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Spinetta R, Petrillo F, Reibaldi M, Tortori A, Mazzoni M, Metrangolo C, Gelormini F, Ricardi F, Giordano A. Intravitreal DEX Implant for the Treatment of Diabetic Macular Edema: A Review of National Consensus. Pharmaceutics 2023; 15:2461. [PMID: 37896220 PMCID: PMC10610055 DOI: 10.3390/pharmaceutics15102461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic macular edema (DME)'s therapeutic approach can frequently be challenging. The purpose of the review is to propose evidence-based recommendations on the employment of intravitreal dexamethasone implants (DEX) when approaching patients suffering from DME. Seven national consensuses redacted by different groups of retina specialists from Europe and Asia were examined and confronted. Each consensus was redacted utilizing a Delphi approach, in person meetings, or by reviewing the literature. DEX can be studied as a first-line strategy in individuals suffering from DME with inflammatory OCT biomarkers, in vitrectomized eyes, in patients with recent cardiovascular events, in pregnant women, in patients scheduled to undergo cataract surgery or with poor compliance. The other parameters considered were the indications to the DME treatment, when to switch to DEX, the definition of non-responder to anti-VEGFs agents and to the DEX implant, whether to combine DEX with laser photocoagulation, the association between glaucoma and DEX, and the management of DEX and the cataract. Although several years have passed since the introduction of DEX implants in the DME treatment, there is still not a unified agreement among retina specialists. This paper compares the approach in the DME treatment between countries from different continents and provides a broader and worldwide perspective of the topic.
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Affiliation(s)
| | - Francesco Petrillo
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Michele Reibaldi
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Antonia Tortori
- Ophthalmology Unit, Surgery Department, Piacenza Hospital, 29121 Piacenza, Italy;
| | - Maria Mazzoni
- University Center for Studies on Gender Medicine, University of Ferrara, 44124 Ferrara, Italy;
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Cristian Metrangolo
- Ophthalmology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy;
| | - Francesco Gelormini
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Federico Ricardi
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
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Ranno S, Vujosevic S, Mambretti M, Metrangolo C, Alkabes M, Rabbiolo G, Govetto A, Carini E, Nucci P, Radice P. Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema. J Clin Med 2023; 12:jcm12062297. [PMID: 36983298 PMCID: PMC10056256 DOI: 10.3390/jcm12062297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Currently, the gold standard of diabetic macular edema (DME) treatment is anti-vascular endothelial growth factor (VEGF) injections, although a percentage of patients do not respond optimally. Vitrectomy with or without internal limiting membrane (ILM) peeling is a well-established treatment for DME cases with a tractional component while its role for nontractional cases is unclear.The aim of this study is to evaluate the role of vitrectomy with or without ILM peeling in nontractional refractory DME.Methods: We performed a retrospective review of twenty-eight eyes with nontractional refractory DME treated with vitrectomy at San Giuseppe Hospital, Milan, between 2016 and 2018. All surgeries were performed by a single experienced vitreoretinal surgeon. In 43.4% of cases, the ILM was peeled. Best corrected visual acuity and optical coherence tomography (OCT) scans were assessed preoperatively and at 6, 12, and 24 months post-vitrectomy. Results: The mean central macular thickness improved from 413.1 ± 84.4 to 291.3 ± 57.6 μm at two years (p < 0.0001). The mean logarithm of the minimum angle of resolution logMAR best-corrected visual acuity (BCVA) improved after two years, from 0.6 ± 0.2 to 0.2 ± 0.1 (p < 0.0001). We found no difference between ILM peeling vs. no ILM peeling group in terms of anatomical (p = 0.8) and visual outcome (p = 0.3). Eyes with DME and subfoveal serous retinal detachment (SRD) at baseline had better visual outcomes at the final visit (p = 0.001). Conclusions:We demonstrated anatomical and visual improvement of patients who underwent vitrectomy for nontractional refractory DME with and without ILM peeling. Improvement was greater in patients presenting subretinal fluid preoperatively.
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Affiliation(s)
- Stefano Ranno
- Ophthalmology Department, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
- Correspondence:
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Eye Clinic, IRCCS MultiMedica, 20138 Milan, Italy
| | - Manuela Mambretti
- Ophthalmology Department, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
| | - Cristian Metrangolo
- Ophthalmology Department, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
| | - Micol Alkabes
- Eye Clinic, University Hospital Maggiore della Carità, 28100 Novara, Italy
| | | | - Andrea Govetto
- Ophthalmology Department, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
| | - Elisa Carini
- Ophthalmology Department, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Paolo Radice
- Ophthalmology Department, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
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Donati S, Appolloni E, Ceriani S, Premi E, Premoli L, Metrangolo C, Ravasio A, Azzolini C, Radice P. COVID-19 pandemic and ophthalmological emergencies: a case-control analysis of the impact of lockdowns in a University Hospital in Lombardy region, Italy. Ann Med 2023; 55:2248882. [PMID: 37619403 PMCID: PMC10453995 DOI: 10.1080/07853890.2023.2248882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 03/16/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE To evaluate the incidence of ocular pathologies seen at the ophthalmological emergency department (OED) during the national lockdown in 2020 due to the COVID-19 pandemic and compare it to the corresponding period in 2019. METHODS Electronic records of patients who presented at the OED of our University Hospital in Varese, Italy during the COVID-19 lockdown were compared with that from the corresponding period in 2019. Records from the spring (2020A) and winter (2020B) lockdowns were compared with each other and with the same periods in 2019 (2019A and 2019B). Statistical analyses were performed by unpaired Student's t-tests, Poisson's regression and Chi-square test. RESULTS The number of consultations at the OED significantly decreased during the COVID-19 lockdown (p value <.0001). The largest decreases were observed in the youngest (age <15 years: -77.3%) and oldest (age >61 years, -68.5%) age groups. The proportion of men who consulted increased significantly from 61.76% in 2019A to 67.63% in 2020A, and from 54.56% in 2019B to 62.79% in 2020B. A significant reduction in deferrable consultations was also reported (from 943 in 2019 to 335 in 2020; p value <.0001). A statistically significant decrease in the number of consultations involving ocular trauma was also reported despite an increase in its proportion among all consultations for ocular pathologies in 2020. CONCLUSIONS Our evaluation showed a significant reduction in the number of OED consultations in all deferrable pathologies. Although the incidence of conditions that affect visual function was lower, these were more frequent in the lockdown period. The significant reduction in the number of deferrable consultations highlights the misuse of the OED.
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Affiliation(s)
- Simone Donati
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
- U.O.C. Oculistica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Edoardo Appolloni
- U.O.C. Oculistica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
- Department of Neurological and Vision Sciences, Eye Clinic, University of Brescia, Brescia, Italy
| | - Sebastiano Ceriani
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Elias Premi
- U.O.C. Oculistica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese-Como, Italy
| | - Laura Premoli
- U.O.C. Oculistica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Cristian Metrangolo
- U.O.C. Oculistica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Arianna Ravasio
- U.O.C. Oculistica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Claudio Azzolini
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Paolo Radice
- U.O.C. Oculistica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
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Mazzola M, Premoli L, Metrangolo C, Cattaneo J, Premi E, Donati S, Azzolini C. Myopic Simple Hemorrhage Presenting as Radial Hemorrhage in Henle's Fiber Layer. Case Rep Ophthalmol 2021; 12:446-450. [PMID: 34177540 PMCID: PMC8216004 DOI: 10.1159/000510626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022] Open
Abstract
This case report describes a simple hemorrhage (SH) presenting as radial hemorrhage in Henle's fiber layer (HFL) in a patient with high myopia. A 26-year-old girl with high myopia was referred to our center for sudden onset of decreased vision and a central scotoma in the right eye (OD). Best corrected visual acuity (BCVA) was 20/100 OD. Fundus examination showed a stellate intraretinal hemorrhage in the fovea of the OD. The hemorrhage was organized in a peculiar petaloid pattern with feathery distal edges, suggesting localization within the radially oriented HFL. The presence of both choroidal neovascularization and microvascular abnormalities consistent with macular telangiectasia type 2 (MacTel 2) were excluded. Based on these findings, a diagnosis of myopic SH was made. At 4-month follow-up BCVA OD spontaneously improved to 20/40, without any treatment been ever administered to the patient. Spectral-domain optical coherence tomography OD showed reabsorption of the hemorrhage and almost complete restoration of the foveal architecture. The intraretinal location and spread of the hemorrhage into the HFL in our patient are an unusual presentation of SH, which vividly highlights the anatomy of the fovea. Since fibers in HFL are quite delicate and loosely arranged, this layer is very susceptible to deposition of transudates, exudates, hemorrhage, and other products. Radial hemorrhage in HFL has been originally reported in 4 patients as complication of MacTel 2. It has been previously postulated that it may represent a characteristic finding in MacTel 2 that may develop as a result of microvascular abnormalities of the deep retinal capillary plexus. On the contrary, our data suggest that radial hemorrhage in the HFL does not represent a characteristic finding of MacTel 2, but must rather be considered a non-specific sign with multiple possible etiologies.
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Affiliation(s)
- Marco Mazzola
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy.,Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Premoli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Cristian Metrangolo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Jennifer Cattaneo
- Ophthalmology Clinic, Department of Neuroscience, ASST Ovest Milanese, Legnano, Italy
| | - Elias Premi
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Simone Donati
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Claudio Azzolini
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
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Azzolini C, Cattaneo J, Premoli L, Metrangolo C, Chiaravalli M, Donati S. The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment. Int Ophthalmol 2021; 41:2109-2116. [PMID: 33748901 PMCID: PMC8172501 DOI: 10.1007/s10792-021-01768-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Purpose To evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging. Methods In this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data. Results Multiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes. Conclusion Multimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.
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Affiliation(s)
- Claudio Azzolini
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Jennifer Cattaneo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Laura Premoli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Cristian Metrangolo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Maurizio Chiaravalli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Simone Donati
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy.
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Scalinci SZ, Scorolli L, Meduri A, Grenga PL, Corradetti G, Metrangolo C. Effect of basic fibroblast growth factor and cytochrome c peroxidase combination in transgenic mice corneal epithelial healing process after excimer laser photoablation. Clin Ophthalmol 2011; 5:215-21. [PMID: 21386914 PMCID: PMC3046991 DOI: 10.2147/opth.s16866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the role of prepared basic fibroblast growth factor (bFGF) and cytochrome c peroxidase (CCP) combination eyedrops in corneal epithelial healing of transgenic mice (B6(A)-Rpe(rd12)/J) after excimer laser photoablation. MATERIALS AND METHODS In this prospective study, 216 eyes of 108 mice underwent bilateral photorefractive keratectomy. We considered 4 groups: A, B, C, and D. Group A received standard topical postoperative therapy with tobramycin, diclofenac, and dexamethasone eyedrops plus CCP at 3 drops per day for a week or until corneal re-epithelialization was achieved. Group B received standard topical postoperative therapy plus bFGF eyedrops and phosphate-buffered saline (PBS) 3 drops per day for a week or until corneal re-epithelialization was complete. In group C, 1 eye received standard topical postoperative therapy plus CCP eyedrops, bFGF eyedrops, and PBS 3 drops per day for a week or until corneal re-epithelialization was complete. Control eyes (group D) received a standard topical postoperative therapy plus placebo eyedrops. Mice were followed-up for a week from the day after the surgery to evaluate the rate of corneal re-epithelialization. RESULTS Data were analyzed by ANOVA using the XLSTAT 2010 software. Eyes in group A, B, and C healed completely before the fifth postoperative day, achieving, respectively, a re-epithelialization time of 92 hours ± 10 SD, 90 hours ± 12 SD, and 86 hours ± 12 SD. Group D had a re-epithelialization time of 121 hours ± 8 SD (P < 0.05). No side effects or toxic effects were documented. CONCLUSIONS Results suggest that re-epithelialization after phototherapeutic keratectomy can benefit from topical therapy with CCP/bFGF combination eyedrops. Further clinical studies are needed to evaluate the long-term effectiveness of these eyedrops to prevent corneal haze.
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Gismondi A, Colonna S, Micalella F, Metrangolo C. [Hyperbaric oxygen therapy in thrombotic occlusion of the central retinal vein]. Minerva Med 1981; 72:1413-5. [PMID: 7243027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The thrombosis of the retina's central vein is a monocular disease and generally touches old women. It causes failure of the sight and lessening of vision field. Experiences in the treatment of three cases with hyperbaric oxygen are reported. It is concluded that this treatment can be advantageously used in this disease.
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Gismondi A, Micalella F, Metrangolo C, Colonna S. [Treatment of cerebral ischemia with hyperbaric therapy]. Minerva Med 1981; 72:1417-20. [PMID: 7243028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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