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II Quadrimestre Maggio-Agosto 2020 Sommario Cosa Leggerete in Questa Edizione P Anno XI - 2020 II Quadrimestre Maggio-Agosto 2020 sommario COSA LEGGERETE IN QUESTA EDIZIONE P. 3 oftalmologiadomani Anno XI - II Quadrimestre di Antonio Rapisarda Maggio-Agosto 2020 LE INTERVISTE DI OFTALMOLOGIA DOMANI P. 6 Soci Fondatori: Intervista al Dott. Lucio Zeppa Costantino Bianchi Antonio Rapisarda a cura di Amedeo Lucente Direttore Responsabile: OFTALMOLOGIA PEDIATRICA P. 11 Antonio Rapisarda Importanza della prevenzione oculare in età pediatrica di Emilia Gallo, Luca Rombetto Vice Direttore: Amedeo Lucente CHERATECTOMIA FOTOREFRATTIVA P. 14 Scientific Board: Complicanze della PRK e loro gestione Romeo Altafini di Leopoldo Spadea Paolo Angeletti Aldo Caporossi Odile Correnti Stefano Fichera COVID-19 P. 23 Michele Figus Emilia Gallo Pandemie & SARS-CoV-2 Daniela Lombardo di Amedeo Lucente Tommaso Salgarello GLAUCOMA P. 42 [email protected] Valutazione della Qualità di Vita nel glaucoma di Romeo Altafini Progetto grafico e impaginazione: PRONTO SOccORSO P. 49 Urgenze chirurgiche in oftalmologia di Antonino Pioppo, Gregorio Lo Giudice Jaka Congressi Via della Balduina, 88 00136 Roma www.jaka.it SEMEIOTICA STRUMENTALE P. 54 Semeiotica nel paziente con epifora: esami strumentali Art di Giuseppe Vadalà, Luigi Carucci, Umberto Ciabatti, Alessio Vitale Simona Pelosi [email protected] 2 cosaleggeretecosaleggeretecosaleggeretecosaleggeretecosaleggerete PDF Cosa leggerete in questa edizione Antonio Rapisarda Anche in questo tempo di pandemia e di sofferto lock- territorio, ma altrettanto pongono l’accento sulla ne- down Oftalmologia Domani arriva alla vostra atten- cessità di percorsi diagnostici, con consulti oculistici ed zione con un numero veramente ricco e interessante. eventuali valutazioni ortottiche nell’ambito di proto- Non nego la fatica che sta dietro la costruzione di una colli prestabiliti, condivisi sul territorio nazionale. La Rivista che vuole continuare ad essere porta aperta loro appassionata difesa della funzione visiva nell’in- sull’Oftalmologia, con uno sguardo sempre atten- fanzia termina con un cocente ed eloquente interro- to sulle patologie oculari più interessanti, ancor più gativo: ingenti risorse sono investite nella prevenzione in questo infelice periodo. Dopo l’intervista a Lucio e nella gestione delle patologie oculari degli anziani; Zeppa, punzecchiato dalle domande affettuose e al cosa si aspetta a riservare la medesima attenzione per contempo insidiose di Amedeo, Maestro tra i più ec- i bambini? celsi eletto dalla SOI, il II° Quadrimestre si inoltra con - Nell’articolo “Complicanze della PRK e loro gestio- articoli, Review e un compendio storico sulle pandemie ne” Leopoldo Spadea ci introduce nella chirurgia dei che susciteranno proficui spunti di riflessione e, spero, difetti rifrattivi. Dopo un’ampia e dettagliata disamina tutto il vostro interesse. delle procedure chirurgiche, si sofferma essenzialmen- - L’importanza della prevenzione oculare in età pe- te sulla cheratectomia fotorifrattiva (PRK), prima pro- diatrica è sempre stato un tema dibattuto e ribadito cedura con laser ad eccimeri per il trattamento dei vizi negli anni. Emilia Gallo e Luca Rombetto ribadiscono di rifrazione efficace e sicura. la necessità di valutare l’entità e le cause dei deficit Il paziente rifrattivo, come si sa, è di palato fine! visivi e l’efficacia dei servizi esistenti in ciascun paese, L’insoddisfazione è dietro l’angolo. E i ritrattamen- garantendo sistemi di monitoraggio dei deficit visivi, ti sono vissuti come un errore chirurgico da parte del la loro evoluzione nel tempo, l’efficacia dell’ assisten- giovane paziente se non ben edotto e introdotto nella za e riabilitazione oculare. La prima prevenzione parte chirurgia che sta per affrontare. dall’età neonatale e pediatrica. Il nostro sistema sani- Come sempre la storia clinica e gli esami strumentali, tario non prevede programmi di prevenzione visiva ogni giorno più sofisticati e completi, aiutano nella dell’infanzia adeguatamente stilati e redatti su base scelta più appropriata. Lo haze, vero spauracchio del nazionale, nonostante l’Italia è tra le prime potenze chirurgo corneale, ancora imprevedibile per molti ver- industriali. L’attuale legislazione ha affidato ai pediatri si, più frequente agli albori degli eccimeri, può essere di base il compito di eseguire un primo controllo visivo trattato, e con buoni risultati, con una cheratectomia avvalendosi del test dell’acuità visiva e del test di Lang fototerapeutica e/o l’uso della mitomicina C. per la valutazione della stereopsi. Se lo haze resta uno spauracchio non meno temuti so- Gli autori si soffermano sulla funzione essenziale del no i decentramenti e le aberrazioni post operatorie. La pediatra di base per la loro capillare distribuzione nel vita del chirurgo rifrattivo non è semplice come si dice: 3 oftalmologiadomani Anno XI - 2020 cosaleggeretecosaleggeretecosaleggeretecosaleggeretecosaleggerete a fronte di presunti facili guadagni e di poche respon- inevitabilmente, potranno ancora purtroppo affacciar- sabilità rispetto a chirurgie oculari più impegnative e si nel corso della storia. complesse, le difficoltà sono tante, cresciute con le at- - Romeo Altafini con lo stile e l’eloquio che lo contrad- tese sempre più esigenti del paziente, che richiede e distinguono, ci fa affrontare un tema assolutamente pretende solo ottimi risultati. non considerato nella routine clinica dei pazienti glau- Con una robusta bibliografia a seguito, Leopoldo ci of- comatosi: la qualità di vita. Il glaucoma è tema caro fre così un panorama del paziente insoddisfatto pro- all’autore, tanto che per molti, non solo in Veneto, ponendo la lezione sempre valida dei nostri Maestri: Romeo è un punto di riferimento, un’ancora di salvez- nella chirurgia meglio prevenire che reintervenire. A za nei casi complicati, che non sono pochi. tal fine l’Autore riafferma la necessità di approfondire Romeo indica tabelle, schemi, valutazioni, che sembra- le indagini strumentali preoperatorie e le informative no avulse dal nostro lavoro. Abbassare il tono oculare date al paziente, complete ed esaustive, che deve esse- è cosa buona e giusta nell’immediato e nel breve tem- re sempre studiato nel migliore dei modi. Leopoldo, la po. Ma la compliance del paziente alla terapia sappia- Redazione ti ringrazia. mo essere fondamentale per ridurre i danni alle cellu- - Amedeo Lucente in questa secondo quadrimestre le ganglionari nel lungo tempo. La definizione data della nostra Rivista si è cimentato in un articolo sulle dall’Organizzazione Mondiale della Sanità (OMS) nel pandemie, mettendole in relazione al Covid-19. Devo 1948 della Qualità di Vita QoL è stata modificata. Oggi dire che la disamina completa ed esaustiva delle infe- è definita come “Completo benessere fisico, psicologi- zioni pandemiche che ha illustrato, i riferimenti storici co e sociale e non solamente assenza di malattia”. curati ed appropriati, e i dati bibliografici pertinenti Gli studi epidemiologici dimostrano che il 2% degli e copiosi da cui ha tratto spunto, rendono la lettura adulti di età superiore ai 40 anni soffre di glaucoma. estremamente interessante, sempre fluente, assoluta- Il peso sociale di quest’affezione rimane elevato, in- mente convincente. La ricerca dei particolari accadu- teressando 80 milioni di persone; il 10% presenta un ti nella storia sono descritti in modo dettagliato, così grave ipovisus bilaterale. Capire l’impatto sulla QoL del come ogni particolare del Covid-19, che purtroppo glaucoma, una delle principali cause di menomazione ancora subiamo. Dall’interesse per l’imaging alla disa- visiva e cecità nel mondo occidentale, e poterla miglio- mina storica delle pandemie la strada è lunga e, ben rare, è lo scopo che Romeo si è proposto. Leggendo si comprende, senza troppe connessioni. Evidente è attentamente il testo si trovano risposte e si scoprono la passione per la ricerca di Amedeo non limitata agli aspetti che renderanno il nostro rapporto con il pa- OCT. L’autore questa volta si spinge oltre, offrendoci ziente glaucomatoso diverso, sicuramente migliore. un panorama storico non sempre noto sulle epidemie, Grazie Romeo e alla prossima. oltremodo completo. - Antonino Pioppo con il dottor Gregorio Lo Giudice Il lockdown per il nostro Vicedirettore è evidente- ci offrono una Review molto interessante di alcune mente stato proficuo; gli ha permesso d’immergersi a emergenze oculistiche. fondo nell’argomento trattato. Il sapore culturale che Il Pronto Soccorso è sempre stato nella pratica medica ci resta al termine della lettura, che consiglio senza i “un affare difficile”, una rogna, un thriller che pochi tempi contingentati come avviene in camera operato- vivono volentieri. In Oftalmologia la questione si com- ria, rimarrà a lungo nella nostra memoria. Si rivivono, plica per il campo ristretto in cui si opera, e per le con- immerse in altre epoche e contesti del tutto differenti, seguenze facilmente invalidanti, sempre dietro l’ango- le vicende che dolorosamente il nostro paese e il mon- lo. Un modo efficace di fare esperienza per il giovane do intero stanno ancora subendo, con una prospetti- specializzando è andare dietro un collega più anziano, va nuova, corroborata dalla conoscenza storica del vivere tutto il turno di pronto soccorso, di solito otto passato. ore, fianco a fianco ad un tutor. Queste consapevolezze e le esperienze maturate in Questa pratica, se protratta per alcuni anni, tre/quat- campo medico, anche attraverso il rapporto persona- tro volte la mese, porta ad una buona esperienza le con altri colleghi, dovrebbero essere
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