Corneal Toxicity of Mirvetuximab Soravtansine: Multimodal Imaging Features and Implications for Ophthalmologic Management Francesco De Dominicis, Andrea Giudiceandrea, Martina Cocuzza, Simone Bruzio, Romina Fasciani, Luigi Mosca, Chiara Giudiceandrea, Matteo Salgarello, Epifanio Giudiceandrea, Filippo Amore, Stanislao Rizzo, Maria Vittoria Carbone, Vanda Salutari, Anna Fagotti, Tommaso Salgarello Diagnostics, 2026 Background: Mirvetuximab soravtansine (MIRV) improves outcomes in FRα-positive, platinum-resistant ovarian cancer; however ocular adverse events (OAEs), particularly corneal epithelial toxicity, are frequent and warrant structured ophthalmologic monitoring. Methods: In this retrospective observational study, 31 consecutive patients receiving MIRV for FRα-positive gynecologic malignancies underwent standardized ophthalmic assessments at baseline and prior to each treatment cycle (every 21 days). The protocol included best corrected visual acuity (BCVA), slit-lamp biomicroscopy, anterior-segment optical coherence tomography (AS-OCT), corneal topography, and tear film analysis. OAEs were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0, based on symptom severity and functional impairment. Results: OAEs occurred in all patients (31/31, 100%), predominantly grade 1–2. Corneal epithelial toxicity was documented in 28/31 patients (90.3%), while no grade ≥ 3 events were observed. Symptoms typically developed 7–14 days after the second infusion. AS-OCT and corneal topography consistently revealed epithelial microcysts and surface irregularities, which were usually detected during scheduled pre-cycle ophthalmologic evaluations. Tear-film instability (break-up time ≤ 5 s) developed in 19/31 patients (61.3%), generally within 10 days after the second infusion, and improved in all but 2 patients (6.5%) following prophylactic lubrication. Transient refractive changes occurred in 28/31 patients (90.3%) and were associated with a temporary BCVA reduction (mean nadir ~20/32 Snellen), followed by recovery during follow-up. Conclusions: MIRV-related ocular alterations are frequent but reversible and clinically manageable. Multimodal imaging combined with functional and refractive assessment provides sensitive markers of corneal epithelial toxicity and supports integrated ophthalmologic monitoring to preserve visual function and maintain oncologic treatment continuity.
A Narrative Review on the Diagnosis of Dry Eye Disease: Insights from the Italian Dry Eye Consensus (IDEC) Group Romina Fasciani, Salvatore Troisi, Mario Troisi, Silvia Odorici, Piera Versura Ophthalmology and Therapy, 2026 The purpose of this manuscript is to report the state-of-the-art advances and consensus proposed by an Italian Dry Eye Consensus Group (IDEC) for the diagnosis of dry eye disease (DED). A targeted review of the literature was carried out, not intended as a meta-analysis or systematic review, but as a selection of authoritative evidence-based guidelines and consensus papers issued by scientific societies or expert panels, which provided the basis for structured group discussion. The diagnostic criteria reported in these publications were organized in tables with a subdivision into levels, from basic to more complex tests, and were discussed in light of both the published data and daily clinical experience. The IDEC consensus highlights a pragmatic, stepwise diagnostic workflow: careful documentation of symptoms (using validated questionnaires where possible), identification of risk factors, slit-lamp assessment with vital stains (fluorescein and lissamine green), and measurement of tear film stability by tear break-up time (TBUT)—or by noninvasive TBUT measurement (NIBUT) where available, and corneal sensitivity—represent the minimum cost-effective core set. A series of second-level targeted tests can then be selectively applied to refine the diagnosis, including corneal sensitivity, osmolarity, meibography, Schirmer I test or meniscometry, and ocular surface imaging. The group also discussed the potential role of all-in-one high-tech devices and digital tools (e.g., smartphone-based applications) as these become more accessible. Grounded in real-life clinical experience, the IDEC consensus offers a pragmatic and cost-effective diagnostic workflow that complements international guidelines and can be readily applied in daily practice. Dry eye disease is a common, chronic condition that affects the surface of the eye and can cause discomfort, vision problems, and a reduced quality of life. Diagnosing dry eye disease can be challenging because symptoms vary greatly from person to person, and the relationship between symptoms and measurable signs is often weak. The Italian Dry Eye Consensus (IDEC) Group—made up of 35 eye specialists from across Italy—reviewed scientific studies and combined them with real-life clinical experience to develop practical suggestions for diagnosing dry eye disease. They recommend starting with a detailed patient history to identify risk factors, using symptom questionnaires (such as OSDI or DEQ-5), and examining the eyes with a slit lamp and special dyes to detect surface damage. Basic tests, such as measuring tear stability (TBUT), tear production (Schirmer test), and corneal sensitivity, are key for all patients. In some cases, additional targeted tests—such as meibography, tear osmolarity measurement, or imaging with high-tech devices—can help identify specific types of dry eye disease and guide treatment choices. The IDEC approach provides a step-by-step diagnostic pathway that can be adapted to different clinical settings, aiming for accurate diagnosis and tailored treatment for each patient.
Cross-Linked Carboxymethyl Cellulose and Silk Proteins in Corneal Re-Epithelialization: A Case Series Francesco Boselli, Fabio Scarinci, Romina Fasciani Journal of Clinical Medicine, 2025 Background/Objectives: Corneal re-epithelialization is a critical process following surgical procedures such as photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK), and corneal UV cross-linking (CXL), as well as cases of corneal abrasion. Delayed epithelial healing can lead to increased discomfort, a higher risk of infection, and suboptimal visual outcomes. This retrospective case series aims to evaluate the efficacy of a novel ophthalmic solution containing cross-linked carboxymethyl cellulose (CX-CMC) and silk proteins in promoting corneal re-epithelialization and improving post-surgical recovery. Patients and methods: A total of 15 patients who underwent PRK, PTK, or CXL or who presented with corneal abrasions were included in the study. Along with standard post-surgical treatment, patients received CX-CMC and silk protein-based eye drops (CORDEV, Ophtagon, Rome, Italy) six times a day. Corneal epithelial thickness was assessed using topography at follow-up visits. Results: Corneal re-epithelialization was observed in all subjects within 24 to 48 h post-procedure. The mean corneal epithelial thickness at 48 h was 73.21 µm, which falls within the typical range of a proliferating corneal epithelium. Conclusions: The CX-CMC and silk protein-based formulation accelerated corneal healing, achieving rapid epithelial recovery. This novel ophthalmic solution offers a promising alternative to conventional post-surgical treatments, potentially improving patient outcomes by reducing healing time, minimising discomfort, and lowering the risk of complications associated with delayed re-epithelialization.
Dry Eye Disease: From Causes to Patient Care and Clinical Collaboration—A Narrative Review Pasquale Aragona, Stefano Barabino, Antonio Di Zazzo, Giuseppe Giannaccare, Edoardo Villani, Francesco Aiello, Elena Antoniazzi, Stefano Bonini, Emilia Cantera, Gianpaolo Carlini, Chiara Chierego, Rossella Colabelli, Romina Fasciani, Antonella Franch, Giovanna Gabbriellini, Caterina Maria Rita Gagliano, Andrea Leonardi, Angelo Macrì, Rita Mencucci, Luigi Mosca, Vincenzo Orfeo, Antonio Pinna, Augusto Pocobelli, Romolo Protti, Paolo Rama, Laura Rania, Miguel Rechichi, Pierangela Rubino, Andrea Russo, Vincenzo Scorcia, Leopoldo Spadea, Marco Trentadue, Salvatore Troisi, Piera Versura, Maurizio Rolando Ophthalmology and Therapy, 2025 Dry eye disease (DED) is a common condition of the ocular surface that affects tens of millions of people worldwide. It is often characterized by decreased tear production or increased evaporation, resulting in a wide range of signs and symptoms. This review provides a comprehensive analysis of the literature related to DED, detailing causes, diagnostic tests, and medical management. Several mechanisms contribute to the maintenance of the physiological integrity of the ocular surface, and their dysfunction may result in noticeable symptoms. Accurate diagnosis is therefore essential, even when physiological function is only minimally impaired or no clear pathological signs are present. The review emphasizes the importance of addressing the underlying causes through a combination of treatment options, lifestyle changes, and enhanced communication between patients and healthcare providers to break the cycle of inflammation and tear instability. It aims to raise awareness among patients, healthcare professionals, and researchers regarding the diagnosis and treatment of DED, while also highlighting recent advancements and future challenges in its management.
Topographical and functional analysis of different surgical strategies for advanced pellucid marginal degeneration: A long term follow-up Luigi Mosca, Matteo Mario Carlà, Laura Guccione, Umberto De Vico, Luca Scartozzi, Romina Fasciani, Stanislao Rizzo European Journal of Ophthalmology, 2025 Purpose To compare clinical and topographical outcomes of three different surgical strategies for advanced pellucid marginal degeneration (PMD). Methods Retrospective, interventional case series of 8 advanced PMDs undergoing three different surgical interventions: Sliding Keratoplasty (SK), Sliding Keratoplasty with Relaxing Incision (SKRI), Sector Lamellar Keratoplasty (SLK). Pre-operatively and at 1, 3, 6, 12-month and final follow-up (50.8 ± 20.6 months) post-operatively, we collected: uncorrected and corrected distance visual acuity (UDVA and CDVA), spherical equivalent (SE), refractive astigmatism (RA), corneal Ks, topographical astigmatism (TA) and calculated against-the-rule (ATR) component. Results CDVA significantly improved from 6 months after surgery ( p = 0.04), while final CDVA was at least 20/40 in 75% of eyes. As desired, surgery led to an overcorrection toward with-the-rule astigmatism at 1-month, which then decreased at 12-month and at final follow-up ( p < 0.05). The ATR-component was significantly decreased at 1-month (1.9 ± 1.1 vs. 17.6 ± 6.3 D pre-operatively, p = 0.0015) and remained quite stable over time (4.2 ± 4.2 D at final follow-up). In subgroup analysis, SK and SKRI offered better CDVA and lower RA, while SLK showed more TA stability. The ATR component, comparing baseline and final follow-ups, decreased from 16.8 ± 8.3 D to 5.9 ± 3.6 after SK; from 18.9 ± 3.6 D to 3.3 ± 3.3 D after SKRI; from 17.0 ± 10.3 D to 1.9 ± 1.5 D after SLK. Conclusion The surgical treatment of advanced PMD showed long-term favourable outcomes. SK and SKRI offered better visual outcomes, but were more inclined to astigmatism regression over time. Conversely, SLK had more stable results but offered worse refractive outcomes.
Utilising Narrative Medicine to Identify Key Factors Affecting Quality of Life in Dry Eye Disease: An Italian Multicentre Study Pasquale Aragona, Stefano Barabino, Ertugrul Akbas, Robert Ryan, Linda Landini, Maria G. Marini, Alessandra Fiorencis, Antonietta Cappuccio, Andrea Leonardi, Antonio Vercesi, Rino Frisina, Francesco Bandello, Luigi Berchicci, Emanuela Aragona, Francesco Semeraro, Vito Romano, Igor Di Carlo, Michele Reibaldi, Andrea Ghilardi, Stefano De Cillà, Giorgio Marchini, Daniele Tognetto, Luigi Fontana, Piera Versura, Domenico D’Eliseo, Alessandro Mularoni, Carlo Cagini, Rita Mencucci, Marco Coassin, Antonio Di Zazzo, Stanislao Rizzo, Romina Fasciani, Luca Gualdi, Andrea Cusumano, Leopoldo Spadea, Emily Cantera, Vincenzo Scorcia, Giuseppe Giannaccare, Pasquale Rosa, Salvatore Troisi, Antonio Provenzano, Francesca Simonelli, Michele Marullo, Lorenza Ciracì, Ciro Costagliola, Vito Primavera, Caterina Gagliano, Antonio Pinna, Alessio Giovanni, Francesco Boscia, Aldo Gelso, Leonardo Mastropasqua, Enza Bonfiglio, Maurizio Rolando, Stefano Bonini Ophthalmology and Therapy, 2024 INTRODUCTION: Despite an improved understanding of its pathogenesis, dry eye disease (DED) remains relatively underestimated and its treatment challenging. A better alignment between the clinical evaluation and the patient self-assessment also requires capturing the whole patient experience of DED. This project aimed to unveil this experience through narrative medicine (NM). METHODS: The project involved 38 expert centres in Italy and one in San Marino, targeting adult patients with DED, their informal caregivers and their treating ophthalmologists. Written narratives and sociodemographic and quality of life (QoL)-related data were anonymously collected through the project's webpage. Narratives were analysed through MAXQDA (VERBI Software, Berlin, Germany), NM classifications and content analysis. RESULTS: A total of 171 patients with DED, 37 informal caregivers and 81 ophthalmologists participated in the research. DED was defined as a disabling condition by 19% of patients and 35% of caregivers; 70% of patients reported that a therapeutic alliance is an integral part of DED treatment and 32% hope for more effective therapies. Forty-four per cent of patients assessed their own QoL as good; however, DED emerged as importantly impacting work performance and social events. DED physical, emotional and economic burden and the cruciality of a trusting care relationship represent the main themes that emerged across all narratives, while empathy and effective treatment are among the factors favouring coping with DED. CONCLUSION: This project marked a pioneering initiative investigating the lived experience of patients with DED through NM, simultaneously involving all viewpoints involved in the care pathway. NM enabled the unveiling of factors favouring the ability to cope with DED and its associated QoL implications and provided valuable insights to improve the therapeutic alliance.
Chorio-retinal vessel density in women affected by functional hypothalamic amenorrhea: a monocentric observational cross-sectional study to evaluate the impact of hypoestrogenism on chorio-retinal vascularization Alice Diterlizzi, Anna Tropea, Emanuela Angelini, Valentina Cestrone, Romina Fasciani, Annamaria Merola, Giovanna Notaristefano, Martina Asia Policriti, Teresa Polimeno, Monia Ranalli, Maria Cristina Savastano, Ghazal Tannous, Valeria Versace, Stanislao Rizzo, Giovanni Scambia, Antonio Lanzone, Rosanna Apa Archives of Gynecology and Obstetrics, 2024 Purpose Functional hypothalamic amenorrhea (FHA) is characterized by an estrogen deficiency which in turn can cause vascular dysfunction. The aim of this study is to evaluate any changes in the chorio-retinal circulation in patients affected by FHA. 24 patients with FHA and 24 age-matched controls underwent a gynecological evaluation and an OCT angiography (OCTA) to study chorio-retinal vascularization. Results OCTA in FHA patients showed an increase in vessel density in the choriocapillaris (CC) layer (both in the fovea area, at 5% p value = 0.037 and in the whole area, at 5% p value = 0.028) and an increase in vascular density in the deep fovea (DVP) (at 10% p value = 0.096) in the whole district compared to controls. Simple linear regressions show a significant negative association between CC vessel density and insulin (p = 0.0002) and glucose values (p = 0.0335) for the fovea district and a negative association between DVP vessel density and endometrial thickness (at 10%, p value: 0.095) in the whole district. Conclusion Our study shows that CC vessel density is increased in women affected by FHA. This could represent a compensation effort to supply the vascular dysfunction caused by estrogen deficiency. We also found an increasing trend in vascular density in DVP associated with the decrease of endometrial thickness, an indirect sign of estrogenization. Considering that these changes occur in absence of visual defects, they could be used as a biomarker to estimate hypoestrogenism-induced microcirculation changes before clinical appearance.
3D Heads-up digital filters for cataract surgery and corneal transplantation Luigi Mosca, Luca Scartozzi, Alessandro De Filippis, Laura Guccione, Romina Fasciani, Stanislao Rizzo European Journal of Ophthalmology, 2024 Purpose To describe the advantages of Ngenuity 3D digital filters for enhancing visualization during cataract and corneal transplant surgery. Methods All surgeries were performed by the same experienced surgeon (L.M.) using the Ngenuity 3D heads-up visualization system connected to a microscope. Images were simultaneously captured with and without the filter in each of the following phases: endothelial evaluation, capsulorhexis, capsule rupture, vitreous leak, cortex removal, visco removal, corneal suture, descemetorhexis, DMEK graft preparation and insertion. Results In cataract surgery, green and monochrome filters facilitate capsulorhexis in difficult situations by highlighting the anterior capsule and can improve visualization of a posterior capsular tear. The enhanced contrast of the monochrome filter is also useful for cortex and viscoelastic removal. In corneal surgery, the green filter highlights the rim of the DMEK graft during tissue preparation, the yellow filter enhances the contrast of the stained DMEK graft in the anterior chamber, the monochrome filter simplifies descemetorhexis by improving visualization of the Descemet/endothelial layer and allows a better view in red saturated images while performing sutures. Conclusions Ngenuity digital filters have the potential to enhance tissue visualization during cataract and corneal surgeries, especially in poor visibility conditions.
Chorioretinal biomarkers in hypothalamic amenorrhea Maria Cristina Savastano, Claudia Fossataro, Matteo Mario Carlà, Valentina Cestrone, Ilaria Biagini, Leonardo Sammarco, Federico Giannuzzi, Romina Fasciani, Rosanna Apa, Antonio Lanzone, Alice Diterlizzi, Martina Policriti, Enrico Di Stasio, Raphael Killian, Clara Rizzo, Stanislao Rizzo Graefe S Archive for Clinical and Experimental Ophthalmology, 2024 Purpose The aim of our study was to evaluate changes in the retinal and choriocapillaris circulations in patients with hypothalamic amenorrhea. Methods Prospective, cross-sectional observational study on 25 patients (50 eyes) diagnosed with hypothalamic amenorrhea and 25 age-matched healthy women. Optical coherence tomography angiography (OCTA) was used to evaluate the vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris VD layers in whole 6.4 × 6.4-mm image and in fovea grid-based image. In patients’ group, systemic parameters were collected: body mass index (BMI), endometrial rhyme thickness, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, insulin, and cortisol. Results SCP and DCP did not show any statistical difference when comparing patients and controls (all p > 0.05). Differently, choriocapillaris VD in the whole region showed a non-significant tendency toward higher values in the patients group in both eyes (p = 0.038 for right eye [RE], p = 0.044 for left eye [LE]). Foveal choriocapillaris VD was higher in hypothalamic amenorrhea women vs. healthy controls (66.0 ± 2.4 vs. 63.7 ± 6.6%, p = 0.136 for RE; 65.0 ± 2.4 vs. 61.6 ± 7.0%, p = 0.005 for LE). Focusing on correlation with systemic parameters, SCP and DCP foveal density had a medium/high effect size with endometrial rhyme, along with DCP in the fovea area vs. cortisol and SCP in the whole area vs. FSH. Conclusion When comparing hypothalamic amenorrhea patients to healthy subjects, OCTA detected changes in the choriocapillaris layer, showing increased VD in the early stage of the systemic pathology, suggesting that microvascular “compaction” could be a first phase of hypoestrogenism adaptation.
One Soul and Several Faces of Evaporative Dry Eye Disease Antonio Di Zazzo, Stefano Barabino, Romina Fasciani, Pasquale Aragona, Giuseppe Giannaccare, Edoardo Villani, Maurizio Rolando Journal of Clinical Medicine, 2024 The ocular surface system interacts with, reacts with, and adapts to the daily continuous insults, trauma, and stimuli caused by direct exposure to the atmosphere and environment. Several tissue and para-inflammatory mechanisms interact to guarantee such an ultimate function, hence maintaining its healthy homeostatic equilibrium. Evaporation seriously affects the homeostasis of the system, thereby becoming a critical trigger in the pathogenesis of the vicious cycle of dry eye disease (DED). Tear film lipid composition, distribution, spreading, and efficiency are crucial factors in controlling water evaporation, and are involved in the onset of the hyperosmolar and inflammatory cascades of DED. The structure of tear film lipids, and subsequently the tear film, have a considerable impact on tears’ properties and main functions, leading to a peculiar clinical picture and specific management.
The Management of Dry Eye Disease: Proceedings of Italian Dry Eye Consensus Group Using the Delphi Method Pasquale Aragona, Giuseppe Giannaccare, Rita Mencucci, Pierangela Rubino, Emilia Cantera, Claudia Yvonne Finocchiaro, Sabrina Vaccaro, Francesco Aiello, Elena Antoniazzi, Stefano Barabino, Stefano Bonini, Gianpaolo Carlini, Chiara Chierego, Rossella Anna Maria Colabelli Gisoldi, Antonio Di Zazzo, Romina Fasciani, Antonella Franch, Giovanna Gabbriellini, Caterina Gagliano, Andrea Leonardi, Angelo Macrì, Luigi Mosca, Vincenzo Orfeo, Antonio Pinna, Augusto Pocobelli, Romolo Protti, Paolo Rama, Laura Rania, Miguel Rechichi, Andrea Russo, Vincenzo Scorcia, Leopoldo Spadea, Marco Trentadue, Salvatore Troisi, Piera Versura, Edoardo Villani, Maurizio Rolando Journal of Clinical Medicine, 2022
Biological parameters determining the clinical outcome of autologous cultures of limbal stem cells Graziella Pellegrini, Paolo Rama, Stanislav Matuska, Alessandro Lambiase, Stefano Bonini, Augusto Pocobelli, Rossella Gisoldi Colabelli, Leopoldo Spadea, Romina Fasciani, Emilio Balestrazzi, Paolo Vinciguerra, Pietro Rosetta, Achille Tortori, Marco Nardi, Giovanna Gabbriellini, Carlo E Traverso, Claudio Macaluso, Lorena Losi, Antonio Percesepe, Beatrice Venturi, Francesca Corradini, Athanasios Panaras, Antonio Di Rocco, Paolo Guatelli, Michele De Luca Regenerative Medicine, 2013