1. What drove your decision to choose the specialty of ophthalmology and the subspecialty of retina?
I have wanted to be a surgeon since I was a child and have never doubted my decision to practice medicine. During medical studies, I attended the department of neurosurgery for quite some time. I then became fascinated with the eye and, within that, vitreoretinal surgery, which is by far the most diverse and fascinating aspect of ophthalmology. I think sight is the most important gift, and to help patients who have lost their sight and, in some cases, to save their sight is an immensely gratifying experience.
2. What surgical cases do you find most enjoyable to perform and rewarding once successfully completed?
Retinal detachment, without a doubt. It's the surgery that has the most diverse approach, scleral buckle or vitrectomy, with no clear guidelines. It is most satisfying when a surgical intervention is successful and there are no complications, and therefore the patient is satisfied. Ocular trauma surgery is also fascinating and varied, as it is a true emergency surgery and requires immediate and accurate decision-making. Although these procedures take a long time to complete, when you save the eye in these cases it is very satisfying.
3. Have any recent studies or new technologies influenced your surgical technique?
I exclusively use minimally invasive techniques, primarily with 25-gauge instrumentation. I am eager to try the 27-gauge system because I believe that, if I can achieve the same surgical and functional results with this technology, then using a less invasive technique is the best approach.
Currently, I am studying a glue for sclerotomy closure with colleagues at the University of Chicago. It is a very interesting solution because many surgeons tend to suture after surgery, especially when using a 23-gauge system. This special glue is being evaluated for corneal tunnel closure in cataract surgery but will hopefully also soon have applications in vitreoretinal surgery. The main advantage, apart from avoiding postoperative hypotony, is a theoretical absence of postoperative infections, as the glue creates a barrier between the outside and inside of the eye. We have already started human clinical trials and hope to have good results to present soon.
4. How would you describe your approach to patients and to medicine in general?
Today, the health care system in Italy is changing profoundly, and therefore the relationship between doctor and patient is changing as well. I always maintain thorough and honest communication with patients and try to make the right therapeutic decisions with them. I explain that I will do my best to take care of their problem, but perfect outcomes are not always possible.
In my experience, Italian patients, as opposed to American patients for example, expect every health problem to be fixed, and are often prepared to fight against their doctors when their expectations are not met. Lawsuits against physicians are becoming more frequent for no reason, and these have even prompted the foundation of a national association for physicians unjustly accused of malpractice (AMAMI) to defend doctors. I am very honest with patients when discussing their conditions and treatment options, which includes explaining the possible intraoperative or postoperative complications. Although our work is becoming increasingly frustrating, it is still immensely rewarding.
5. How do you spend your leisure time?
I have different hobbies, but the most important one is music. I play piano and have a 9-member band called Uxmal (www.uxmalband.com). Up to 2 or 3 years ago, we played only Bruce Springsteen songs (we were a Bruce cover band), but today we play classic soul music such as Wilson Pickett, James Brown, Aretha Franklin, and so on. We play in the nightclubs or in recording studios, and it really is an excellent pastime. Life is music, and music is life!