OPINIONS ON LOMBARDI EYE CLINIC ROME
Dear Prof. Lombardi,
after two years (February 5, 2004) the employment I am writing these few lines to prove to you my gratitude for bringing me back to a “normal life.”
After bringing to 25 years, hard contact lenses, because of a bilateral keratoconus advanced degree and therefore in this case there being no other means of correction of vision if not the same corneal lenses, all compounded by the fact that the My emergency medical work involves me working night shifts, I met you agreeing to be operated with the technique of asymmetric radial keratotomy.
This intervention has meant that you unleashed me from the bondage of contact lenses, with all further damage to the cornea and the ailments that they were causing me, allowing me also to bring normal eyeglasses for further vision correction.
I hope that this letter will be read by people like me living the drama of keratoconus and can give you confidence to rely on your hands, thereby authorizing it to publication in the manner and form that you will (press, internet, etc.).
With gratitude and affection
Benevento, February 5, 2006
A brief history of Refractive Surgery :The Road to Mini A.R.K. (by Hari Navarro)
Many are under the misconception that Mini A.R.K. (Asymmetric Radial Keratotomy) is a totally new and radical form of ocular treatment.
Although it is true that this asymmetric, shortened incision form of R.K. (Radial Keratotomy) is an inspired departure from previous forms of the technique, refractive surgery in fact has its roots many years ago.
As far back as 1869, Dutch ophthalmologist Herman Snellen (born 1834, Zeist [Utrecht]; died 1908) contemplated the use of corneal incisions across a steepened meridian to flatten and, thus, correct astigmatism.
[His name synonymous with the famous eye chart].
But it was Xavier Galezowski (Polish-French ophthalmologist, born 1832, Lipowice [Poland]; died 1907), some 20 years later, that would actually attempt to surgically flatten the corneal contour, although he was to meet with little success. These were times of innovation and disappointment but historical, ground-breaking discoveries in ophthalmology were about to be realized.
Trainee Dutch physician Leendert Jan Lans was, in about the same period, meticulously studying the base principles that would go on to define what we now consider keratotomy. His work is still regarded by many as a standard by which modern refractive surgery is assessed. He was a forerunning practitioner of surgical corneal flattening, this he achieved by incisions made on the anterior surface of the cornea. In varying the number, direction and shape of the incisions, he could manipulate the refractive error and customize the correction.
The modern age of refractive surgery is generally acclaimed to the late professor Tsutomu Sato of the Juntendo University, Tokyo. In 1936, he observed that spontaneous breaks in the Descement membrane in keratoconus patients produced a flattening of the cornea when these wounds healed. This led him to the idea of posterior corneal incisions. He also observed that injury to the Descemet membrane was greater than that induced by injury on the Bowman layer, suggesting that surgery on the posterior cornea would be more effective than surgery on the anterior cornea. In the late 1940s, anterior incisions were added to enhance the effect of the posterior incisions after experimental studies on radial and tangential incisions in rabbits to correct astigmatism. His work built upon the principles outlined by Lans nearly half a century earlier and thus he applied his variant R.K. incisions to his corneal surgeries.
After a period of dormancy, refractive surgery and radial keratotomy were to have their next burst of creativity halfway around the world, in the former U.S.S.R.
Svyatoslav Nikolatevich Fyodorov (August 8, 1927- June 2, 2000) was one of those men whose intense intellect was only to be surpassed by his all encompassing lust for life.
He was a giant in the field of ophthalmology, with his true achievements only now being fully appreciated. Born in Pruskurov (now Khmelnytskyy, Ukraine), he graduated from Rostov Medical Institute, then worked as a practicing ophthalmologist in a small town in Rostov Oblast.
In 1960 he performed the first intraocular lens replacement operation in the Soviet Union.
During the 1970s and 80s, Fyodorov developed a system of anterior radial keratotomy that, by varying the number of incisions and the amount of uncut, clear central zones between them, permitted him to carefully control the degree of visual correction.
He opened his work and clinic to the world and began teaching foreign specialists his methods.
Many took their new-found knowledge that radial keratotomy (R.K.) could indeed reduce or eliminate myopia, back to their respectively sceptical countries. Fyodorov had started performing surgery in humans in 1974 using a freehand razor blade fragment in a blade holder, checking the depth of the incision with a depth gauge and deepening the incisions as required.
In 1980 he became a head of the Moscow Research Institute of Eye Microsurgery.
Fyodorov also had political aspirations and was a member of Congress of People\’s Deputies in 1989-1991. He was elected to the lower house of the Russian parliament Duma in 1993. He ran for Russian president in 1996.
Tragically the world was to abruptly lose the mind and influence of this man far ahead of his time, when in June 2000 he died in a helicopter crash outside of Moscow.
Prof. Massimo Lombardi a frequent pupil of Fyodorov had, even by 1984, imported (RK) radial keratotomy from Moscow into his native Italy.
The ophthalmologic establishment were far from welcoming, making no secret of their distain for what they regarded a radical procedure. The fact that it originated within the former Soviet Union provided prejudices of its own.
Remember that at this time even intraocular lens implants were not being performed or even considered in Italy, Fyodorov had been doing so since the 60s.
Prof. Lombardi’s diamond blade surgery for myopia, it would seem, stood little chance of acceptance. The academic fighting, rejection and recriminations were to continue for many years. That is until the excimer laser, a godsend for those not capable or willing to devote the many years required to perfect surgical skills, descended and created master surgeons at the push of a button.
It was in this early part of the 80’s that Prof. Lombardi pondered that “If strategically located incisions on a cornea flatten the points of application correcting myopia diopters, maybe the same could occur in those affected by keratoconus”.
Putting his contention into practice R.K for keratoconus met with early success, he began operating systematically with increasing results.
Patients were happy but not fully because they still experienced some visual distortion. It soon became apparent that by applying the symmetric R.K. as taught by Fyodorov, he was repeating the same irregularities below the previous Keratometric level.
Improved sight and myopia correction was still achieved, but there was the feeling that some sort of adaptation was required.
At the time there was no way to perceive the corneal surface, there wasn’t a method to see what effect asymmetrically placed incisions would make.
This problem was solved when the first corneal map was presented at congress. Immediately the answer became evident, and A.R.K. (Asymmetric radial keratotomy) was born.
Many years of technical refinement and improvement followed. Then one day, whilst in surgery, Prof. Lombardi\’s then assistant, Dr. Marco Abbondanza, commented that recently an American ophthalmologist had published a paper on mini-R.K suggesting very good results using shorter incisions.
Prof. Lombardi then decided that same day to try this reduced version of R.K in his A.R.K., considering that he could always prolong the incisions should the experiment fail.
This turning point was witnessed by Prof. Lombardi’s nurse and ophthalmologic assistant Silvia Micarelli, the anaesthesiologist, Dr. Franco Bianco and colleague Dr. Massimo Fratalocchi. Also the secretaries at
the Lombardi clinic, Giovanna and Angela, whom are still there to this day, knew of the new modification
the same day.
[I only mention this as there is some contention as to Mini Arks beginnings].
And so Mini A.R.K. came into existence, but still the road its life and evolution seem to take is a rocky one.
The paternity of its creation is contested; it is classified as an outdated technique by those who know nothing of its function; it is beaten and bruised from all quarters… all quarters, that is, except for those patients, such as myself, that can see again and will be forever indebted to the road it took to get here.
At the end of the day the politics mean nothing, they pale in the face of the result… And its true the results do vary, each case is unique, each patient has a diffrent expectation of what they consider \’Success\’.
All I can personally hope is that, at the very least, Mini A.R.K can be held up as a viable option… to be seen as an addition to an arsenal in which we KCer\’s have far too few weapons.
Please understand that this is only my take on the sequence of events, I invite discussion on any inaccuracies I may have unintentionally made.
Hari Navarro [Nov. 2005]
Hi, my name is Niccolo Vargas. I had surgery for my keratoconus I think in 2008. I\’ve had a few check ups since then by local ophthalmologists and they have confirmed the progression of the disease has at least stalled. I currently enjoy near perfect vision (without glasses) and can still drive perfectly at night. Your staff was very accommodating and Dr. Lombardi was confident in my case. I wanted to wait sometime before I gave my formal feedback but now I am fully grateful to Dr. Lombardi and everyone in his office. My vision is almost something I never think about except for how thankful I am to have found the Lombardi Eye Clinic. I welcome any and all questions on how I am doing.
Niccolo P. Vargas
Dear Dr. Lombardi,
When we were in Texas recently, my ophthalmologist, Dr. Arno, reported that my eyes had not changed since my last visit in the spring of 2010. I can still see and, though my husband recently told me of doubts about the usefulness of this process, I wanted you to know that it has meant a great deal to me to be able to see and do all the things that sight allows. The research that reports that stem cell implants can halt damage caused by Macular Degeneration seems to be true for me – at least up until now.
I have attached the scans made then for your information.
Thank you again for this which is for me a wonderful gift.
Grace and peace,
Professor me operated eyes to reduce Keratoconus who destroyed my vision (-21 and -17 before the operation).Today 25 months have passed and my vision is (-4 and -2) significantly improved, pain due to Keratoconus (much less present and sorrowful.To conclude, I only have the positive and a new life that to started for me and my entourage.Thanks to the Professor for his interest, tenacity and talent show gift from heaven for his surgical expertise.
Is 09 March 2013 to my experience for the benefit of prospective patients of the Professor Massimo Lombardi.
Testimonial of Mini ARK Surgery 2004 – 2005 by Jimmy Peacock
Early in 2002, I decided to go for a consultation in the UK for LASIK laser eye surgery. The first part of this consultation was to take a corneal map of my eyes. It was here that I found out I had Kerataconus (KC) & there was no way the laser procedure could be carried out due to the thinning of the cornea. This was a huge disappointed as I had waited years for my prescription to become available for this correction surgery. My prescription was +5.75 in each eye, only 5 – 10% cases of KC are longsighted, typical “it could only happen to me” & also my age 38 was slightly unusual. I went to see a corneal expert at my local hospital & found my KC was at development stage 1, no big deal but had to be monitored. I was still wearing contact lenses.
In early 2004 I was working one day 60 metres up on an oil processing column in Qatar in the middle east. I went to lean on some hand railing & almost ended up falling over; I would of if it was not for a trusted workmate. I was now experiencing ghosted / double images wearing contact lenses which had almost cost me my life. I decided there & then to resign from my job & get my KC problem rectified. I did not have a clue how!!!
I roamed the internet & came across a Professor Massimi Lombardi who claimed to have a cure for KC using Mini Arc Surgery. This is what I wanted; I did not want any temporary measures such as specialist contact lenses which only mask a problem which is still there. So in February 2004 after a few telephone calls & emails to the Lombardi Eye Clinic, I flew to Rome with a friend to get the Mini Arc procedure carried out. Here I met the Professor & his staff who I have found to be 1st class through my experience. So I went for it, after intensive tests of the eyes, KC had deleveloped to level 2+, the procedure was carried out. Micro incisions were cut into my eyes to correct the shape of the cornea. I could not sleep that night due to the pain in my eyes (The pain seemed ten times worse than the pain experienced once caused by a welding arc), but I thought no pain no gain. I revisited the clinic six weeks later for a retouch, which consisted of more micro incisions. In total I have 7 & 10 micro incisions per eye respectively. I went to the clinic one more time for a check up & the all clear. My prescription had remained the same which was excellent considering the procedure is a refinement of the ARC procedure used to correct short sightedness. I talked with the Professor & decided that I would return in one year’s time & look at correcting my long sightedness, probably by using Implant able Contact Lenses (ICL’s).
I returned to the clinic in August 2005 for a check up. The Professor was more than pleased with the results & suggested that due to the shape and improvement in corneal thickness LASIK laser eye treatment was now a possibility. So here I was, had come round in a full circle & could now have LASIK surgery carried out, “amazing”. So I went for it, in September LASIK was carried by the Professor & one of his colleagues. I returned in October for a check up, no more glasses. Well that’s a lie; one side affect of the treatments is that I have slight glare problems at night with artificial lights, so I have zero prescription anti glare spectacles for driving. A very small price to pay, don’t you think. I will return to the clinic once every year for a check up.
Looking back on the experience on Mini Arc / LASIK, it’s been a very long & tiring but rewarding road. I have been to Rome five times in 20 months, which has taken a lot of dedication, time off work & money (which I have been the fortunate position to have). To my knowledge I am the first and only patient to this date from the United Kingdom to have the procedure carried out. Once again I would like to thank the Professor & his staff for their professionalism.
If anyone would like contact me about my about my experience they can do so through email on firstname.lastname@example.org
You can get view the Lombardi Eye Clinic’s web site on www.lombardieyeclinic.com
Best Regards To All,
I live in California. I used to have about -8, and very strong astigmatism. I was diagnosed with keratoconus in early 2003 when I decided to apply for a Lasik surgery, and I was turned down. I was told that my cornea was “uneven,” and no doctor would agree to operate on it. I didn’t hear the term “keratoconus” until I went to a different specialist.
I started noticing that I couldn’t see well with my right eye in the late 1990’s. It was as if I didn’t have any focal point. No matter how close or far I would hold a book, the letters would remain blurred. I consulted with a doctor, but he could see nothing at the time.
Another specialist who saw me in early 2004 in California told me that I had keratoconus. In his opinion, it was still possible to correct it with reading glasses or contact lenses. When I asked about other treatment options and the progression of the disease over time , I was told the following: “You can still see now, and when you become completely disabled we will put you on the cornea transplant list.” It sounded terrible – as though my blindness was a complete certainty. He didn’t even say “IF I become completely disabled”!
I started to search the Web in order to find out as much as I could about keratoconus. Quite soon, I found information about Professor Lombardi. What struck me immediately was that Prof. Lombardi referred to Svyatoslav Fyodorov, a world-famous ophthalmologist from Russia, as his “mentor.” Everyone in Russia, as well as many people outside Russia, know about Professor Svyatoslav Fyodorov and his unique clinic. I myself happened to live not far from the clinic in Moscow. My grandfather used to go there to treat his glaucoma and cataract on both eyes and was always impressed with the quality of the care and the results.
I contacted Prof. Lombardi by e-mail and very soon I received an invitation to come to his clinic in Rome.
My first operation took place in September 2004. The operation went very well, although from a lay patient’s point of view it has to be called an extraordinary experience. There is no pain during the surgery. The biggest problem for me on the operating table was to have to look straight at the very bright microscope light while relaxing my eyes. A special device is used to keep the eyes open, but if they are not relaxed enough, the eyelids can become quite sore after the operation.
The first ‘uncomfortable’ night after the surgery went as predicted. In my case it was probably a little more uncomfortable because I was heavily jetlagged after my flight from California.
I was able to walk around Rome on the day immediately following the surgery (wearing sunglasses) and do some sightseeing. The most important problem for me was the sun, and any bright light in general. I stayed in Rome and went to the clinic for check-ups for two more days, and then I flew back to California. I was able to start working full time a week after the surgery.
After about four months, at the end of January 2005, I went to Rome again for a check-up and Prof. Lombardi decided to make a small enhancement. Everything went as planned, except that I had a micro-perforation of the cornea on my right eye. After the surgery I had no more than -1 on both eyes and almost no astigmatism. Prof. Lombardi told me that my cornea was stable in terms of its curvature and thickness. Finally, in July 2008, I was told that I was ready for the next surgery, this time accompanied by riboflavin crosslinking in order to further reinforce the cornea.
The procedure took place in December 2008, without any complications. The first half of the procedure was a standard ARK surgery enhancement, and it proceeded as usual. Prof. Lombardi then made me sit up on the operating table and asked me to look at the clock on the wall. I could see very well, just like after the second enhancement surgery. Prof. Lombardi then told me to remember that moment very well, because, as he put it, I would not be able to see that well for a period of 7 to 15 days. At the beginning, nothing unusual happened. I had to lay flat on the operating table while riboflavin was periodically applied to the surface of my cornea andUV light was directed at it. Finally, the procedure was over. When I got off the operating table, I realized that I could see almost nothing. The impression was that I was looking through a thick layer of motor oil. Then I realized that I could in fact see large objects such as doors, windows and people (recognizing their faces). Prof. Lombardi assured me that this was normal, and that it would only be getting better from now on day by day.
I was able to walk back to my hotel by myself with no problem. I was able to insert the key and open the door.
The night after the surgery was not much more uncomfortable than usual. I was given some anesthetic drops, but I didn’t need to use them. In the morning, however, I was already able to see the telephone number pad (with my ‘better’ eye)! Three days after the surgery, I left Rome. By then, I had enough eyesight to get around in the city, at the train station, the airport, etc. Even on the second day after the surgery, I was able to go to a restaurant and read the menu. It took my right eye about a week to catch up with the left one. I stopped seeing ‘machine oil’ colors completely after about two weeks. I cannot say that the sensitivity to light was much worse after the last surgery as compared to the previous surgeries.
I ordered my first, very mild pair of eyeglasses a month after the surgery. I keep my eyeglasses mostly in my car.
By the way, it’s quite an experience to order glasses after the surgeries. I became very famous in my optometrist’s office, and it took him a while to get used to the fact that my vision is changing to the better. At first he could not believe that my astigmatism had decreased so much and he kept asking about how that was done.
I am now looking forward to seeing Professor Lombardi and his staff again, and to hearing about the final quality of the results of my treatment.