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Antonio Leccisotti

Publications and source records attributed to Antonio Leccisotti.

14 recordsLinked to original sources
PubMed2006

Corneal ectasia after photorefractive keratectomy.

BACKGROUND: Corneal ectasia after photorefractive keratectomy (PRK) has only been occasionally reported, and its incidence has not been assessed. METHODS: In a retrospective, non-comparative case series, incidence of corneal ectasia was evaluated in a personal consecutive 6453-case series of myopic PRK with a minimum follow-up of 18 months. Features and prognosis were evaluated in all patients with ectasia after PRK (in both personal and referred cases). RESULTS: Ectasia was detected in three eyes of two patients (patients 1 and 2) 3 years and 1 year after PRK performed elsewhere. In addition, in the personal PRK series, two eyes of two patients (patients 3 and 4) developed corneal ectasia 5 months after surgery (incidence: 0.03%). Pre-operatively, forme fruste keratoconus was present in patients 1, 3 and 4; keratoconus in the fellow eye in patient 2; pachymetry <500 micron in patients 2 and 3. In patient 1, rigid contact lenses were prescribed, and in patient 2 deep anterior lamellar keratoplasty was needed; in patients 3 and 4, low induced astigmatism resulted, requiring driving spectacles in patient 3. CONCLUSIONS: PRK induced corneal ectasia in predisposed eyes, even after low myopic ablations. Forme fruste keratoconus and keratoconus in the fellow eye were the main pre-operative findings. Prognosis varies according to severity.

Adult↗
PubMed2006

Refractive lens exchange in keratoconus.

PURPOSE: To evaluate the visual results and complications of refractive lens exchange to correct myopia associated with early-stage keratoconus. SETTING: Private practice, Siena, Italy. METHODS: This prospective noncomparative interventional series comprised 34 consecutive eyes of 20 patients with stages I to II keratoconus. Mean patient age was 56.7 years +/- 10.4 (SD). Preoperative mean spherical equivalent (SE) was -11.0 +/- 4.65 diopters (D), (range -5.75 to -22). Ultrasound biometry was performed using videokeratographic central K-readings and the Holladay 2 formula. An intraoperative handheld autorefractor was used to check the power of implanted intraocular lenses. RESULTS: Intraocular lens exchange due to inaccurate power occurred in 11 eyes (32%; 9 eyes intraoperative, 2 eyes postoperative). At 12 months, mean SE was -1.31 +/-1.08 D and mean defocus equivalent was 1.94 +/- 1.57 D. Twenty-two eyes (65%) were within +/-2 D of defocus equivalent, 16 eyes (47%) were within +/-1 D, and 3 eyes (9%) were within +/-0.5. Mean surgically induced astigmatism (vector analysis) was 0.54 +/- 0.43 D. Preoperative mean best spectacle-corrected visual acuity (BSCVA) was 0.55 +/- 0.20, and postoperative mean BSCVA was 0.76 +/- 0.23; the difference was statistically significant (P<.05; 95% confidence interval, 0.19 to 0.25). Postoperative mean uncorrected visual acuity was 0.48 +/- 0.25. The safety index was 1.38, and the efficacy index was 0.87. Complications were posterior vitreous detachment (9%) and dysphotopsia phenomena (15%). Corneal endothelial cell density at 12 months decreased by 6.3%. CONCLUSION: Refractive lens exchange in keratoconic eyes predictably corrected myopia. However, ultrasound biometry was inaccurate in almost one third of eyes. Intraoperative autorefractometry is recommended to improve refractive outcome.

Aged↗
PubMed2006

Iridocyclitis associated with angle-supported phakic intraocular lenses.

PURPOSE: To evaluate incidence, features, risk factors, and prognosis of iridocyclitis after angle-supported phakic intraocular lens (IOL) implantation. SETTING: Private practice, Siena, Italy. METHODS: This retrospective analysis comprised 356 consecutive eyes of 212 patients. In myopic eyes, the ZSAL-4 IOL (205 eyes of 125 patients) or the ZSAL-4 Plus IOL (106 eyes of 63 patients) was used. In hyperopic eyes (45 eyes of 24 patients), the Type 54 IOL was implanted. Haptic posterior angulation was 19 degrees (ZSAL-4), 23 degrees (ZSAL-4 Plus), and 14 degrees (Type 54). RESULTS: Clinically significant iridocyclitis occurred in 11 eyes (3.1%) of 11 patients. Mean patient age was 37.3 years +/- 9.4 (SD). Sixty-four percent were male (odds ratio [OR], 3.0; 95% confidence interval [CI], 0.8 to 7.4, not statistically significant). Iridocyclitis was observed in 4.4% of hyperopic eyes (OR, 1.6; 95% CI, 0.3 to 7.4; not statistically significant) and in 2.9% of myopic eyes. In myopic eyes, it followed the implantation of ZSAL-4 IOL in 3.9% of eyes (OR, 4.1; 95% CI, 0.5 to 33.6; not statistically significant), and of ZSAL-4 Plus IOL in 1%. Mean time from surgery was 8.5 +/- 10.6 months). Presentation included aqueous flare (100%), posterior synechiae (82%), blurred vision (82%), redness (36%), pain (27%), IOL precipitates (18%), and angular synechiae (9%). Only 1 patient had recurrences, leading to IOL explantation and cataract surgery. After topical therapy, best spectacle-corrected visual acuity was fully recovered in 9 of 11 eyes. CONCLUSION: Iridocyclitis can occur months or years after the implantation of angle-supported phakic IOLs. No statistically significant risk factors were identified. Functional prognosis is generally good.

Adult↗
PubMed2006

Haze after photorefractive keratectomy caused by iatrogenic lagophthalmos.

A 22-year-old man had shortening of the levator muscle for a congenital blepharoptosis in the right eye in 2000. In September 2004, he was successfully treated by bilateral photorefractive keratectomy (PRK) for myopia and was asymptomatic with an uncorrected visual acuity of 20/20. In October 2005, right eye visual acuity decreased because of an inferiorly localized haze caused by nocturnal lagophthalmos. Fluorometholone eyedrops and lubrication induced full visual recovery after 2 months, but corresponding topographical abnormalities were only partially improved. Corneal exposure can induce haze after PRK, even in the long term. The efficacy of topical steroids indicates a role for inflammatory mediators in this condition. Eyelid position and dynamics must be evaluated before PRK to rule out lagophthalmos.

Adult↗
PubMed2006

Traumatic pupillary capture of the haptic of an angle-supported phakic intraocular lens.

A 27-year-old woman had implantation of an angle-supported phakic intraocular lens (pIOL) for myopia in the left eye in 2003. Moderate iris atrophy and pupil ovalization were noted in 2005. In 2006, the eye was hit by a plastic bullet shot from a toy gun. The pupil became distorted as the inferior haptic engaged the pupil edge. Visual acuity was not affected. Surgical repositioning was uneventful, yielding a round pupil with no damage to the iris sphincter or the lens. The endothelium was not affected by the trauma or surgery. Previous iris atrophy may have facilitated pupillary capture because of reduced iris elasticity and pupil ovalization by the haptic. Blunt trauma can dislocate angle-supported pIOLs. Implantation of these IOLs should be discouraged in patients who perform activities that put them at risk for eye trauma.

Adult↗
PubMed2006

Effect of circular keratotomy on keratoconus.

Circular keratotomy was performed in 3 eyes of 3 patients with keratoconus before planned lamellar keratoplasty. After peribulbar anesthesia, a circular 400 microm cut centered on the geometrical corneal center was made using a Hessburg-Barron 7.0 mm trephine (Altomed). The circular cut was deepened with a guarded diamond blade set at 90% of the thinnest point in the circumference and closed with a single 10-0 nylon running suture. Videokeratography revealed increased astigmatism and increased central curvature in all eyes. In 1 patient, a 0.2 improvement in best spectacle-corrected visual acuity (BSCVA) was noted, associated with overall corneal steepening. In the other 2 patients, refraction, BSCVA, and corneal profile worsened, requiring lamellar keratoplasty. Circular keratotomy increased corneal curvature and worsened keratoconus and is therefore not recommended.

Adult↗
PubMed2006

Bioptics: where do things stand?

PURPOSE OF REVIEW: Bioptics treats complex refractive errors by combining refractive techniques with different mechanisms of action, usually using an intraocular implant (a phakic or pseudophakic intraocular lens) followed by a corneal procedure (laser ablation, intrastromal implant). RECENT FINDINGS: In myopia and hyperopia, bioptics with phakic intraocular lenses or refractive lens exchange and subsequent excimer laser yields improved predictability and unchanged safety, compared with sole intraocular lens surgery. Complications are related mainly to intraocular lenses. In keratoconus and pellucid marginal degeneration, intracorneal rings have been successfully combined with phacoemulsification or with phakic intraocular lenses in a limited number of eyes. In the author's series, angle-supported phakic intraocular lenses were implanted in 12 eyes to correct a mean regression of -8 D after excimer laser (reverse bioptics), achieving a mean spherical equivalent of -0.3 D, mean best spectacle-corrected visual acuity of 0.7, and mean uncorrected visual acuity of 0.5, with 83% of eyes within 0.5 D of spherical equivalent. SUMMARY: Bioptics improves vision and halos and adds no particular risks to phakic or pseudophakic intraocular lens implantation in either myopia or hyperopia. Reverse bioptics, with phakic intraocular lenses or refractive lens exchange, can be used to correct regressed corneal surgery.

Cornea↗
PubMed2005

Clinical results of ZSAL-4 angle-supported phakic intraocular lenses in 190 myopic eyes.

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic intraocular lenses (IOLs) in myopia. SETTING: Private practice, Siena, Italy. METHODS: This prospective noncomparative single-surgeon interventional case series comprised 190 consecutive myopic eyes of 115 patients having implantation of a ZSAL-4 IOL (Morcher GmbH) through a 5.5 mm x 3.0 mm sclerocorneal tunnel along the steepest meridian with a surgical iridectomy. Preoperatively, the mean spherical equivalent was -14.37 diopters (D) +/- 4.40 (SD) and the mean astigmatism, 1.66 +/- 1.36 D. RESULTS: Postoperatively, the mean defocus equivalent (DEQ) was 1.55 +/- 1.06 D and the mean astigmatism, 1.41 +/- 1.11 D. The mean surgically induced astigmatism (vector analysis) was 1.03 +/- 0.77 D (95% confidence interval [CI], 0.92 to 1.15); 146 eyes (77%) were within +/-2.0 D of the DEQ, 76 eyes (40%) were within +/-1.0 D, and 36 eyes (19%) were within +/-0.5 D. The safety index was 1.25 and the efficacy index, 0.78. The improvement in best spectacle-corrected visual acuity (0.17) was statistically significant (95% CI, 0.14 to 0.2). Complications were intraocular pressure spike due to topical steroids, 18%; chronic iridocyclitis, 1%; explantation of unstable IOL, 1%; explantation of IOL for iridocyclitis, 0.5%; pupil ovalization, 11%; halos, 18%; and macular hemorrhage, 1%. CONCLUSIONS: Angle-supported IOLs can effectively correct high myopia, although residual refractive errors may require secondary procedures. The main intraoperative and postoperative complications were halos, steroid response, and incorrect IOL sizing. The role of surgery in inducing macular hemorrhages should be assessed further.

Adult↗
PubMed2005

Angle-supported phakic intraocular lenses in hyperopia.

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic intraocular lenses (PIOLs) in hyperopia. SETTING: Private practice, Siena, Italy. METHODS: A prospective noncomparative single-surgeon interventional case series comprised 42 consecutive hyperopic eyes of 22 patients having implantation of a type PIOL (Morcher) through a sclero-corneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, with surgical iridectomy. The mean preoperative defocus equivalent (DEQ) was 7.30 diopters (D) +/- 1.89 (SD). The mean spherical equivalent (SE) was 6.61 +/- 1.47 D (range 4.0 to 10.5 D), and the mean refractive astigmatism was 1.51 +/- 1.33 D (range 0 to 5 D). The mean age was 29.9 +/- 6.0 years (range 22 to 42 years). Thirteen patients (59%) were men. RESULTS: Postoperative mean SE was 0.38 +/- 0.52 D (range 0 to 2 D); mean DEQ 0.93 +/- 0.98 D; mean astigmatism 0.95 +/- 1.17 D; mean surgically induced astigmatism (vector analysis) 0.67 +/- 0.58 D (95% confidence interval, 0.49-0.85); 38 eyes (90%) were within +/-2 D of DEQ, 34 eyes (81%) within +/-1 D, and 24 eyes (57%) within +/-0.5 D. Safety index was 1.05; efficacy index 0.85. Complications were night halos 10%; pupil ovalization 7%; pupillary block reversed by neodymium:YAG laser 7%; monocular anterior subcapsular opacity 5%; monocular iridocyclitis 5%; and intraocular pressure rise due to topical steroids 2%. Endothelial cell loss at 12 month was 6% (range +2.5% to -11%). CONCLUSION: High hyperopia was corrected safely and predictably by an angle-supported PIOL with limited complications.

Adult↗
PubMed2005

Corneal topographic changes in a case of limbal conjunctival carcinoma.

PURPOSE: To describe topographic changes in a case of limbal conjunctival carcinoma. METHODS: Corneal topography was performed before and 3 months after excision. RESULTS: Preoperative topography revealed a localized flattening (37.1 diopters [D]) adjacent to the tumor and extending to the corneal apex, causing a 3-diopter asymmetric with-the-rule astigmatism. Preoperative corneal curvature was abnormally flat in all hemimeridians (average 40.8 D). During surgical excision, no corneal infiltration was found. Three months later, the astigmatism was 0.3 D, and corneal curvature had increased to normal values in all hemimeridians (45.5 D in the tumor area; average of all hemimeridians 45.5 D). Corneal steepening after tumor excision measured by topography almost doubled that observed in refraction. CONCLUSION: The similarity with the patterns induced by pterygia, the lack of corneal infiltration, and the complete reversal of astigmatism after excision support the theory that tear pooling at the tumor apex is responsible for secondary astigmatism and diffuse corneal flattening. However, the irregularity induced by the tumor may affect the precision of topographic measurements.

Aged, 80 and over↗
PubMed2004

Secondary procedures after presbyopic lens exchange.

PURPOSE: To assess the indications, incidence, and outcome of secondary procedures after presbyopic lens exchange (PRELEX). SETTING: Private practice, Siena, Italy. METHODS: This prospective nonrandomized single-surgeon study comprised 52 patients having PRELEX by phacoemulsification and multifocal intraocular lens (IOL) implantation. The preoperative mean spherical equivalent (SE) was +2.50 diopters (D) +/- 1.38 (SD) (range 0 to +6.0 D). RESULTS: Monocular PRELEX was performed in 8 patients who canceled the fellow-eye surgery because of halos; in this group, the residual refractive error was corrected by photorefractive keratectomy (PRK) in 4 eyes, but this did not alleviate halos and IOL exchange was ultimately needed in 7 eyes. Binocular PRELEX was completed in 44 patients; in this group, 14 eyes (8 patients) had PRK for a residual error. The postoperative mean absolute SE in the 18 PRK-treated eyes was 0.33 D (95% confidence interval [CI] of improvement, 0.57-1.32) and the mean uncorrected visual acuity, 0.8 (95% CI of improvement, 0.32-0.45). The final SE was within +/-0.5 D in 15 eyes (83.0%) and within +/-1.0 D in 18 eyes. Halos after PRK were unchanged in 6 patients, slightly improved in 4, and improved in 2. Photorefractive keratectomy or IOL exchange was needed in eyes with a preoperative SE between plano and +1.75 D (15/40 eyes, 38%) and not needed in eyes with a preoperative SE greater than +1.75 D (0%) (95% CI of difference, 23%-53%). CONCLUSIONS: Presbyopic lens exchange in eyes with emmetropia and low hyperopia was associated with a significantly higher percentage of secondary procedures. Photorefractive keratectomy enhancement can improve distance vision but has a limited effect on halos.

Accommodation, Ocular↗
PubMed2003

Angle-supported phakic intraocular lenses in eyes with keratoconus and myopia.

PURPOSE: To evaluate the visual results and complications of angle-supported phakic intraocular lenses (IOLs) to correct myopia associated with early-stage keratoconus. SETTING: Private practice, Siena, Italy. METHODS: In a prospective noncomparative single-surgeon interventional case series, outcomes in 12 consecutive eyes of 8 patients with stage I to II keratoconus, myopia from -6.50 to -14.00 diopters (D), and astigmatism from -1.00 to -5.00 D were analyzed after the implantation of angle-supported phakic IOLs (ZSAL-4, Morcher). The minimum follow-up was 12 months. Implantation was performed through a sclerocorneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, after which a surgical basal iridectomy was created. RESULTS: The spherical error in all cases was corrected within +/-1.00 D. Astigmatism magnitude did not significantly improve. The uncorrected visual acuity (UCVA) was 20/40 or better in all cases. The best spectacle-corrected visual acuity (BSCVA) was equal or improved in all cases. The safety index (postoperative BSCVA/preoperative BSCVA) was 1.18; the efficacy index (postoperative UCVA/preoperative BSCVA) was 0.77. Three eyes had significant halos that improved considerably over 3 months. Spectacles were permanently used by 1 patient (2 eyes in the study) and only for driving by 5 patients. Complications were limited to 3 cases of mild pupil ovalization and 1 case of IOL rotation. Endothelial loss at 12 months was 7.2%. CONCLUSIONS: Implantation of angle-supported phakic IOLs to correct myopia in patients with keratoconus stage I to II was an effective procedure. Although astigmatism did not improve by the creation of the incision, it was well tolerated by most patients. Long-term endothelial safety must be assessed.

Adult↗