Paola Valente

Ospedale Pediatrico Bambino Gesù, Roma, Latium, Italy

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Publications (16)37.92 Total impact

  • The Journal of pediatrics 12/2013; · 4.02 Impact Factor
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    ABSTRACT: To evaluate the efficacy of diode laser welding to close corneal wounds in penetrating keratoplasty (PKP) and cataract surgery in pediatric patients. Ophthalmology Department, Bambino Gesù Children's Hospital, Rome, Italy. Prospective observational study. Patients had surgery for congenital cataract (Group 1) or femtosecond laser-assisted PKP (Group 2). The surgery was followed by corneal wound closure using diode laser welding of the stroma. In Group 1, no standard suturing was used. In Group 2, the donor button was sutured onto the recipient using 8 single nylon sutures or a 10-0 nylon running suture (12 passages). Laser welding was then used as an adjunct to the traditional suturing procedure. Group 1 comprised 7 eyes (7 patients; mean age 8.1 years ± 5.3 [SD], range 1 to 15 years) and Group 2, 5 eyes (5 patients; mean age 10.6 ± 3.3 years, range 6 to 15 years). The adhesion of the laser-welded tissues was perfect; there were no collateral effects, and restoration of the treated tissues was optimum. Seidel testing showed no wound leakage during the follow-up. Postoperative astigmatism did not change significantly from the first day after cataract surgery and shifted moderately 3 months after PKP. Laser welding of corneal tissue appeared to be safe and effective in children for whom a sutureless surgical procedure is important to reduce the use of anesthesia for suture management, prevent endophthalmitis, and improve the antiamblyopic effect. No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 10/2013; · 2.75 Impact Factor
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    ABSTRACT: Diode laser welding of ocular tissues is a procedure that enables minimally invasive closure of a corneal wound. This procedure is based on a photothermal effect: a water solution of Indocyanine Green (ICG) is inserted in the surgical wound, in order to stain the corneal tissue walls. The stained tissue is then irradiated with a low power infrared diode laser, delivering laser light through a 300-μm core diameter optical fiber. This procedure enables an immediate closure of the wounds: it is thus possible to reduce or to substitute the use of surgical threads. This is of particular interest in children, because the immediate closure improves refractive outcome and anti-amblyopic effect; moreover this procedure avoids several general anaesthesia for suture management. In this work, we present the first use of diode laser welding procedure in paediatric patients. 5 selected patients underwent cataract surgery (Group 1), while 4 underwent fs-laserassisted penetrating keratoplasty (Group 2). In Group 1 the conventional surgery procedure was performed, while no stitches were used for the closure of the surgical wounds: these were laser welded and immediately closed. In Group 2 the donor button was sutured upon the recipient by 8 single stitches, instead of 16 single stitches or a running suture. The laser welding procedure was performed in order to join the donor tissue to the recipient bed. Objective observations in the follow up study evidenced a perfect adhesion of the laser welded tissues, no collateral effects and an optimal restoration of the treated tissues.
    Ophthalmic Technologies XXIII; 02/2013
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    ABSTRACT: To report the long-term therapeutic results for patients with conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma who were treated with intralesional injections of interferon-α (IFN-α). Prospective, nonrandomized, interventional case series. Twenty eyes of 16 patients with histologically proven conjunctival MALT lymphoma in the absence of systemic disease. Patients were given 1,500,000 international units (IU) of IFN-α (Roferon-A; Roche s.p.a., Milano, Italy) subconjunctivally inside the lesion 3 times weekly for 4 weeks. If there was even a minimal response, a further cycle of 1,000,000 IU 3 times weekly for 4 weeks was administered. Patients were followed up clinically using slit-lamp examination to determine evidence of tumor disappearance or recurrence. In 10 eyes, an incisional biopsy was performed 6 months after therapy to verify the histologic absence of the lesion. A complete response was obtained in 15 eyes (75%) at the end of first cycle treatment, and in 5 eyes (25%) after further cycles. Seventeen eyes (85%) showed no local recurrence after a median follow-up of 65 months (range, 15-136 months). Three eyes (15%) demonstrated recurrence at variable points after treatment. One patient with stage IIA lymphoma exhibited systemic lymphoma progression. Local immunotherapy with IFN-α seems to be an effective and lasting treatment method and provides an alternative to radiotherapy for conjunctival MALT lymphomas. Very few transient side effects were detected.
    Ophthalmology 03/2012; 119(3):494-500. · 5.56 Impact Factor
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    ABSTRACT: To report the early results of big-bubble deep anterior lamellar keratoplasty assisted by femtosecond laser in children. Five eyes of 5 pediatric patients were enrolled in the study; 3 had keratoconus and 2 corneal opacities. An IntraLase 60 KHz femtosecond laser (Abbott Medical Optics, Inc) was used to create mushroom incisions on both donor and recipient corneas. All patients were evaluated for best-corrected visual acuity, spherical equivalent, refractive astigmatism, keratometric astigmatism, mean K value, and corneal thinnest point. The big bubble was always achieved, and all eyes were treated successfully without intraoperative complications. The follow-up was of 10 months. At 10 months (at least 3 months after complete suture removal), the mean postoperative best-corrected visual acuity was 20/30 (range, 20/25 to 20/30), mean spherical equivalent was -1.8 ± 1.2 diopters (D) (range, -0.25 to 1.25 D), mean refractive astigmatism was 1.8 ± 1.4 D (range, 0 to 4.0 D), mean keratometric astigmatism was 5.1 ± 2.1 D (range, 3.5 to 8.59 D), mean K value was 46.2 ± 0.8D, and mean corneal thinnest point was 581 ± 46 μm (range, 511-638 μm). Our early findings suggest that the big-bubble technique in deep anterior lamellar keratoplasty assisted by femtosecond laser is safe and effective also in pediatric patients in the attempt to decrease the rejection percentage, improve the refractive outcome, and then provide an antiamblyopic effect.
    Cornea 02/2012; 31(9):1083-6. · 1.75 Impact Factor
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    ABSTRACT: Purpose. To report the 12-month follow-up after big-bubble deep anterior lamellar keratoplasty (DALK) assisted by femtosecond laser that we have called IntraBubble. Methods. A 60 kHz IntraLase femtosecond laser (Abbott Medical Optics) firstly created a 30° angled intrastromal channel to insert the air injection cannula, 50 μ above the thinnest corneal site measured by Sirius Scheimpflug camera (CSO, Firenze, Italy), then performed a full lamellar cut 100 μ above the thinnest corneal point, and from the same corneal depth, created a mushroom incision. The lamella was removed, and the smooth cannula of Fogla was inserted into the stromal channel and air was injected to achieve a big bubble. The follow up is 12 months, and sutures were removed by the 10th postoperative month in all patients. Best Corrected Visual Acuity (BCVA), spherical equivalent and, by Sirius Scheimpflug camera (CSO, Firenze, Italy) keratometric astigmatism were evaluated. Results. All procedures were completed as DALK except 2 converted to PK because an inadvertent intraoperative macroperforation occurred. Mean postoperative BCVA was 0.8, mean spherical equivalent was -3.5 ± 1.7 D, and mean keratometric astigmatism was 4.8 ± 3.1 D. Conclusion. The femtosecond laser could standardize the big-bubble technique in DALK, reducing the risk of intraoperative complications and allowing good refractive outcomes.
    Journal of Ophthalmology 01/2012; 2012:264590. · 1.37 Impact Factor
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    ABSTRACT: To evaluate the efficacy of amniotic membrane transplantation in lamella melting after anterior lamellar keratoplasty (ALK) assisted by femtosecond laser in a pediatric patient. An 11-year-old girl with progressive keratoconus underwent ALK assisted by femtosecond laser on the right eye. The surgical procedure was performed under general anesthesia. The 60-KHz IntraLase femtosecond laser (Abbott Medical Optics) created both the donor (thickness 350 µm; diameter 8.1 mm; side cut 70°) and recipient (thickness 260 µm; diameter 8.0 mm; side cut 70°) lamellae. The recipient lamella was then gently removed and donor was fitted into place and sutured using 4 interrupted sutures added to a running suture in nylon 10-0. The surgery was uneventful. Two months after surgery, a lamella melting was observed. One month after topical steroid treatment, amniotic membrane transplantation was performed. When lamella melting was observed, the best-corrected visual acuity (BCVA) was 0.1 and 0.5 with foramen and no inflammatory reaction in the anterior chamber was reported. Eleven months after amniotic membrane transplantation, BCVA was 0.9 and no visual acuity increase was recorded with foramen. Our findings show that amniotic membrane transplantation could be considered in lamella melting after ALK assisted by femtosecond laser in children.
    European journal of ophthalmology 10/2011; 22(3):477-80. · 0.91 Impact Factor
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    ABSTRACT: To evaluate the long-term efficacy of verteporfin photodynamic therapy (PDT) as the primary treatment for symptomatic circumscribed choroidal hemangioma (CCH). Prospective consecutive, 2-centered, noncomparative, interventional case series. Twenty-five subjects with symptomatic CCH. All patients had recent onset of visual symptoms and evidence of exudative macular changes on fluorescein angiography (FA) and optical coherence tomography (OCT). Verteporfin 6 mg/m(2) body surface area was administered intravenously over a 10-minute interval. Five minutes after infusion, a 689 nm laser was applied with a light dose of 50 J/cm(2) for the first 3 patients and a light dose of 100 J/cm(2) for all the other patients. Retreatments were performed in case of persistent exudation found on OCT. Evaluation of best-corrected visual acuity (BCVA) using Early Treatment of Diabetic Retinopathy Study (ETDRS) criteria, FA, indocyanine green angiography (ICGA), OCT, and ultrasound were performed before PDT and on follow-up examinations. All patients were followed for at least 5 years. Primary outcome measures were changes in BCVA and foveal center thickness (FCT) between baseline and month 60. Secondary measures were tumor thickness decrease, absence of leakage on FA, and adverse events. Twenty-two patients received 1 PDT session at 100 J/cm(2), and no recurrences were detected. Three eyes, treated with 50 J/cm(2), received a second PDT session at 100 J/cm(2) 1 month after the first session. After a follow-up of 60 months, BCVA improved an average of 18.5 ETDRS letters (P<0.001); BCVA improved by > or =2 lines in 19 eyes (76%). The FCT decreased from a mean of 386.20 microm to 179.2 microm, and OCT showed the complete resolution of macular exudation in all cases. All tumors responded with a reduction in size. No treatment-related adverse events or complications were identified. The 5-year results of PDT in treating symptomatic CCH support treatment with a light dose of 100 J/cm(2) after slow intravenous infusion of verteporfin to stabilize or improve visual acuity and resolution of macular exudation.
    Ophthalmology 04/2010; 117(8):1630-7. · 5.56 Impact Factor
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    ABSTRACT: To evaluate the refractive and keratometric effect of arcuate keratotomy performed using the IntraLase femtosecond laser (Abbott Medical Optics) in patients with high postoperative keratoplasty astigmatism. Nine eyes of nine patients (mean age 45 +/- 7.5 years; mean spherical equivalent refraction -2.50 +/- 3.60 diopters [D]) who had undergone a penetrating keratoplasty were considered. The subjective refraction was measured, and corneal thickness and keratometric parameters were calculated by the Pentacam (Oculus Optikgeräte). All uncomplicated surgeries were performed with the IntraLase femtosecond laser. Paired 70 degrees arc length incisions were performed at 80% depth of the corneal thickness. The mean optical zone was 5.9 mm. The side cut was 90 degrees. All incisions were performed in the graft itself. Mean change in best spectacle-corrected visual acuity (BSCVA), refractive and keratometric astigmatism, and spherical equivalent refraction was evaluated. Follow-up was 3 months. Refractive and keratometric data were analyzed using vector analysis as described by Alpins. A paired Student t test was used to compare preoperative and 3-month postoperative data. A P value <.05 was considered significant. Mean preoperative BSCVA was 20/30, increasing to 20/25 postoperatively (P > .05). The mean refractive astigmatism decreased by 6.00 D (P < .05), whereas the mean keratometric value decreased by 4.60 D (P < .05). The mean spherical equivalent refraction did not change significantly. The surgical vectors in the refractive and keratometric analysis were calculated, showing good predictability. Arcuate keratotomy performed with the IntraLase femtosecond laser could be an effective, safe, and relatively predictable treatment of high postoperative keratoplasty astigmatism.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 09/2009; 25(8):709-14. · 2.47 Impact Factor
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    ABSTRACT: To evaluate epithelial healing, postoperative pain, and best spectacle-corrected visual acuity (BSCVA) after transepithelial photorefractive keratectomy (PRK) performed with a new phototherapeutic keratectomy (PTK) mode using the NIDEK CXIII excimer laser. Fifteen eyes from 10 patients with myopia underwent transepithelial PRK using a multistage program to perform PTK followed by PRK. The PTK incorporated Flex Scan, which accounts for the loss of radial ablation efficiency on the peripheral cornea. The epithelium was removed with the excimer laser by monitoring the disappearance of blue fluorescence during the ablation. Epithelial healing was evaluated by taking slit-lamp photographs every 24 hours until complete reepithelialization. Postoperative pain was measured according to the Faces Pain Rating Scale. All outcomes are reported for 3 months postoperatively. Haze was graded by two ophthalmologists, each masked to the other's result. Mean reepithelialization took 3.50+/-0.85 days, mean pain score was 3.00+/-1.20, and BSCVA was 20/20 for 9 eyes, 20/30 for 3 eyes, and 20/40 for 3 eyes. All patients had haze below grade 2. The outcomes of the preliminary study show that the incorporation of the Flex Scan algorithm in the PTK mode is as safe and effective as conventional PTK algorithms. The primary advantage of this new PTK mode may be more consistent epithelial removal. Additional studies are needed to determine long-term outcomes.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 02/2009; 25(1 Suppl):S122-4. · 2.47 Impact Factor
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    ABSTRACT: To compare corneal aberration changes 1 year after myopic laser in situ keratomileusis (LASIK) performed with a mechanical microkeratome and IntraLase femtosecond laser. Twenty four eyes of 15 patients underwent LASIK with the Hansatome microkeratome, and 23 eyes of 13 patients underwent LASIK with the IntraLase femtosecond laser. A standard ablation was performed with the Bausch & Lomb Technolas 217 excimer laser. Topography data were used to calculate corneal aberrations with a 3.0 mm and 5.00 mm pupil, before and 12 months after surgery. The increasing factor (IF), defined as the ratio between the postoperative and preoperative mean value of the optical aberration, was calculated. The method of Mulhern et al was used to evaluate the centration of ablation. The comalike aberration was correlated with the decentration of ablation. The Student t test was used for the statistical anaylsis. The postoperative mean decentration of ablation was <0.5 mm. The comalike aberration appeared to be positively correlated with the decentration of ablation in both groups with a 5.0-mm pupil (P < 0.05). With a 3.00-mm pupil, the comalike aberration changed in the Hansatome group, whereas with a 5.00-mm pupil, all aberrations statistically significantly changed in both groups (P < 0.05). The IF similarly increased in 2 groups for spherical-like aberration, whereas IF greatly increased for total and comalike aberrations in the Hansatome group. Wavefront corneal aberrations change significantly 1 year after myopic LASIK performed with the Hansatome microkeratome as well as with IntraLase femtosecond lasers. Both of the procedures induce higher-order aberrations in the anterior corneal surface, but the amount of comalike aberration increases more with the Hansatome mechanical microkeratome.
    Cornea 03/2008; 27(2):174-9. · 1.75 Impact Factor
  • Acta ophthalmologica 01/2008; 86:0-0. · 2.44 Impact Factor
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    ABSTRACT: To assess the efficacy and safety of LASIK in patients with high myopic anisometropia and to provide specific screening guidelines for anisometropic patients undergoing refractive surgery. Twenty-six eyes of 16 patients with high myopic anisometropia (>3.0 diopters) were enrolled in this study. Complete pre- and postoperative ophthalmologic and orthoptic examinations were performed. The preoperative orthoptic examination was done with glasses and contact lenses. Twenty-two eyes of 13 patients underwent uncomplicated LASIK; the second eye was treated 2 weeks after the first eye. Patients were examined 1 day, 7 days, and 1, 3, 6, and 12 months after surgery. Thirteen patients obtaining good results at red glass bar test (RGB) underwent LASIK without postoperative diplopia; four showed an improvement of the sensorial assessment. Three patients were excluded from surgery because of diplopia with RGB values <4 to 5. LASIK temporarily induced diplopia in the suppressed eye of one patient; however, the diplopia disappeared after surgery of the fixating eye. Patients with high myopic anisometropia and a weak sensorial state who undergo refractive surgery may be at risk for postoperative diplopia. We suggest clinical guidelines to reduce the occurrence of this complication.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 05/2006; 22(5):461-6. · 2.47 Impact Factor
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    ABSTRACT: To evaluate retinal thickness at the posterior pole of the fundus in ocular hypertension (OHT) and open-angle glaucoma (OAG), and to correlate morphometric findings with visual sensitivity as determined by automated perimetry. One randomly selected eye from 41 patients with clinical diagnosis of OHT (n = 25) or early to moderate OAG (n = 16) and 16 age-matched normal controls was examined. Retinal thickness was measured by Retinal Thickness Analyzer (RTA), acquiring 5 pre-defined scans covering the central 20 degrees of the fundus. RTA average thickness and thickness profile data, including hemispheric asymmetries calculated as relative (superior/inferior and nasal/temporal) or absolute (vertical and horizontal, ie, independent of which hemisphere was thinner) parameters, were calculated. For each eye, white-on-white Humphrey 30-2 visual field results were analyzed, in addition to standard global indices, by quantifying perimetric sensitivities for regions of the posterior pole corresponding to those sampled by the RTA. On average, central retinal thickness was reduced (P < 0.05) in OAG compared with OHT or normal control eyes. Vertical hemispheric absolute thickness asymmetry was increased (P < or = 0.01) in OAG eyes compared with the other groups. Horizontal hemispheric absolute thickness asymmetry was increased (P < 0.01) in both OHT and OAG eyes, compared with control eyes. At least one of the RTA parameters was altered in 13 of 25 OHT (52%) and 12 of 16 OAG eyes (75%), most frequently involving thickness asymmetries. In OAG, but not OHT eyes, superior/inferior asymmetry was positively (r = 0.69, P < 0.01) correlated with the corresponding asymmetry in perimetric sensitivity. The RTA can reveal increased hemispheric thickness asymmetries in both OHT and OAG eyes. In OAG eyes thickness asymmetries are associated with corresponding perimetric asymmetries. The findings in OHT eyes suggest that localized anatomic and functional damage to inner retina may not develop in parallel early in the disease process.
    Journal of Glaucoma 11/2005; 14(5):375-83. · 1.87 Impact Factor
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    ABSTRACT: To compare changes in anterior corneal wavefront aberrations after myopic laser-assisted subepithelial keratectomy (LASEK) and laser in situ keratomileusis (LASIK). Institute of Ophthalmology, Catholic University, Rome, Italy. This prospective study included 36 eyes of 25 myopic patients: 18 eyes of 12 patients had LASEK and 18 eyes of 13 patients, LASIK. The topography data (CSO EyeMap, version 6.2) were used to calculate corneal aberrations with 3.0 mm and 7.0 mm pupils before and 3 months after surgery. Total corneal aberrations increased similarly after LASEK and LASIK with the 7.0 mm pupil but did not change with the 3.0 mm pupil. Coma-like and spherical-like aberrations changed similarly after both procedures, but spherical-like aberrations increased after LASEK with the 3.0 mm pupil (P<.05, independent t test). With the 7.0 mm pupil, the amount of achieved correction was positively correlated with changes in total corneal aberrations after LASIK (P =.007) and with spherical-like aberrations after LASEK (P =.03) and LASIK (P<.003). Although there was no significant difference between LASEK and LASIK (P>.05, independent t test), in individual eyes with an achieved correction less than 7.50 diopters (D), spherical-like aberrations increased more after LASEK than after LASIK. In this preliminary study, myopic LASEK and LASIK changed total and higher-order corneal aberrations. In both procedures, changes in spherical-like aberrations were dependent on the achieved correction. However, in individual eyes, spherical-like aberrations increased more after LASEK than after LASIK for low-moderate achieved correction, suggesting that these procedures may induce the same optical changes in the anterior corneal surface in different ways.
    Journal of Cataract and Refractive Surgery 10/2004; 30(9):1929-33. · 2.53 Impact Factor
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    ABSTRACT: 588 melanocytes, 741 tumors, 510 electroretinography: clinical Abstract Body: Purpose: Early treatment of choroidal melanoma is an essential goal in order to reduce the risk of metastatic spread. Currently available risk factors employed to assess which small melanocytic choroidal lesions should be treated are based on clinical features. The aim of this study was to evaluate whether multifocal ERG and MP-1 microperimetry alterations found in some choroidal melanocytic lesions correlate with the presence of clinical risk factors for growth. Methods: Fifteen patients with choroidal nevi were included in the study. All patients underwent binocular ophthalmoscopy, epilesional OCT and US examination to assess the presence of clinical risk factors. Cone-driven multifocal ERGs were recorded in response to the m-sequence modulation of 61 hexagons presented to the central 30 degrees of the retina. Response amplitude densities (RAD) and implicit times of the first order kernel N1-P1-N2 components were measured. Ring (5 rings between 0 and 25 degrees eccentricity) and sector (nasal, temporal superior and inferior fields) analyses were performed. MP-1 microperimetry was performed using Goldmann III stimuli and a 4-2-1 staircase strategy. The stimuli were projected on the area overlying the melanocytic lesion and on the same area in the controlateral unaffected eye. Results: Seven eyes of seven patients had no risk factors for growth, whereas five eyes of five patients had 1 risk factor for growth and four eyes of four patients presented with 2 risk factors for growth. None of the patients without any risk factor presented mfERG response changes in the sector affected. Four patients (80%) with one risk factor had mfERG response changes and four patients (100%) with two risks factors showed reduced mfERG response amplitudes in the sector affected. On MP-1 microperimetry the light threshold on the retinal area overlying the lesion was comparable to a similar area in the unaffected eye in six out of seven eyes (85.71%) without risk factors, whereas in three out of five eyes (60%) with one risk factor and in four out of four eyes (100%) with two risks factors the sensitivity threshold was remarkably Abstract Print View

Publication Stats

100 Citations
37.92 Total Impact Points

Institutions

  • 2011–2012
    • Ospedale Pediatrico Bambino Gesù
      • Department of Ophthalmology
      Roma, Latium, Italy
  • 2008
    • IRCCS Ospedale Casa Sollievo della Sofferenza
      • Department of Ophthalmology
      Giovanni Rotondo, Apulia, Italy
  • 2006
    • The Catholic University of America
      Washington, Washington, D.C., United States