Devoted to Eye Care

by Chow Ee-Tan

Dr. Barbara Parolini is recognized as one of the leading authorities in the field of vitreo-retinal surgery, not only in her native country of Italy but also internationally. A force to be reckoned with in ophthalmology, she is passionate and committed to changing the field of vitreo-retina for the better.

Since she started her practice in 1997, Dr. Barbara Parolini, director of Vitreo-Retinal Service at Eyecare Clinic in Brescia, Italy, has done 15,000 eye surgeries — mainly vitreo-retinal cases as well as cataract, cornea, glaucoma, and refractive (phakic lenses and excimer laser).

She has performed live surgeries in Italy and abroad, more specifically at the Frankfurt Retina Meeting, the Portuguese VR Society, FLORetina 2019, and EVRS. She has published 70 peer-reviewed manuscripts, five book chapters, and one e-book on vitreo-retinal techniques (released in 2018) for surgical training.

“My main area of expertise concentrates on complex cases of submacular surgery, high myopia, as well as eye reconstruction after trauma,” shared Dr. Parolini. “However, I started my initial practice by opening a refractive surgery center in north Italy, one of the firsts in the country. From being a refractive specialist, I switched to retina, while still performing cataract surgeries.”

Dr. Parolini graduated from Italy Medical School with Laude in 1993 and obtained a diploma in ophthalmology in 1997. She then took a postdoctoral fellowship in basic science at UCSF (San Francisco, USA) and UMDNJ (Newark, USA), studying retinal pigment epithelium transplantation in vitro and in vivo. Between 1997 and 1998, she was the director of Clinical Studies for the FDA for the Medjet Company in Edison, USA.

After undergoing both scientific and humanistic studies during high school, Dr. Parolini entered medical school. “I was passionate about everything. But it was when I became an intern in ophthalmology, and more specifically when I looked through the microscope, that I fell in love with what I was seeing and thought I could dedicate my entire life studying the eye — a micromacro universe.”

“I was passionate about everything. But it was when I became an intern in ophthalmology, and more specifically when I looked through the microscope, that I fell in love with what I was seeing and thought I could dedicate my entire life studying the eye — a micro-macro universe.”

During residency, she thought there were too many unmet needs in retina. “I was fascinated by what could be seen (and what still could not be seen) through the microscope and the imaging options. I was caught by the challenges of the unknown and undone, by the dream of offering new sights to the blind. Retina was and still is full of enigmas that should be solved,” she enthused.

Dr. Parolini has maintained an interest in the retina and was happy to pursue the transplantation of retinal pigment epithelium (RPE) and choroid in vivo, changing the surgical technique to optimize results.

“I discovered that perfluorocarbon liquid (PFCL) could be used under the retina to stabilize the graft of choroid and that it was indeed indispensable to avoid the rolling and floating of the graft itself,” she shared. “My team and I also discovered that the choroid could be cut without major bleeding, and that the patch of choroid could integrate and we could save the macula.” the technique since then.

“In 2020, I decided that instead of focusing on building a new medical device, it was smarter to concentrate on a commercially available product. I focused then on the ALJ product and decided to modify the shape and insert it with an easier surgical technique,” she shared.

“In 2020, I decided that instead of focusing on building a new medical device, it was smarter to concentrate on a commercially available product. I focused then on the ALJ product and decided to modify the shape and insert it with an easier surgical technique.” buckle; and clinical researches on intraoperative OCT and widefield OCT/OCT-A.

Dr. Parolini has been working in hospitals in Italy, but most of the time, she has been in private practice. She had also been a consultant surgeon in Kuwait, working there one week per month from 2016 to 2020.

Dr. Parolini’s other focus since 2007 has also been the transplantation of autologous choroids. She explored the benefits of transplantation of autologous retina and the combination of the two surgeries, and discovered that the retina can do much more than we think in adults and children.

Furthermore, since 2008, she has been dedicating her studies to myopic traction maculopathy (MTM). “MTM patients have always been considered as patients destined to blindness. The treatment had not been improved because the etiopathogenesis had not been totally understood,” she explained. She has also studied the natural

For the studies on lamellar macular holes (LMH), she discovered during a surgery in 2008 that there were two different epiretinal proliferations (ERP) connected to the LMH.

“I arranged a new group study in Munich led by Christos Haritoglou, in order to make a correlation between the optical coherence tomography (OCT) image, the surgical aspect of the tissue and the histological, and immunohistochemical composition of the membranes,” she continued.

The study, published in Investigative Ophthalmology & Visual Science (IOVS) in 2011, led to a huge step forward in the comprehension of LMH and the types of epiretinal membrane (ERM) associated with it.

At the same time, Dr. Parolini was studying how to buckle the macula in high myopes without suturing the buckle behind the macula, by trying many home/self-made devices. She presented her model at the Heatam meeting in 2009 for the first time in Amsterdam and has been improving

“I wanted to leave room for my professional expansion. I was head of department in a hospital in Italy for more than one year, but I did not enjoy it. I was losing contact with patients and studies,” she continued.

But even outside of the university, she has been working in ‘academic style’ — collecting data, teaching and training other colleagues, and lecturing at meetings in Italy and countries around the world.

Here is a doctor who believes in collecting all her data. Dr. Parolini constantly analyzes what she does in order to improve and publish new discoveries — she considers it the only way to work and grow.

Some of her most meaningful achievements include long-term data on the results of choroidal autologous transplant for maculopathies; the description of the two epiretinal proliferations associated with LMH; the description of myopic traction maculopathy staging system, which is now widely used; the creation of the surgical strategy of macular patients (their actual and their past OCT). She personally viewed each one of them, in order to reconstruct and understand the evolution of the disease. That study allowed her to find a schematic progression of the disease, which has been collected in one single table: The MTM staging system table.

Dr. Parolini has collected many publications on the new staging system of MTM, which is now internationally validated. She then studied the best treatment per each stage of the disease and developed a new model of macular buckle to treat the macular detachment secondary to MTM.

“I channeled my energy and time into making the surgical strategy easier in order to enlarge the indications and use of the MB. I hope this year I will be able to release a new model which will be shortly presented,” she shared.

Dr. Parolini has a wishlist that she hopes will be realized one day. “I would love to see us as a large community sharing big data easily on multiple subjects in a safe and intelligent way. I hope we can find a cure for genetic mutations and have easier access to research and development of new ideas and devices,” she said wishfully.

One thing’s for sure, Dr. Parolini has faced many challenges throughout her career, but they did not set her back. “I still feel a sense of guilt and frustration when I cannot save the sight of a patient,” she confessed.

She says it can be frustrating when she faces difficulties against bureaucracy and economics. “For example, I know how to build the perfect macular buckle, but to do so I would have to undergo a very long and expensive study. The final product would cost so much that it would not be suitable for the market,” she said expressing her disappointment.

“Also, it can be challenging to keep up with patients and with academic duties. I have many meetings as an organizer, presenter, and moderator, and I do a lot of traveling, studying, and publishing. I am in the process of building a practice with coworkers,” she shared.

However, it is most rewarding when she knows she has done something that touches others’ lives. “[It feels good] when I hear my patients tell me that they are not afraid anymore because they know I am there to do anything I can to save their sights,” she shared.

Dr. Parolini also finds satisfaction in helping and mentoring colleagues. “I am happy knowing that I am able to offer advice to younger colleagues. It is gratifying to know that somewhere on the other side of the planet, there are colleagues who are doing something because they heard me lecturing [about it], or read a paper I wrote,” she noted.

Dr. Parolini’s family means the world to her. She is married to Giovanni, a radiologist, and they have two daughters: Sofia, 23, and Sara, 18.

“My husband has always been very supportive,” she shared. “We have always split our time equally with our girls when needed. Our girls have grown extremely independent since childhood, not only understanding they have to be responsible for their behavior and choices, but also knowing they could always count on our guidance.”

Traveling is also a big part of their family life. “We traveled the world together because I had the luck and honor to be invited as keynote speaker in many different countries. Both our girls very much enjoyed traveling with us, which allowed us to build lifelong memories together,” she shared.

Dr. Parolini considers herself lucky that her daughters consider her and her husband not only as their role models but also their best friends. “This is our greatest achievement,” she beamed. “I still remember the time they told me, ‘Mom, we don’t know what we want to do in our lives, but whatever we do we want to do it with the same passion you have for your work.’”

Ultimately, Dr. Parolini has been inspired by life itself. “I am happy to tell you that I am still alive after fighting a bad retroperitoneal liposarcoma removed with major surgery in 2011 and treated with chemo and radiotherapy,” she earnestly shared. “I had some health issues related to that the year after, but again I am here to tell the story!”

“I don’t mean to sound presumptuous, but I am driven by the desire to leave a trace of me in history. I believe this is what makes us immortal,” she concluded.

Born in Verona, Italy, Dr. Barbara Parolini is an ophthalmic surgeon. She graduated from Medical School in Italy with Laude in 1993 and obtained a diploma in Ophthalmology in 1997. She has undertaken a postdoctoral fellowship at UCSF (San Francisco, USA) and UMDNJ (Newark, USA), on retinal pigment epithelium transplantation in 1994-1995 and 1997-1998. She was the director of Clinical Studies for FDA for the Medjet Company, in Edison, USA, from 1997 to 1998. Her expertise is in complex cases of submacular surgery, diabetic retinopathy, and high myopia, as well as eye reconstruction after trauma. She is a tutor of Bremen EVRS VitreoRetinal School and Thessaloniki VitreoRetinal School, and has performed live surgeries in Italy and abroad; of note, at the Frankfurt Retina Meeting, the Portuguese VR Society, and FLORetina 2019. She serves as a reviewer of various peer reviewedjournals including Graefe’s Archives of Ophthalmology, Retinal Journal, European Journal of Ophthalmology, British Medical Journal of Ophthalmology , and others. Since 2016, she has been serving as vice president of the European VitreoRetina Society, and since 2020, a board member for Retina World Congress leading the RWC-Global Research Group. She obtained a patent of a model of macular buckle and a kit for episcleral surgery. On June 16, 2023, she due to receive the DOC Retina Science Award.

parolinibarbara@gmail.com