Leopoldo Spadea

Peer reviewed article authored by (Spadea L, Paroli MP). Read article or submit your manuscript for publishing.

Peer reviewed article authored by (Spadea L, Mencucci R). Read article or submit your manuscript for publishing.

Background: The purpose of this paper is to report the results of using combined treatment of customized excimer laser-assisted photorefractive keratectomy (PRK) and prophylactic corneal collagen crosslinking (CXL) for residual refractive error in a group of patients who had previously undergone lamellar keratoplasty for keratoconus. Methods: The study included 14 eyes from 14 patients who had originally been treated for keratoconus in one eye by excimer laser-assisted lamellar keratoplasty (ELLK), and subsequently presented with residual ametropia (-6.11 D ± 2.48, range -2.50 to -9.50). After a mean 40.1 ± 12.4 months since ELLK they underwent combined simultaneous corneal regularization treatment with topographically guided transepithelial excimer laser PRK (central corneal regularization) and corneal CXL induced by riboflavin-ultraviolet A. Results: After a mean 15 ± 6.5 (range 6–24) months, all eyes gained at least one Snellen line of uncorrected distance visual acuity (range 1–10). No patient lost lines of corrected distance visual acuity, and four patients gained three lines of corrected distance visual acuity. Mean manifest refractive spherical equivalent was -0.79 ± 2.09 (range +1 to -3.0) D, and topographic keratometric astigmatism was 5.02 ± 2.93 (range 0.8–8.9) D. All the corneas remained clear (haze < 1). Conclusion: The combination of customized PRK and corneal CXL provided safe and effective results in the management of corneal regularization for refractive purposes after ELLK for keratoconus.

Peer reviewed article authored by (Spadea L, Cantera E, Cortes M, Evangelista Conocchia E, Stewart CW). Read article or submit your manuscript for publishing.

To evaluate the anatomic and functional results of optical pachymetry-guided custom excimer laser-assisted lamellar keratoplasty in keratoconus patients. Eye Clinic, University of L'Aquila, L'Aquila, Italy. Prospective noncomparative case series. Patients with keratoconus having unilateral surgery using custom excimer laser-assisted lamellar keratoplasty were evaluated. A transepithelial excimer laser ablation was planned to leave an estimated uniform thickness residual stromal corneal bed of 200 μm. The donor lamella was prepared with the excimer laser and subsequently sutured to the host cornea using 16 single 10-0 nylon sutures. The eyes were examined preoperatively and 3, 6, 12, and 24 months postoperatively. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, computerized videokeratography, pachymetry, and endothelial specular microscopy. Of the forty-three treated eyes, 35 were available at the 24-month follow-up visit, at which time the UDVA was better than 20/60 in 16 patients (45.7%) and the CDVA was 20/40 or better in 31 patients (88.6%). The mean refractive astigmatism was -2.11 diopters (D) (P<.05) and the mean spherical equivalent manifest refraction, -2.60 D (P<.05). No statistically significant changes in mean corneal endothelial cell density were observed postoperatively. In 1 case, the donor lamella was exchanged secondary to an altered reepithelialization process with initial corneal melting. Two-year findings indicate that pachymetry-guided custom excimer laser-assisted lamellar keratoplasty is a useful surgical treatment for moderate to advanced keratoconus, preventing the need for the more invasive procedure of penetrating keratoplasty.

The rates of post-operative endophthalmitis have been low for many years, but recent reports suggest that this type of ocular infection may be on the rise. Fluctuations in the number of cases appear to correlate with the type of intraocular surgery performed. Post-operative endophthalmitis has been reported as a consequence of nearly every type of ocular surgery, but is most common following cataract surgery. Numerous reports have demonstrated that Gram-positive bacteria cause the vast majority of post-operative endophthalmitis cases. Coagulase-negative staphylococcal isolates are the most common. Most intraocular infections resulting from infection with coagulase-negative staphylococci can be treated with antibiotic and anti-inflammatory agents, resulting in restoration of partial or complete vision. However, the more virulent the bacterial strain, the more devastating the visual outcome. Intraocular infections with Staphyloccus aureus , enterococci, Bacillus or Gram-negative strains are often intractable, and blindness or loss of the eye itself is not uncommon. The therapeutic success of treating post-operative endophthalmitis depends largely on accurate and prompt diagnosis. Antibiotic therapy can be topical, sub-conjunctival, systemic or intravitreal. Vitrectomy must be reserved for patients who present with initial visual acuity of light perception. Only in these cases has vitrectomy been shown to be more advantageous with respect to the intravitreal antibiotic injection.

To report the possibility of post myopic photorefractive keratectomy (PRK) haze treatment in a patient with expressed reluctance for any additional laser therapy. Seven months after bilateral PRK with subsequent development of corneal haze and refractive regression in both eyes, a 37-old-year male patient presented a best-spectacle corrected visual acuity (BSCVA) of 20/30 in the right eye and of 20/22 in the left eye. Both eyes were sequentially treated by scraping the stromal surface and application of mitomycin C (MMC) for 2 minutes. Both eyes had significant improvement in corneal transparency. Eighteen months after this treatment BSCVA had improved to 20/20 in each eye. No toxic effects were observed during either re-epithelialization or follow-up periods. In conclusion scraping and application of MMC could be considered a good tool in the treatment of selected cases of haze after myopic PRK, especially with patients that are reluctant to undergo a secondary laser procedure.

Purpose: To report the results of corneal collagen crosslinking (CXL) in a patient with corneal ectasia developed after excimer laser–assisted lamellar keratoplasty for keratoconus and a secondary photorefractive keratectomy (PRK) for residual refractive error. Methods: A 33-year-old woman, who had originally been treated for keratoconus in the right eye by excimer laser–assisted lamellar keratoplasty, subsequently had her residual ametropia treated by topographically guided, transepithelial excimer laser PRK. Five years after PRK, the patient developed corneal ectasia showing concomitant visual changes of best spectacle-corrected visual acuity (BSCVA) reduced to 20/33 with a refraction of −6.00 +6.00 ^× 30. The minimum corneal thickness at the ectasia apex was 406 µm. A treatment of riboflavin-UVA–induced corneal CXL was performed on the right eye. Results: Two years after the CXL treatment, the right eye improved to 20/20 BSCVA with a refraction of plano +1.00 ^× 50 while exhibiting a clear lamellar graft. Conclusions: Corneal CXL provided safe and effective management of ectasia developed after excimer laser–assisted lamellar keratoplasty and PRK.

PURPOSE: To report the results of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A irradiation in a patient affected by pellucid marginal degeneration (PMD). METHODS: A 43-year-old man with bilateral PMD underwent CXL in the left eye. The treatment was performed in standard fashion with the exception of slightly inferior decentration of the 9-mm–diameter irradiated area preserving an untreated surface area 1 mm from the limbus. RESULTS: Epithelial regrowth was complete after 4 days' use of a bandage soft contact lens. No side effects or damage to the limbal region were observed during re-epithelialization or during follow-up. Corrected distance visual acuity improved from 20/200 to 20/63 at 3 months and was stable through the 12-month interval. Keratometric astigmatism showed a 1.40-diopter (D) reduction and the power of ectasia apex decreased from 82.00 D to 78.00 D. CONCLUSIONS: Corneal collagen CXL was a safe tool in the management of PMD, improving some parameters in advanced stages of the disease. [ J Refract Surg . 2010;26:375–377.]

Purpose: To evaluate in a long-term period the effectiveness and safety of topographically guided two-step laser in situ keratomileusis (LASIK) and standard LASIK technique in the correction of refractive errors after successful penetrating keratoplasty (PKP) for keratoconus. Methods: At least 2 years after PKP and 6 months after removal of all sutures, 15 eyes of 15 patients (Group 1; mean manifest refraction spherical equivalent (MRSE) −7.23 D ± 3.42 SD) were submitted to standard LASIK and 15 eyes of 15 patients (Group 2; mean MRSE −4.37 D ± 1.97 SD) to a topographically guided two-step LASIK procedure (first the flap and at least 2 weeks later the laser ablation). In all cases, a superior hinged corneal flap (160 μm/9.5 mm) was created. Results: After a follow-up of 36 months, in Group 1 the mean uncorrected visual acuity (UCVA) was 0.51 logarithm of the minimum angle of resolution (logMAR) ± 0.41 SD and the mean best-corrected visual acuity (BCVA) was 0.03 logMAR ± 0.05 SD, with a mean MRSE of −1.57 D ± 2.65 SD. In Group 2, the mean UCVA was 0.28 logMAR ± 0.24 SD and the mean BCVA was 0.01 logMAR ± 0.03 SD, with a mean MRSE of −0.07 D ± 1.00 SD. In both groups, no complications were observed. Conclusions: After a long follow-up period, both topographically guided two-step LASIK and standard LASIK could be considered effective and safe tools in the correction of refractive errors after successful PKP for keratoconus.