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(Adnkronos Salute) - In Italia quasi 10 persone al giorno rischiano gli occhi per un'infezione alla cornea. Nel nostro Paese si stimano infatti oltre 2mila casi di infezioni corneali causate da funghi e circa 800 da Acanthamoeba, un patogeno acquatico che trova nelle lenti a contatto, specie se morbide, un terreno ideale per proliferare. E' uno dei temi su cui si confrontano gli esperti della Società internazionale cornea, cellule staminali e superficie oculare (Sicsso), riuniti in congresso a Grosseto. Gli specialisti rilevano un continuo aumento di queste infezioni, che nel 50% dei casi non rispondono alle terapie mediche e richiedono un trapianto di cornea. Più di una volta su due, però, l'intervento fallisce, soprattutto perché l'operazione viene eseguita troppo tardi. Una speranza arriva dal trapianto di cornea lamellare anteriore o Dalk, nel quale non viene impiantata la cornea a tutto spessore, ma si sostituiscono solamente gli strati corneali effettivamente compromessi, preservando quelli funzionalmente non danneggiati. I risultati di questa tecnica, di cui l'Italia è un'eccellenza mondiale, garantiscono un successo in quasi il 100% dei pazienti, se l'intervento viene eseguito precocemente nei casi in cui l'infezione di grado più severo è resistente ai farmaci. "Il trapianto parziale di cornea, purché precoce, è oggi la vera soluzione alle infezioni gravi ovviamente non rispondenti alla terapia medica", afferma Vincenzo Sarnicola, presidente Sicsso, tra i chirurghi più esperti al mondo in questa metodica, noto alle cronache internazionali per aver ricostruito l'anno scorso un occhio vedente da due non vedenti. "In Italia - spiega Sarnicola - si stima che si verifichino circa 3mila casi all'anno di cheratiti per infezioni da funghi o da Acanthamoeba. Purtroppo le terapie mediche non sempre riescono a eradicare le infezioni. I microorganismi hanno così il tempo di penetrare nella cornea e danneggiarla, al punto di richiedere un trapianto che, se a tutto spessore, fallisce in oltre la metà dei casi, mentre nel 25% i risultati sono anatomici, ma non funzionali, e nel 5% portano all'enucleazione dell'occhio". Risultati migliori sono possibili la tecnica Dalk, che "consiste nella sostituzione del solo foglietto intermedio della cornea (stroma) al posto di tutta la cornea - descrive lo specialista - e consente di sostituire soltanto la porzione malata lasciando intatto tutto il resto. Il trapianto risulta quindi molto meno invasivo, con grandi vantaggi per il paziente. Se eseguito precocemente riesce quasi sempre a eradicare l'infezione, garantendo una sopravvivenza dei tessuti trapiantati del 99%, con pochi casi di rigetto e facilmente trattabili". "Resta la difficoltà di apprendere una metodica decisamente complessa che richiede grande perizia tecnica perché i migliori risultati si ottengono ancora separando manualmente i vari strati della cornea - evidenzia Eduard Holland della Cincinnati University, negli Usa - L'Italia vanta i chirurghi più esperti al mondo in questa tecnica mininvasiva che vede gli Stati Uniti ancora in ritardo, con solo mille interventi Dalk eseguiti ogni anno, a fronte di 39mila patologie dello stroma corneale in cui sarebbe invece indicata"."Oggi nel nostro Paese - conclude Sarnicola - dei circa 7mila trapianti di cornea eseguiti ogni anno, oltre il 40% sono mininvasivi. Si tratta di trapianti parziali, realizzati cioè con tecniche selettive o lamellari. I risultati italiani costituiscono dunque un'eccellenza mondiale della quale andare fieri per lo sviluppo e la diffusione di tecniche chirurgiche sempre più innovative". di Adnkronos   28-06-2024 - 17:11 Link copiato Commenti Leggi la Netiquette

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