparative study of 169 eyes with dDME that underwent treatment. The eyes divided into 3 groups: in the PPV Group, 59 eyes received PPV with gas tamponade; in the DIODE Group, 53 eyes received a laser grid; in the IVT Group, 57 eyes received an intravitreal injection of 4 mg of triamcinolone acetonide. The follow up ranged from 6 to 24 months. The eyes were classified according to the new DME Classification based on OCT. Change in foveal thickness as determined by Optical Coherence Tomography (OCT); change in visual acuity; intra and postoperative complications. Mean visual acuity (VA) improved at 3 months with every treatment. At one year only eyes which underwent PPV still had better VA than the pre-op value, while eyes which underwent IVT and laser treatment showed regression. PPV show the greater percentage of eyes which gain 3 or more lines of VA at one year (17%). Mean foveal thickness improved at 3 months with every treatment. Only the eyes into the PPV Group showed relatively low foveal thickness at one year. Better final VA and foveal thickness were obtained if preop VA is > or = 0.3 and if earlier stages of DME were treated according to the new DME Classification. PPV was the treatment which offered the most stable results with at one year or longer. Similar results were observed into the PPV Groups as a whole and into a subgroup of eyes with preoperative PVD. No complications were encountered with laser diode treatment. Long term complications into the IVT Group were elevated IOP (8%), retinal detachment (3.5%) and posterior cataract (15%). Long term complications into the PPV Group were retinal detachment (3.4%) and cataract (90%). Diode laser, PPV with gas tamponade and IVT are effective alternative treatments to decrease foveal thickness and improve visual acuity in eyes with DME. However while the results of PPV are stable in the long term follow-up, diode laser and IVT do not offer stable results. Complications may be severe with PPV and IVT. It is necessary to carefully select cases which would benefit from these types of treatments. The authors think that the OCT Classification may serve as a guide for the choice of treatment.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2014
To evaluate the incidence of cystoid macular edema (CME) after 23-gauge pars plana vitrectomy (PP... more To evaluate the incidence of cystoid macular edema (CME) after 23-gauge pars plana vitrectomy (PPV) with or without combined cataract surgery for the treatment of idiopathic epiretinal membrane (ERM). Retrospective, non-comparative, interventional case series. Data included patient age, indication for surgery, and intra- and post-operative complications. The follow-up lasted 1 year. Best-corrected visual acuity (BCVA logMAR), central foveal thickness (CFT micron-μ) and the incidence of intra-retinal cysts were evaluated. CME was defined as post-operative observation of intra-retinal cysts at optical coherence tomography, preventing improvement or causing reduction of BCVA when compared to the pre-operative value. Statistical analysis was performed to identify the risk factors of CME. Two hundred and forty two eyes of 242 patients underwent PPV for the treatment of idiopathic ERM. Statistical analysis showed that the presence of preoperative intra-retinal cysts were associated with persistent CME following surgery (odds ratio 3.89; 95%CI: 1.63-9.28, P = 0.0004). However, postoperative CME occurred in 10 % of eyes that did not show preoperative CME. In addition, there was a significant correlation between the baseline value of CFT and the values of CFT at each time point during the follow up (p < 0.0001), with greater values of the pre-operative thickness correlating to greater values of post-operative thickness. Persistent or new CME following surgery for idiopathic ERM are frequently identified after PPV for ERM. The statistical results of the current study suggest that intraretinal cysts and increased preoperative CFT are associated with reduced visual acuity after surgery.
Although cataract is widely described among the complications of vitrectomy, the precise relation... more Although cataract is widely described among the complications of vitrectomy, the precise relationship between vitrectomy and the development of lens opacity is not completely understood. This article presents an extensive literature review and the authors' personal experience with this complication.
To report the rate of postoperative complications in 943 consecutive eyes operated on with 23-gau... more To report the rate of postoperative complications in 943 consecutive eyes operated on with 23-gauge transconjunctival pars plana vitrectomy. Single-center, retrospective, noncomparative, interventional case series. Nine hundred and forty-three eyes underwent 23-gauge transconjunctival core and peripheral vitrectomy with peripheral laser at the sclerotomy sites from May 2005 through April 2008. The main outcome measures were intraocular pressure at 1 day and at 1 week and intra- and postoperative complications with at least 6-month follow-up. Eight hundred and thirty-one eyes (88%) did not have either significant intra- or postoperative complications. Sclerotomy leakage requiring suture occurred in 37 eyes (3.9%). One choroidal detachment (0.1%) spontaneously resolved 1 week after surgery. At postoperative Day 1, 31 eyes (3.3%) experienced transient hypotony. Forty-five eyes (4.8%) presented a subtle vitreous hemorrhage that resolved spontaneously. Two retinal detachments (0.2%) occurred, one at 1 month and one at 3 months. They resolved with one further vitrectomy. Seven hundred and forty eyes completed the 12-month follow-up and presented no further complications. Twenty-three-gauge complete vitrectomy and peripheral laser seem safe for a variety of vitreoretinal surgical procedures. The rate of post- and intraoperative complications compares favorably with 25-gauge and with the standard 20-gauge vitrectomy.
To describe retinal complications after posterior chamber phakic intraocular lens (PCPIOL) implan... more To describe retinal complications after posterior chamber phakic intraocular lens (PCPIOL) implantation and refractive surgery complications after scleral buckling surgery. Retrospective, noncomparative, small case series. Four patients in whom retinal detachment developed after PCPIOL implantation and two patients with previously placed encircling scleral buckles in whom corneal steepening developed after laser in situ keratomileusis (LASIK). The four patients with retinal detachment after PCPIOL implantation underwent vitreoretinal surgery. One of the two patients in whom corneal steepening developed after LASIK underwent buckle removal. The main parameters evaluated were vitreoretinal findings, corneal topography, and pachymetry. Retinal attachment was achieved for all patients. Mean postoperative best-corrected visual acuity (BCVA) was 20/30. One patient lost one line of BCVA. One patient with corneal steepening achieved partial corneal flattening after buckle removal. Vitreous base stimulation related to PCPIOL implantation and manipulation during LASIK may trigger retinal complications. Laser in situ keratomileusis in patients with previously placed scleral buckles may result in unexpected corneal steepening.
Patients affected by chronic renal failure often complain of blurred vision when submitted to hem... more Patients affected by chronic renal failure often complain of blurred vision when submitted to hemodialysis. Refraction, visual acuity and lens transparency have been evaluated in 36 eyes of 18 patients who underwent hemodialysis, before and after the treatment. Student's t test did not prove any statistically significant difference between the considered parameters. However, a change in refraction was noted in 64% of the eyes, always in hyperopic mean. Corrective glasses had to be changed to ensure the same visual acuity as before the hemodialytic treatment. Particular care must be taken in lens prescription in those patients who could undergo dialysis for chronic renal failure.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2011
Several surgical techniques have been described for the treatment of retinal detachment (RD) asso... more Several surgical techniques have been described for the treatment of retinal detachment (RD) associated to myopic macular hole (MMH). In this retrospective study, the anatomical and functional outcomes of pars plana vitrectomy (PPV) with long-term tamponade, using either 1000 cSt silicone oil (SO) or heavy silicone oil (HSO), are compared. Forty-two eyes affected by RD associated with MMH were included. The surgical technique involved standard 3-port 20-gauge PPV with long-term tamponade. The patients were divided into two groups, according to the intraocular tamponade: SO in group 1 (n = 17), and HSO in group 2 (n = 25). Internal limiting membrane (ILM) removal was performed in 15 cases of group 1 and 20 cases of group 2. Tamponade removal was performed 2 to 5 months after primary surgery. The patients were assessed 1 week and 1 month after primary surgery, and then 1 week and 1 month after tamponade removal or after further surgery if macular redetachment had occurred. The patients were also visited every 2 months for at least 1 year after final tamponade removal. Follow-up was considered closed at 1 year after final tamponade removal. Preoperative best-corrected visual acuity (BCVA), expressed as LogMar, was 2.8 ± 0.77 for group 1 and 2.1 ± 0.94 for group 2. At the last visit, the BCVA was 1.41 ± 0.96 and 1.48 ± 0.77 for groups 1 and 2 respectively. Retinal reattachment was achieved with one operation in 13 eyes of group 1 (76.5%) and 18 of group 2 (81.8%) (P = 0.69). The average number of surgery needed to achieve retinal attachment by patients of group 1 and 2 was respectively 1.36 ± 0.63 and 1.46 ± 0.59 (P = 0.77). Five patients of group 1 and four of group 2 developed a chronic glaucoma (P = 0.238). PPV with ILM peeling and long-term tamponade was demonstrated to be a good surgical option to treat RD due to MMH; SO and HSO seemed to be equally effective, although the success rates remained far from an ideal 100%.
Journal of refractive surgery (Thorofare, N.J.: 1995)
The HydroBlade and the HydroBrush keratomes are waterjet-based devices for corneal surgery that o... more The HydroBlade and the HydroBrush keratomes are waterjet-based devices for corneal surgery that operate at normal intraocular pressure in two different modes: removal of parallel or shaped lenticules or hinged flaps with a small diameter, high speed waterjet; and removal of the epithelium with a waterjet sheet. The operating principles as well as histology of the cut surfaces are described. A flap was made in one cadaver eye with a Chiron ACS keratome and in the second eye with the HydroBlade keratome. The epithelium was removed in one cadaver eye with a surgical blade and in the second eye by the HydroBrush keratome. Scanning and transmission electron microscopy and light microscopy was obtained. The HydroBlade keratome cleaved only cross-linking fibrils and left intact keratocytes. Shape and dimensions of the flap were accurate. There was no observable hydration or significant heating of the tissue. Mechanical forces on the cornea were small. The HydroBrush keratome removed the ep...
Journal of refractive surgery (Thorofare, N.J.: 1995)
Corneal epithelial removal finds multiple applications in ophthalmic surgery (epithelial herpes i... more Corneal epithelial removal finds multiple applications in ophthalmic surgery (epithelial herpes infections, recurrent epithelial erosion, corneal ulcers and plaques, and intraoperative epithelial clouding). Photorefractive keratectomy is initiated by removal of the epithelium. Current techniques for epithelial removal are suboptimal. We studied the safety and effectiveness of a new technique, hydroepithelial keratectomy, performed with the HydroBrush keratome on live rabbits. Eighteen rabbits (18 eyes) underwent hydroepithelial keratectomy and 18 rabbits (18 eyes) underwent epithelial removal with a surgical blade (blade group). Twelve rabbits were euthanized immediately after the procedure. Twenty-four rabbits were followed for up to 120 hours after treatment. Ultrastructural analysis was performed with light and electron microscopy. The hydroepithelial keratectomy group healed a mean 53 hours after treatment; the blade group healed a mean 78 hours after treatment. The HydroBrush k...
The efficacy of a macular buckle in treating myopic traction maculopathy was studied. Fifty eyes ... more The efficacy of a macular buckle in treating myopic traction maculopathy was studied. Fifty eyes with myopic traction maculopathy, in the form of macular detachment with macular hole (MHMD), or without macular hole (MD) and macular foveoschisis (MF), were treated with vitrectomy combined with macular buckle or with a macular buckle without vitrectomy. Combined group: The combined group comprised 10 eyes with MHMD, 6 eyes with MD, and 4 eyes with MF. The retina was attached in 100% of MD and MHMD and the MF was improved in 100% of cases. The hole was closed in 60% of MHMD. The mean initial and final Snellen best-corrected visual acuity was 20/500 and 20/100 for MHMD, 20/200 and 20/60 for MD, and 20/200 and 20/50 for MF. The mean surgical time was 80 ± 35 minutes. Fundus angiography or indocyanine green revealed no alteration of the chorioretinal blood flow. Buckle shortening was required in 6/20 (30% of cases) patients for lateral extrusion of the sponge through the conjunctiva with the first sponge model. This complication was overcome by changing the arm of the buckle. Buckle group: The buckle group comprised 5 eyes with MHMD, 11 with MD, and 14 with MF. The retina was attached in 100% of MHMD, MD, and MF. The macular hole was closed in 60%. The mean initial and final Snellen best-corrected visual acuity was 20/800 and 20/60 for MHMD, 20/125 and 20/50 for MD, and 20/200 and 20/63 for MF. The mean postoperative decrement in axial length was 1.21 mm. The mean surgical time was 35 ± 15 minutes. Fundus angiography or indocyanine green revealed no alteration of the chorioretinal blood flow. Complications included conjunctiva erosion (15%), diplopia (7.7%), and pain (3.8%). Magnetic resonance imaging showed flattening of the posterior staphyloma. Considering the possible complications and technical difficulties of vitrectomy, we suggest that the macular buckle alone should be the first treatment of myopic traction maculopathy. Vitrectomy should be reserved only for cases of tangential tractions.
The aim is to describe 5 cases of unexplained visual impairment after uneventful episcleral surge... more The aim is to describe 5 cases of unexplained visual impairment after uneventful episcleral surgery associated with submacular lesions occurring post-operatively (bleb-like syndrome). The 5 cases were followed with biomicroscopy and OCT for up to 6 months. At biomicroscopy the 5 eyes presented no visible abnormalities or a yellow subfoveal dot. OCT demonstrated the presence of isolated or multiple subfoveal or submacular blebs. Some cases experienced partial or total slow spontaneous resolution, while other blebs remained stable for months or slightly enlarged. In conclusion, OCT can play an important role in the follow up of patients with unexplained visual impairment after episcleral surgery and diagnose the presence of small subfoveal shallow retinal detachments persistent for months after surgery. We think that OCT should be routinely considered in the follow-up of these patients.
Journal of refractive surgery (Thorofare, N.J. : 1995)
To report four cases of corneal interface complications that occurred after excimer laser in situ... more To report four cases of corneal interface complications that occurred after excimer laser in situ keratomileusis (LASIK). Four eyes of three patients underwent technically uneventful LASIK. One day after LASIK, patients presented with severe pain, blurred vision, conjunctival infection, and diffuse opacity at the interface. Two days after LASIK, significant features were central opacity, striae in the flap, loss of uncorrected and best spectacle-corrected visual acuity, and corneal sensitivity. The findings did not improve by using drugs or by lifting the flap and irrigating the bed. The central opacity partially resolved over 8 to 12 months, leaving a hyperopic shift (one patient), striae (one patient), and loss of two or more lines of best spectacle-corrected visual acuity (three patients). This severe central inflammation after LASIK could be an extreme manifestation of diffuse lamellar keratitis.
A slight difference in brightness between objects close to each other and with no clear-cut outli... more A slight difference in brightness between objects close to each other and with no clear-cut outlines separating them can be recognized by the visual function called contrast sensitivity. This function is particularly developed in the radiologist, whose task is to analyze images in many shades of grey and with no clear-cut outlines, due to kinetic and radiogeometrical shading. Assuming that professional habit might develop this function, the authors compared contrast sensitivity in a group of 26 radiologists with contrast sensitivity in a control group (30 non-radiologists). The Vistech VTCS 6500 test was chosen for the task because of its practicality and reliability. The test consists in the recognition of the orientation of 5 series of alternate bright and dark lines differencing in thickness and contrast. The results obtained in the two groups were studied and compared with the statistical test of the analysis of variance, the T-test by Student and the U-test by Mann-Whitney. Con...
To determine the effectiveness and safety of diode laser, pars plana vitrectomy (PPV) with gas ta... more To determine the effectiveness and safety of diode laser, pars plana vitrectomy (PPV) with gas tamponade, and intravitreal triamcinolone (IVT) as possible treatments for diffuse diabetic macular edema (dDME). To determine whether the new macular edema Classification previously proposed by some of the authors may help as a guide in the choice of treatment. A retrospective, comparative study of 169 eyes with dDME that underwent treatment. The eyes divided into 3 groups: in the PPV Group, 59 eyes received PPV with gas tamponade; in the DIODE Group, 53 eyes received a laser grid; in the IVT Group, 57 eyes received an intravitreal injection of 4 mg of triamcinolone acetonide. The follow up ranged from 6 to 24 months. The eyes were classified according to the new DME Classification based on OCT. Change in foveal thickness as determined by Optical Coherence Tomography (OCT); change in visual acuity; intra and postoperative complications. Mean visual acuity (VA) improved at 3 months with every treatment. At one year only eyes which underwent PPV still had better VA than the pre-op value, while eyes which underwent IVT and laser treatment showed regression. PPV show the greater percentage of eyes which gain 3 or more lines of VA at one year (17%). Mean foveal thickness improved at 3 months with every treatment. Only the eyes into the PPV Group showed relatively low foveal thickness at one year. Better final VA and foveal thickness were obtained if preop VA is > or = 0.3 and if earlier stages of DME were treated according to the new DME Classification. PPV was the treatment which offered the most stable results with at one year or longer. Similar results were observed into the PPV Groups as a whole and into a subgroup of eyes with preoperative PVD. No complications were encountered with laser diode treatment. Long term complications into the IVT Group were elevated IOP (8%), retinal detachment (3.5%) and posterior cataract (15%). Long term complications into the PPV Group were retinal detachment (3.4%) and cataract (90%). Diode laser, PPV with gas tamponade and IVT are effective alternative treatments to decrease foveal thickness and improve visual acuity in eyes with DME. However while the results of PPV are stable in the long term follow-up, diode laser and IVT do not offer stable results. Complications may be severe with PPV and IVT. It is necessary to carefully select cases which would benefit from these types of treatments. The authors think that the OCT Classification may serve as a guide for the choice of treatment.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2014
To evaluate the incidence of cystoid macular edema (CME) after 23-gauge pars plana vitrectomy (PP... more To evaluate the incidence of cystoid macular edema (CME) after 23-gauge pars plana vitrectomy (PPV) with or without combined cataract surgery for the treatment of idiopathic epiretinal membrane (ERM). Retrospective, non-comparative, interventional case series. Data included patient age, indication for surgery, and intra- and post-operative complications. The follow-up lasted 1 year. Best-corrected visual acuity (BCVA logMAR), central foveal thickness (CFT micron-μ) and the incidence of intra-retinal cysts were evaluated. CME was defined as post-operative observation of intra-retinal cysts at optical coherence tomography, preventing improvement or causing reduction of BCVA when compared to the pre-operative value. Statistical analysis was performed to identify the risk factors of CME. Two hundred and forty two eyes of 242 patients underwent PPV for the treatment of idiopathic ERM. Statistical analysis showed that the presence of preoperative intra-retinal cysts were associated with persistent CME following surgery (odds ratio 3.89; 95%CI: 1.63-9.28, P = 0.0004). However, postoperative CME occurred in 10 % of eyes that did not show preoperative CME. In addition, there was a significant correlation between the baseline value of CFT and the values of CFT at each time point during the follow up (p < 0.0001), with greater values of the pre-operative thickness correlating to greater values of post-operative thickness. Persistent or new CME following surgery for idiopathic ERM are frequently identified after PPV for ERM. The statistical results of the current study suggest that intraretinal cysts and increased preoperative CFT are associated with reduced visual acuity after surgery.
Although cataract is widely described among the complications of vitrectomy, the precise relation... more Although cataract is widely described among the complications of vitrectomy, the precise relationship between vitrectomy and the development of lens opacity is not completely understood. This article presents an extensive literature review and the authors' personal experience with this complication.
To report the rate of postoperative complications in 943 consecutive eyes operated on with 23-gau... more To report the rate of postoperative complications in 943 consecutive eyes operated on with 23-gauge transconjunctival pars plana vitrectomy. Single-center, retrospective, noncomparative, interventional case series. Nine hundred and forty-three eyes underwent 23-gauge transconjunctival core and peripheral vitrectomy with peripheral laser at the sclerotomy sites from May 2005 through April 2008. The main outcome measures were intraocular pressure at 1 day and at 1 week and intra- and postoperative complications with at least 6-month follow-up. Eight hundred and thirty-one eyes (88%) did not have either significant intra- or postoperative complications. Sclerotomy leakage requiring suture occurred in 37 eyes (3.9%). One choroidal detachment (0.1%) spontaneously resolved 1 week after surgery. At postoperative Day 1, 31 eyes (3.3%) experienced transient hypotony. Forty-five eyes (4.8%) presented a subtle vitreous hemorrhage that resolved spontaneously. Two retinal detachments (0.2%) occurred, one at 1 month and one at 3 months. They resolved with one further vitrectomy. Seven hundred and forty eyes completed the 12-month follow-up and presented no further complications. Twenty-three-gauge complete vitrectomy and peripheral laser seem safe for a variety of vitreoretinal surgical procedures. The rate of post- and intraoperative complications compares favorably with 25-gauge and with the standard 20-gauge vitrectomy.
To describe retinal complications after posterior chamber phakic intraocular lens (PCPIOL) implan... more To describe retinal complications after posterior chamber phakic intraocular lens (PCPIOL) implantation and refractive surgery complications after scleral buckling surgery. Retrospective, noncomparative, small case series. Four patients in whom retinal detachment developed after PCPIOL implantation and two patients with previously placed encircling scleral buckles in whom corneal steepening developed after laser in situ keratomileusis (LASIK). The four patients with retinal detachment after PCPIOL implantation underwent vitreoretinal surgery. One of the two patients in whom corneal steepening developed after LASIK underwent buckle removal. The main parameters evaluated were vitreoretinal findings, corneal topography, and pachymetry. Retinal attachment was achieved for all patients. Mean postoperative best-corrected visual acuity (BCVA) was 20/30. One patient lost one line of BCVA. One patient with corneal steepening achieved partial corneal flattening after buckle removal. Vitreous base stimulation related to PCPIOL implantation and manipulation during LASIK may trigger retinal complications. Laser in situ keratomileusis in patients with previously placed scleral buckles may result in unexpected corneal steepening.
Patients affected by chronic renal failure often complain of blurred vision when submitted to hem... more Patients affected by chronic renal failure often complain of blurred vision when submitted to hemodialysis. Refraction, visual acuity and lens transparency have been evaluated in 36 eyes of 18 patients who underwent hemodialysis, before and after the treatment. Student's t test did not prove any statistically significant difference between the considered parameters. However, a change in refraction was noted in 64% of the eyes, always in hyperopic mean. Corrective glasses had to be changed to ensure the same visual acuity as before the hemodialytic treatment. Particular care must be taken in lens prescription in those patients who could undergo dialysis for chronic renal failure.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2011
Several surgical techniques have been described for the treatment of retinal detachment (RD) asso... more Several surgical techniques have been described for the treatment of retinal detachment (RD) associated to myopic macular hole (MMH). In this retrospective study, the anatomical and functional outcomes of pars plana vitrectomy (PPV) with long-term tamponade, using either 1000 cSt silicone oil (SO) or heavy silicone oil (HSO), are compared. Forty-two eyes affected by RD associated with MMH were included. The surgical technique involved standard 3-port 20-gauge PPV with long-term tamponade. The patients were divided into two groups, according to the intraocular tamponade: SO in group 1 (n = 17), and HSO in group 2 (n = 25). Internal limiting membrane (ILM) removal was performed in 15 cases of group 1 and 20 cases of group 2. Tamponade removal was performed 2 to 5 months after primary surgery. The patients were assessed 1 week and 1 month after primary surgery, and then 1 week and 1 month after tamponade removal or after further surgery if macular redetachment had occurred. The patients were also visited every 2 months for at least 1 year after final tamponade removal. Follow-up was considered closed at 1 year after final tamponade removal. Preoperative best-corrected visual acuity (BCVA), expressed as LogMar, was 2.8 ± 0.77 for group 1 and 2.1 ± 0.94 for group 2. At the last visit, the BCVA was 1.41 ± 0.96 and 1.48 ± 0.77 for groups 1 and 2 respectively. Retinal reattachment was achieved with one operation in 13 eyes of group 1 (76.5%) and 18 of group 2 (81.8%) (P = 0.69). The average number of surgery needed to achieve retinal attachment by patients of group 1 and 2 was respectively 1.36 ± 0.63 and 1.46 ± 0.59 (P = 0.77). Five patients of group 1 and four of group 2 developed a chronic glaucoma (P = 0.238). PPV with ILM peeling and long-term tamponade was demonstrated to be a good surgical option to treat RD due to MMH; SO and HSO seemed to be equally effective, although the success rates remained far from an ideal 100%.
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Papers by Dr Barbara Parolini