In Italy almost 10 people a day risk their eyes from a corneal infection. In fact, in our country it is estimated that there are over 2 thousand cases of corneal infections caused by fungi and around 800 by Acanthamoeba, an aquatic pathogen that finds an ideal medium for proliferation in contact lenses, especially soft ones. It is one of the topics discussed by the experts of the International Society of Cornea, Stem Cells and Ocular Surface (Sicsso), gathered at a conference in Grosseto.
Specialists note a continuous increase in these infections, which in 50% of cases do not respond to medical therapies and require a cornea transplant. More than once in two, however, the operation fails, mainly because the operation is performed too late. One hope comes from the anterior lamellar cornea transplant or Dalk, in which the full thickness cornea is not implanted, but only the actually compromised corneal layers are replaced, preserving the functionally undamaged ones. The results of this technique, of which Italy is a world leader, guarantee success in almost 100% of patients, if the operation is performed early in cases where the most severe infection is resistant to drugs .
“Partial corneal transplant, provided it is early, is today the real solution to serious infections that obviously do not respond to medical therapy”, states Vincenzo Sarnicola, president of Sicsso, one of the most expert surgeons in the world in this method, known in international news for having reconstructed last year a seeing eye by two blind people.
“In Italy – explains Sarnicola – it is estimated that around 3 thousand cases of keratitis occur per year due to fungal or Acanthamoeba infections. Unfortunately, medical therapies are not always able to eradicate the infections. The microorganisms thus have time to penetrate the cornea and damage it, to the point of requiring a transplant which, if full thickness, fails in over half of the cases, while in 25% the results are anatomical, but not functional, and in 5% they lead to enucleation of the eye”. Better results are possible with the Dalk technique, which “consists in replacing only the intermediate layer of the cornea (stroma) instead of the entire cornea – describes the specialist – and allows only the diseased portion to be replaced, leaving everything else intact. The transplant results therefore much less invasive, with great advantages for the patient. Performed early, it almost always manages to eradicate the infection, guaranteeing 99% survival of the transplanted tissues, with few cases of rejection and easily treatable”.
“The difficulty remains in learning a decidedly complex method that requires great technical expertise because the best results are still obtained by manually separating the various layers of the cornea – highlights Eduard Holland of Cincinnati University, in the USA – Italy boasts the most expert surgeons in the world in this minimally invasive technique which sees the United States still lagging behind, with only a thousand Dalk operations performed every year, compared to 39 thousand pathologies of the corneal stroma in which it would instead be indicated”.
“Today in our country – concludes Sarnicola – of the approximately 7 thousand corneal transplants performed every year, over 40% are minimally invasive. These are partial transplants, i.e. carried out with selective or lamellar techniques. The Italian results therefore constitute a world excellence of what to be proud of for the development and diffusion of increasingly innovative surgical techniques”.
#Medicine #Corneal #Infections #Day #Early #Partial #Transplant #Saves #Eye