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Di Martino V, Mallone F, Lambiase A, Celli M, Mannocci A, Celli L, Mangiantini P, Fino P, Moramarco A. 'BLUES' procedure for assessing the blue level of the sclera in Osteogenesis Imperfecta. Orphanet J Rare Dis 2024; 19:176. [PMID: 38678283 PMCID: PMC11056038 DOI: 10.1186/s13023-024-03192-z] [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] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE Blue sclera is a characteristic and common clinical sign of Osteogenesis Imperfecta (OI). However, there is currently no widely accepted, objective method for assessing and grading blue sclera in individuals with OI. To address this medical need, this study is aimed to design and validate a new method called 'BLUES' (BLUe Eye Sclera) to objectively identify and quantify the blue color in the sclera of patients affected by OI. METHODS Sixty-two patients affected by OI and 35 healthy controls were enrolled in the present prospective study, for a total of 194 eyes analyzed. In the 'BLUES' procedure, eye images from patients with OI and control subjects were analyzed to assess and grade the blue level of the sclera using Adobe Photoshop Software. The validation process then involved comparing the results obtained with the 'BLUES' procedure to the judgement of experienced ophthalmologists (JEO). A receiver-operating characteristic (ROC) curve analysis was used to examine the overall discriminatory power. The sensitivity and specificity levels and the Cohen's Kappa (K) indexes of 'BLUES' and 'JEO' were estimated versus the standard OI diagnosis. The K indexes of 'BLUES' versus 'JEO' were also evaluated. RESULTS The optimal cut-off point of the scleral blue peak was calculated at 17%. Our findings demonstrated a sensitivity of 89% (CI95%: 0.835-0.945) and specificity of 87% (CI95%: 0.791-0.949) for the 'BLUES' procedure with an agreement versus the diagnosis of OI of 0.747. In comparison, the sensitivity and specificity of 'JEO' ranged from 89 to 94% and 77% to 100%, respectively, with an agreement ranging from 0.663 to 0.871 with the diagnosis of OI. The agreement between 'BLUES 'and 'JEO' evaluations ranged from 0.613 to 0.734. CONCLUSIONS Our findings demonstrated an 89% sensitivity and an impressive 87% specificity of our method to analyze the blue sclera in OI. The results indicated high agreement with disease diagnosis and were consistent with evaluations by experienced ophthalmologists. The 'BLUES' procedure appears to be a simple, reliable and objective method for effectively identify and quantify the blue color of the sclera in OI.
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Affiliation(s)
- Valerio Di Martino
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, Rome, 00161, Italy
| | - Fabiana Mallone
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, Rome, 00161, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, Rome, 00161, Italy.
| | - Mauro Celli
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Alice Mannocci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luca Celli
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Pietro Mangiantini
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, Rome, 00161, Italy
| | - Pasquale Fino
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonietta Moramarco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, Rome, 00161, Italy
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Lambiase A, Mallone F, Sacchetti M, Segatto M, Colardo M, Di Martino V, Bruscolini A. Patients with neurotrophic keratitis demonstrate alterations in ocular surface expression of transient receptor potential (TRP) channels. Ocul Surf 2023; 30:295-297. [PMID: 37939847 DOI: 10.1016/j.jtos.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Affiliation(s)
| | - Fabiana Mallone
- University of Rome La Sapienza Department of Organs of Sense, Italy
| | - Marta Sacchetti
- University of Rome La Sapienza Department of Organs of Sense, Italy
| | | | | | | | - Alice Bruscolini
- University of Rome La Sapienza Department of Organs of Sense, Italy
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Mallone F, Alisi L, Lucchino L, Di Martino V, Nebbioso M, Armentano M, Lambiase A, Moramarco A. Insights into Novel Choroidal and Retinal Clinical Signs in Neurofibromatosis Type 1. Int J Mol Sci 2023; 24:13481. [PMID: 37686284 PMCID: PMC10488231 DOI: 10.3390/ijms241713481] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a rare inherited neurocutaneous disorder with a major impact on the skin, nervous system and eyes. The ocular diagnostic hallmarks of this disease include iris Lisch nodules, ocular and eyelid neurofibromas, eyelid café-au-lait spots and optic pathway gliomas (OPGs). In the last years, new manifestations have been identified in the ocular district in NF1 including choroidal abnormalities (CAs), hyperpigmented spots (HSs) and retinal vascular abnormalities (RVAs). Recent advances in multi-modality imaging in ophthalmology have allowed for the improved characterization of these clinical signs. Accordingly, CAs, easily detectable as bright patchy nodules on near-infrared imaging, have recently been added to the revised diagnostic criteria for NF1 due to their high specificity and sensitivity. Furthermore, subclinical alterations of the visual pathways, regardless of the presence of OPGs, have been recently described in NF1, with a primary role of neurofibromin in the myelination process. In this paper, we reviewed the latest progress in the understanding of choroidal and retinal abnormalities in NF1 patients. The clinical significance of the recently revised diagnostic criteria for NF1 is discussed along with new updates in molecular diagnosis. New insights into NF1-related neuro-ophthalmic manifestations are also provided based on electrophysiological and optical coherence tomography (OCT) studies.
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Affiliation(s)
| | | | | | | | | | | | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (F.M.); (L.A.); (L.L.); (V.D.M.); (M.N.); (M.A.); (A.M.)
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Mallone F, Lucchino L, Giustini S, Lambiase A, Moramarco A. An update on choroidal abnormalities and retinal microvascular changes in neurofibromatosis type 1. Orphanet J Rare Dis 2022; 17:223. [PMID: 35698197 PMCID: PMC9195315 DOI: 10.1186/s13023-022-02369-8] [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: 10/26/2021] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
Neurofibromatosis Type 1 (NF1) is a rare neurocutaneous disorder transmitted in an autosomal dominant fashion, mainly affecting the nervous system, the eye and skin. Ocular diagnostic hallmarks of NF1 include iris Lisch nodules, optic gliomas, orbital and eyelid neurofibromas, eyelid café-au-lait spots. In recent years, a new ocular sign represented by choroidal abnormalities (CAs) has been characterized in NF1. The CAs, identified with near-infrared reflectance, have been reported with a frequency of up to 100% in NF1, and have recently been added to the actual diagnostic criteria for NF1. The present Letter to the journal is intended to provide an update on features and clinical significance of CAs in NF1. Moreover, the relation with other ocular manifestations recently described in NF1 including hyperpigmented spots and retinal microvascular abnormalities is discussed.
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Affiliation(s)
- Fabiana Mallone
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Luca Lucchino
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sandra Giustini
- Department of Dermatology and Venereology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Antonietta Moramarco
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Moramarco A, Mallone F, Marcelli M, Alisi L, Roberti V, Giustini S, Lambiase A, Nebbioso M. Neuroretinal dysfunction in patients affected by neurofibromatosis type 1. Int J Ophthalmol 2022; 15:773-779. [DOI: 10.18240/ijo.2022.05.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
AIM: To examine neuroretinal function by using the multifocal electroretinography (mfERG) test in patients with neurofibromatosis type 1 (NF1) without optic pathway gliomas (OPGs).
METHODS: This study was conducted on 35 patients (35 eyes) with NF1 and 30 healthy subjects (30 eyes) for the control group. Each subject underwent a complete ophthalmological examination including spectral domain-optical coherence tomography (SD-OCT) and mfERG. The 1.5-Tesla magnetic resonance imaging (MRI) scan of the brain was performed in NF1 patients to assess the presence of OPGs. All participants were recruited having a best corrected visual acuity (BCVA) of no less than 20/20 in each eye. The amplitude and implicit time of the P1 wave (first-order Kernel component) were evaluated on mfERG. Data analysis was carried out in the two central degrees and in the four quadrants from two to 25 degrees of visual field.
RESULTS: Statistically significant results were obtained for the P1 wave amplitudes in the 4 quadrants in NF1 patients compared to healthy controls, while the reduction was not significant in the 2 central degrees between the groups. A statistically significant difference was observed among the P1 wave amplitudes as recorded in the 4 quadrants within the NF1 group, with lower amplitudes detected in the nasal quadrants. No differences in the implicit times were recorded in the 2 central degrees and in the 4 quadrants as compared between NF1 patients and controls.
CONCLUSION: Impaired neuroretinal function in NF1 patients is expressed in a decreased amplitude of the P1-wave between 2 and 25 central retinal degrees on mfERG. Altered intracellular signal transduction due to abnormal neurofibromin-mediated cyclic adenosine monophosphate (cAMP) generation, can be involved. The possible use of mfERG as subclinical retinal damage indicator has a potential utility in clinical practice for the follow-up of NF1 patients.
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Mallone F, Marenco M, Giustolisi R, Plateroti R, Lambiase A. Platelet-Rich Plasma (PRP) to promote corneal healing in firework-related ocular burn and total limbal stem cell deficiency (LSCD). Eur J Ophthalmol 2022; 33:NP18-NP22. [PMID: 35139684 DOI: 10.1177/11206721221080004] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the case of persistent corneal epithelial defect in total limbal stem cell deficiency (LSCD) after severe firework-related ocular burn treated with autologous Platelet-Rich Plasma (PRP). CASE DESCRIPTION A young patient, victim of fireworks trauma, presented with a large persistent epithelial defect affecting the central cornea of his left eye and progressing to stromal melting, in the context of grade VI ocular surface burn with 12 h limbal involvement. Impression cytology to the cornea confirmed a complete LSCD. Assessment of corneal sensitivity by Cochet Bonnet esthesiometer revealed complete corneal anesthesia. Based on progressive clinical worsening under conventional therapy, the patient was started on very pure autologous PRP eye drops obtained using the Hy-Tissue PRP® technology. Six times a day eye drops administration for 30 days was scheduled in the affected eye. At the end of treatment, the epithelial defect had disappeared being replaced by advancing conjunctiva. CONCLUSION Our findings provide information on management of ocular burns from fireworks, a subject of current interest and concern. Autologous PRP eye drops prepared using the Hy-Tissue PRP® system and administered in the presence of total LSCD and complete corneal anesthesia, prevented corneal stromal melting to progress and allowed the ocular surface epithelial coverage to re-establish. This paved the way for later successful restorative and reconstructive intervention. Also, first description of the Hy-tissue PRP procedure for ophthalmological use is reported.
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Affiliation(s)
- Fabiana Mallone
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Rosalia Giustolisi
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Rocco Plateroti
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
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Abstract
Hypoxia, a condition of low oxygen availability, is a hallmark of tumour microenvironment and promotes cancer progression and resistance to therapy. Many studies reported the essential role of hypoxia in regulating invasiveness, angiogenesis, vasculogenic mimicry and response to therapy in melanoma. Melanoma is an aggressive cancer originating from melanocytes located in the skin (cutaneous melanoma), in the uveal tract of the eye (uveal melanoma) or in mucosal membranes (mucosal melanoma). These three subtypes of melanoma represent distinct neoplasms in terms of biology, epidemiology, aetiology, molecular profile and clinical features.In this review, the latest progress in hypoxia-regulated pathways involved in the development and progression of all melanoma subtypes were discussed. We also summarized current knowledge on preclinical studies with drugs targeting Hypoxia-Inducible Factor-1, angiogenesis or vasculogenic mimicry. Finally, we described available evidence on clinical studies investigating the use of Hypoxia-Inducible Factor-1 inhibitors or antiangiogenic drugs, alone or in combination with other strategies, in metastatic and adjuvant settings of cutaneous, uveal and mucosal melanoma.Hypoxia-Inducible Factor-independent pathways have been also reported to regulate melanoma progression, but this issue is beyond the scope of this review.As evident from the numerous studies discussed in this review, the increasing knowledge of hypoxia-regulated pathways in melanoma progression and the promising results obtained from novel antiangiogenic therapies, could offer new perspectives in clinical practice in order to improve survival outcomes of melanoma patients.
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Affiliation(s)
- Simona D'Aguanno
- Preclinical Models and New Therapeutic Agents Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Donatella Del Bufalo
- Preclinical Models and New Therapeutic Agents Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
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Moramarco A, Mallone F, Sacchetti M, Lucchino L, Miraglia E, Roberti V, Lambiase A, Giustini S. Hyperpigmented spots at fundus examination: a new ocular sign in Neurofibromatosis Type I. Orphanet J Rare Dis 2021; 16:147. [PMID: 33757576 PMCID: PMC7986306 DOI: 10.1186/s13023-021-01773-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neurofibromatosis Type I (NF1), also termed von Recklinghausen disease, is a rare genetic disorder that is transmitted by autosomal dominant inheritance, with complete penetrance and variable expressivity. It is caused by mutation in the NF1 gene on chromosome 17 encoding for neurofibromin, a protein with oncosuppressive activity, and it is 50% sporadic or inherited. The disease is characterized by a broad spectrum of clinical manifestations, mainly involving the nervous system, the eye and skin, and a predisposition to develop multiple benign and malignant neoplasms. Ocular diagnostic hallmarks of NF1 include optic gliomas, iris Lisch nodules, orbital and eyelid neurofibromas, eyelid café-au-lait spots. Choroidal nodules and microvascular abnormalities have recently been identified as additional NF1-related ocular manifestations. The present study was designed to describe the features and clinical significance of a new sign related to the visual apparatus in NF-1, represented by hyperpigmented spots (HSs) of the fundus oculi. RESULTS HSs were detected in 60 (24.1%) out of 249 patients with NF1, with a positive predictive value of 100% and a negative predictive value of 44.2%. None of the healthy subjects (150 subjects) showed the presence of HSs. HSs were visible under indirect ophthalmoscopy, ultra-wide field (UWF) pseudocolor imaging and red-only laser image, near-infrared reflectance (NIR)-OCT, but they were not appreciable on UWF green reflectance. The location and features of pigmentary lesions matched with the already studied NF1-related choroidal nodules. No significant difference was found between the group of patients (n = 60) with ocular HSs and the group of patients (n = 189) without ocular pigmented spots in terms of age, gender or severity grading of the disease. A statistically significant association was demonstrated between the presence of HSs and neurofibromas (p = 0.047), and between the presence of HSs and NF1-related retinal microvascular abnormalities (p = 0.017). CONCLUSIONS We described a new ocular sign represented by HSs of the fundus in NF1. The presence of HSs was not a negative prognostic factor of the disease. Following multimodal imaging, we demonstrated that HSs and choroidal nodules were consistent with the same type of lesion, and simple indirect ophthalmoscopy allowed for screening of HSs in NF1.
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Affiliation(s)
- Antonietta Moramarco
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marta Sacchetti
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Luca Lucchino
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Emanuele Miraglia
- Department of Dermatology and Venereology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Vincenzo Roberti
- Department of Dermatology and Venereology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Sandra Giustini
- Department of Dermatology and Venereology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Nebbioso M, Franzone F, Lambiase A, La Cava M, Mallone F, Pizzuti A, Marchionni E. X-linked dominant RPGR gene mutation in a familial Coats angiomatosis. BMC Ophthalmol 2021; 21:37. [PMID: 33446141 PMCID: PMC7807486 DOI: 10.1186/s12886-020-01791-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/13/2020] [Accepted: 12/25/2020] [Indexed: 11/15/2022] Open
Abstract
Background Retinitis Pigmentosa (RP) is the most frequent retinal hereditary disease and every kind of transmission pattern has been described. The genetic etiology of RP is extremely heterogeneous and in the last few years the large application of Next Generation Sequencing (NGS) approaches improved the diagnostic yield, elucidating previously unexplained RP causes and new genotype-phenotype correlations. The objective of this study was to reevaluate a previously reported family affected by Coats’-type RP without genetic diagnosis and to describe the new genetic findings. Case presentation Cohort, prospective, and single-center observational family case. Three individuals of a family, consisting of a mother and four sons, with a Coats phenotype were revaluated after 25 years of clinical follow-up using visual acuity tests, ophthalmoscopy, Goldmann visual field, electroretinography (ERG), and spectral domain-optical coherence tomography (SD-OCT). Specifically, a RP NGS panel was performed on one member of the family and segregation analysis was required for the other affected and unaffected members. NGS analysis disclosed a RPGR (Retinitis Pigmentosa GTPase Regulator) gene truncating variant segregating with the phenotype in all the three affected members. RPGR mutations are reported as causative of an X-linked RP. Conclusions This is the first reported family with a Coats’-type RP associated to a RPGR mutation and segregating as a dominant X-linked disease, confirming the hypothesis of the genetic origin of this condition and expanding the phenotypic spectrum of diseases caused by RPGR gene mutations. The Authors suggest RPGR gene screening mutations in patients presenting this phenotype.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Federica Franzone
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy. .,Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Maurizio La Cava
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Faculty of Medicine and Odontology, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Enrica Marchionni
- Department of Experimental Medicine, Faculty of Medicine and Odontology, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
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Mallone F, Sacchetti M, Lambiase A, Moramarco A. Molecular Insights and Emerging Strategies for Treatment of Metastatic Uveal Melanoma. Cancers (Basel) 2020; 12:E2761. [PMID: 32992823 PMCID: PMC7600598 DOI: 10.3390/cancers12102761] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 08/23/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
Uveal melanoma (UM) is the most common intraocular cancer. In recent decades, major advances have been achieved in the diagnosis and prognosis of UM allowing for tailored treatments. However, nearly 50% of patients still develop metastatic disease with survival rates of less than 1 year. There is currently no standard of adjuvant and metastatic treatment in UM, and available therapies are ineffective resulting from cutaneous melanoma protocols. Advances and novel treatment options including liver-directed therapies, immunotherapy, and targeted-therapy have been investigated in UM-dedicated clinical trials on single compounds or combinational therapies, with promising results. Therapies aimed at prolonging or targeting metastatic tumor dormancy provided encouraging results in other cancers, and need to be explored in UM. In this review, the latest progress in the diagnosis, prognosis, and treatment of UM in adjuvant and metastatic settings are discussed. In addition, novel insights into tumor genetics, biology and immunology, and the mechanisms underlying metastatic dormancy are discussed. As evident from the numerous studies discussed in this review, the increasing knowledge of this disease and the promising results from testing of novel individualized therapies could offer future perspectives for translating in clinical use.
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Affiliation(s)
| | | | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (F.M.); (M.S.); (A.M.)
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Mallone F, Lucchino L, Franzone F, Marenco M, Carlesimo SC, Moramarco A. High-dose vitamin B supplementation for persistent visual deficit in multiple sclerosis: a pilot study. Drug Discov Ther 2020; 14:122-128. [PMID: 32669520 DOI: 10.5582/ddt.2020.03031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of this study is to investigate the potential neuroprotective effect of high-doses vitamins B1, B6 and B12 in patients with relapsing-remitting multiple sclerosis (RRMS) and persistent visual loss after acute optic neuritis (AON). Sixteen patients (20 eyes) diagnosed with RRMS and visual permanent disability following AON were enrolled for the present open, pilot study. Each patient was treated with oral high-doses 300 mg of vitamin B1, 450 mg of vitamin B6 and 1,500 mcg of vitamin B12, as add-on treatment to concomitant disease-modifying therapies (DMTs) for consecutive 90 days. Outcome measures were to determine changes from baseline to month three in visual acuity (VA) and visual field (VF) testing, with correlations with clinical parameters. Logistical regression was performed to evaluate predictors of final VA. A statistically significant improvement was registered in visual acuity (p = 0.002) and foveal sensitivity threshold (FT) (p = 0.006) at follow-up compared to baseline. A similar trend was demonstrated for mean deviation (MD) (p < 0.0001), and pattern standard deviation (PSD) (p < 0.0001). Age at the time of inclusion was positively correlated with latency time (rho = 0.47, p = 0.03), while showing a negative correlation with visual acuity (rho = - 0.45, p = 0.04) and foveal sensitivity threshold (rho = - 0.6, p = 0.005) at follow up. A statistically significant correlation was demonstrated between foveal sensitivity threshold and visual acuity at baseline (rho = 0.79, p < 0.0001). In a linear regression model, the main predictor of visual acuity at follow up was the foveal sensitivity threshold (B = 1.39; p < 0.0001). Supplemental high-dose vitamins B1, B6 and B12 resulted as effective therapy to improve visual function parameters in MS-related visual persistent disability.
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Affiliation(s)
- Fabiana Mallone
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Luca Lucchino
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Federica Franzone
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Mallone F, Marcelli M, Monsellato R, Franzone F, Gharbiya M, Lambiase A. Self-sealing posterior scleral perforation in airgun ocular trauma, surgical tip: a case report. BMC Ophthalmol 2020; 20:164. [PMID: 32321467 PMCID: PMC7178978 DOI: 10.1186/s12886-020-01435-8] [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: 03/03/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background Intraorbital metallic foreign bodies have varied clinical presentations. Here, we report the unusual case of intraoperative evidence of spontaneously healed posterior scleral perforation in a severe ballistic trauma without previous instrumental signs of penetrating wound and complete visual restoration after surgery. Case presentation The patient was hit by several lead hunting pellets in the chest, abdomen, limbs, face and orbit. Computed Tomography (CT) images revealed the presence of a pellet within the orbitary cavity, close to the optic nerve, with no signs of penetrating ocular wound. While performing vitrectomy for severe vitreous hemorrhage, a point of strong adherence between a old hemorrhage and retinal surface was identified and managed conservatively, as it was attributed to trauma related-impact area. So, lead foreign body took an unusual trajectory impacting the globe and finally lodging back in the deep orbitary cavity, in absence of significant ocular injury and with visual prognosis preservation. Conclusions Our findings provide further information on orbital injuries from airguns, a theme of growing popularity and concern. Intraoperative recognition of hardly removable old hemorrhagic clot as self-blockage site of posterior scleral penetrating trauma, allowed for surgical stabilization and minimal solicitation of the area to avoid inadvertent perforation.
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Affiliation(s)
- Fabiana Mallone
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy.
| | - Michela Marcelli
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Riccardo Monsellato
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Federica Franzone
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Magda Gharbiya
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
| | - Alessandro Lambiase
- Department of Organ of Sense, Sapienza University of Rome, Viale del Policlinico, 155 00161, Rome, Italy
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Moramarco A, Mallone F, Pirraglia MP, Bruscolini A, Giustolisi R, La Cava M, Lambiase A. Clinical Features of Ocular Syphilis: a Retrospective Clinical Study in an Italian Referral Centre. Semin Ophthalmol 2020; 35:50-55. [PMID: 32036734 DOI: 10.1080/08820538.2020.1723651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the clinical characteristics and visual prognosis of ocular involvement in syphilis.Design: A retrospective cohort study.Methods: We studied the charts of 24 patients who visited our Ophthalmological Centre in Rome, Italy. All patients with serological evidence of syphilitic infection were included.Results: Ocular involvement was the first manifestation of syphilitic disease in 96% and Human Immunodeficiency Virus (HIV) seropositivity was found in 29% of the cases. The most frequent ocular manifestation was posterior uveitis. Vitreous involvement was frequent. Patients with papillitis at onset showed better visual outcome with antisyphilitic treatment. Posterior uveitis at onset and HIV seropositivity were negative prognostic factors for visual outcome. HIV-positive patients showed more severe and frequent bilateral course of ocular involvement in syphilis.Conclusions: The ophthalmologist should suspect syphilis in patien ts with uveitis or optic neuropathy associated with high-risk sexual behaviour and/or HIV, or in patients with posterior placoid chorioretinitis, necrotising retinitis, or interstitial keratitis.
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Affiliation(s)
| | - Fabiana Mallone
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | - Alice Bruscolini
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | - Maurizio La Cava
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
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Moramarco A, Himmelblau E, Miraglia E, Mallone F, Roberti V, Franzone F, Iacovino C, Giustini S, Lambiase A. Ocular manifestations in Gorlin-Goltz syndrome. Orphanet J Rare Dis 2019; 14:218. [PMID: 31533758 PMCID: PMC6749644 DOI: 10.1186/s13023-019-1190-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/03/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome, is a rare genetic disorder that is transmitted in an autosomal dominant manner with complete penetrance and variable expressivity. It is caused in 85% of the cases with a known etiology by pathogenic variants in the PTCH1 gene, and is characterized by a wide range of developmental abnormalities and a predisposition to multiple neoplasms. The manifestations are multiple and systemic and consist of basal cell carcinomas in various regions, odontogenic keratocistic tumors and skeletal anomalies, to name the most frequent. Despite the scarce medical literature on the topic, ocular involvement in this syndrome is frequent and at the level of various ocular structures. Our study focuses on the visual apparatus and its annexes in subjects with this syndrome, in order to better understand how this syndrome affects the ocular system, and to evaluate with greater accuracy and precision the nature of these manifestations in this group of patients. Results Our study confirms the presence of the commonly cited ocular findings in the general literature regarding the syndrome [hypertelorism (45.5%), congenital cataract (18%), nystagmus (9%), colobomas (9%)] and highlights strabismus (63% of the patients), epiretinal membranes (36%) and myelinated optic nerve fiber layers (36%) as the most frequent ophthalmological findings in this group of patients. Conclusions The presence of characteristic and frequent ocular signs in the Gorlin- Goltz syndrome could help with the diagnostic process in subjects suspected of having the syndrome who do not yet have a diagnosis. The ophthalmologist has a role as part of a multidisciplinary team in managing these patients. The ophthalmological follow-up that these patients require, can allow, if necessary, a timely therapy that could improve the visual prognosis of such patients.
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Affiliation(s)
- Antonietta Moramarco
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy.
| | - Ehud Himmelblau
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy.
| | - Emanuele Miraglia
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Roberti
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Federica Franzone
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Chiara Iacovino
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Sandra Giustini
- Department of Internal Medicine and Medical Specialties, Unit of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
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Bruscolini A, La Cava M, Mallone F, Marcelli M, Ralli M, Sagnelli P, Greco A, Lambiase A. Controversies in the management of neuromyelitis optica spectrum disorder. Expert Rev Neurother 2019; 19:1127-1133. [DOI: 10.1080/14737175.2019.1648210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alice Bruscolini
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Maurizio La Cava
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Michela Marcelli
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Paolo Sagnelli
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
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Moramarco A, Lambiase A, Mallone F, Miraglia E, Giustini S. A characteristic type of retinal microvascular abnormalities in a patient with Neurofibromatosis type 1. Clin Ter 2019; 170:e4-e9. [PMID: 30789191 DOI: 10.7417/ct.2019.2101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aims to describe a typical retinal microvascular abnormality in patients with neurofibromatosis type 1 (NF-1). A 64-year-old man with diagnosis of NF-1 was evaluated by complete ophthalmological examination, including fluorescein angiography and spectral Domain OCT in Near-Infrared (NIR-OCT) modality. Slit lamp exam showed the presence of more than 10 Lisch nodules for each eye. Ophthalmic examinations and NIR-OCT scans showed the presence of retinal tortuous vessels ending in a 'puff of smoke' arrangement. The clinical significance as diagnostic and prognostic factor of this novel type of retinal microvascular abnormality in NF-1 should be further investigated.
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Affiliation(s)
- A Moramarco
- Department of Organ of Sense, Sapienza University of Rome, Rome
| | - A Lambiase
- Department of Organ of Sense, Sapienza University of Rome, Rome
| | - F Mallone
- Department of Organ of Sense, Sapienza University of Rome, Rome
| | - E Miraglia
- Department of Dermatology, Sapienza University of Rome, Rome, Italy
| | - S Giustini
- Department of Dermatology, Sapienza University of Rome, Rome, Italy
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Moramarco A, Miraglia E, Mallone F, Roberti V, Iacovino C, Bruscolini A, Giustolisi R, Giustini S. Retinal microvascular abnormalities in neurofibromatosis type 1. Br J Ophthalmol 2019; 103:1590-1594. [PMID: 30705042 DOI: 10.1136/bjophthalmol-2018-313002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/02/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to provide a classification of the different retinal vascular arrangements in neurofibromatosis 1 (NF1), with appropriate qualitative and quantitative information. METHODS This study was conducted on 334 consecutive patients with NF1 and 106 sex-matched and age-matched healthy control subjects. Each patient underwent a comprehensive ophthalmological examination inclusive of near-infrared reflectance retinography by using the spectral domain Optical coherence tomography (OCT), a complete dermatological examination and 1.5 T MRI scan of the brain to assess the presence of optic nerve gliomas. To evaluate the predictability and the diagnostic accuracy of our identified retinal microvascular arrangements, we calculated the diagnostic indicators for each pattern of pathology, with corresponding 95% CI. In addition, we evaluated the association between the microvascular arrangements and each National Institutes of Health diagnostic criteria. RESULTS Microvascular abnormalities were detected in 105 of 334 NF1 patients (31.4%), the simple vascular tortuosity was recognised in 78 of 105 cases (74.3%) and whether the corkscrew pattern and the moyamoya-like type showed a frequency of 42.8% (45 of 105 cases) and 15.2% (16 of 105 cases), respectively. We found a statistically significant correlation between the presence of retinal microvascular abnormalities and the patient age (p=0.02) and between the simple vascular tortuosity, the patient age and the presence of neurofibromas (p=0.002 and p=0.05, respectively). CONCLUSIONS We identified microvascular alterations in 31.4% of patients and a statistically significant association with patient age. Moreover, the most frequent type of microvascular alterations, the simple vascular tortuosity, resulted positively associated with age and with the presence of neurofibromas.
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Affiliation(s)
| | | | - Fabiana Mallone
- Department of Organ of Sense, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Roberti
- Department of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Chiara Iacovino
- Department of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Alice Bruscolini
- Department of Organ of Sense, Sapienza University of Rome, Rome, Italy
| | - Rosalia Giustolisi
- Department of Organ of Sense, Sapienza University of Rome, Rome, Italy.,Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Sandra Giustini
- Department of Dermatology, Sapienza University of Rome, Rome, Italy.,Department of Clinical Dermatology, University of Rome "Sapienza", Rome, Italy
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Moramarco A, Giustini S, Nofroni I, Mallone F, Miraglia E, Iacovino C, Calvieri S, Lambiase A. Near-infrared imaging: an in vivo, non-invasive diagnostic tool in neurofibromatosis type 1. Graefes Arch Clin Exp Ophthalmol 2017; 256:307-311. [PMID: 29290016 DOI: 10.1007/s00417-017-3870-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 09/04/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Only a few reports in the literature have investigated the presence of ocular abnormalities in neurofibromatosis type 1 (NF-1) patients. The aim of this study was to evaluate the prevalence of ocular abnormalities in a large population of NF1 patients, focusing on the choroidal changes. METHODS This study was conducted on 160 consecutive patients with NF1 and 106 sex- and age-matched healthy subjects (control). Each patient underwent a complete ophthalmological examination inclusive of best-corrected visual acuity, intraocular pressure measurement, slit-lamp biomicroscopy, indirect fundus biomicroscopy, and near-infrared reflectance (NIR) retinography by using the spectral domain OCT. Moreover, all patients underwent complete dermatological exam and 1.5-Tesla MRI scan of the brain to assess the presence of optic nerve gliomas. RESULTS Choroidal abnormalities were detected in 97% of patients, with a positive predictive value of 100% and a negative predictive value of 96.4%. Interestingly, a small number of patients (4/160; 2.5%) showed Lisch nodules without choroidal abnormalities, whereas a larger number of patents (22/160; 13.75%) presented choroidal lesions in absence of Lisch nodules. None of the patients showed the absence of both choroidal lesions and Lisch nodules. The number of choroidal lesions increased with age (r = 0.364, p = 0.0001) and with the severity of pathology (r = 0.23, p = 0.003). Any statistically significant correlation between choroidal lesions, visual acuity, and intraocular pressure was observed. CONCLUSIONS NIR imaging represents an in vivo, non-invasive, sensitive and reproducible exam to detect choroidal nodules in NF-1 patients, suggesting that choroidal changes may represent an additional diagnostic criteria for NF1.
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Affiliation(s)
- Antonietta Moramarco
- Department of Sense Organs, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sandra Giustini
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Emanuele Miraglia
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Chiara Iacovino
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Stefano Calvieri
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Trebbastoni A, Marcelli M, Mallone F, D'Antonio F, Imbriano L, Campanelli A, de Lena C, Gharbiya M. Attenuation of Choroidal Thickness in Patients With Alzheimer Disease: Evidence From an Italian Prospective Study. Alzheimer Dis Assoc Disord 2017; 31:128-134. [PMID: 27875364 DOI: 10.1097/wad.0000000000000176] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To compare the 12-month choroidal thickness (CT) change between Alzheimer disease (AD) patients and normal subjects. METHODS In this prospective, observational study, 39 patients with a diagnosis of mild to moderate AD and 39 age-matched control subjects were included. All the subjects underwent neuropsychological (Mini Mental State Examination, Alzheimer disease Assessment Scale-Cognitive Subscale, and the Clinical Dementia Rating Scale) and ophthalmological evaluation, including spectral domain optical coherence tomography, at baseline and after 12 months. CT was measured manually using the caliper tool of the optical coherence tomography device. RESULTS After 12 months, AD patients had a greater reduction of CT than controls (P≤0.05, adjusted for baseline CT, age, sex, axial length, and smoking). DISCUSSION CT in patients with AD showed a rate of thinning greater than what could be expected during the natural course of aging.
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Affiliation(s)
- Alessandro Trebbastoni
- Departments of *Neurology and Psychiatry †Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy
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Gharbiya M, Giustolisi R, Marchiori J, Bruscolini A, Mallone F, Fameli V, Nebbioso M, Abdolrahimzadeh S. Comparison of Short-Term Choroidal Thickness and Retinal Morphological Changes after Intravitreal Anti-VEGF Therapy with Ranibizumab or Aflibercept in Treatment-Naive Eyes. Curr Eye Res 2017; 43:391-396. [DOI: 10.1080/02713683.2017.1405045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Magda Gharbiya
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Rosalia Giustolisi
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Jessica Marchiori
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Alice Bruscolini
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Fabiana Mallone
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Valeria Fameli
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Marcella Nebbioso
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
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