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Rapoport Y, Veldman P. A Comprehensive Review of Postoperative Management of Descemet’s Membrane Endothelial Keratoplasty. Semin Ophthalmol 2016; 32:104-110. [DOI: 10.1080/08820538.2016.1228414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yuna Rapoport
- Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Peter Veldman
- Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Affiliation(s)
- Shaohui Liu
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Peter Veldman
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Applications of Anterior Segment Optical Coherence Tomography in Cornea and Ocular Surface Diseases. J Ophthalmol 2016; 2016:4971572. [PMID: 27721988 PMCID: PMC5046038 DOI: 10.1155/2016/4971572] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/31/2016] [Indexed: 11/29/2022] Open
Abstract
Optical coherence tomography (OCT) is a noncontact technology that produces high-resolution cross-sectional images of ocular tissues. Anterior segment OCT (AS-OCT) enables the precise visualization of anterior segment structure; thus, it can be used in various corneal and ocular surface disorders. In this review, the authors will discuss the application of AS-OCT for diagnosis and management of various corneal and ocular surface disorders. Use of AS-OCT for anterior segment surgery and postoperative management will also be discussed. In addition, application of the device for research using human data and animal models will be introduced.
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Detection of graft detachments immediately following Descemet membrane endothelial keratoplasty (DMEK) comparing time domain and spectral domain OCT. Graefes Arch Clin Exp Ophthalmol 2016; 254:2431-2437. [DOI: 10.1007/s00417-016-3484-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/27/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022] Open
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55
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Rebubbling Techniques for Graft Detachment After Descemet Membrane Endothelial Keratoplasty. Cornea 2016; 35:759-64. [DOI: 10.1097/ico.0000000000000829] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wan KHN, Yiu EPF, Young AL. Corneal transplantation: Beyond the horizon. World J Ophthalmol 2015; 5:36-44. [DOI: 10.5318/wjo.v5.i2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/04/2015] [Accepted: 04/02/2015] [Indexed: 02/06/2023] Open
Abstract
Evolving techniques in keratoplasty have undoubtedly led to thinner corneal grafts. These newer iterations of keratoplasty aim to reduce graft rejections, improve visual acuity and visual rehabilitation. Each technique poses its own advantages and disadvantages; the surgeon should select patients suitable for a particular technique while accounting for their surgical competency given the learning curve associated with these newer techniques. Alternatives to corneal transplant may have a role in addressing the shortages of corneal graft, these bioengineered material and medical treatment still need further studies to demonstrate its clinical applicability.
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Ghouali W, Tahiri Joutei Hassani R, Liang H, Dupont-Monod S, Auclin F, Baudouin C, Labbé A. [Imaging of corneal dystrophies: Correlations between en face anterior segment OCT and in vivo confocal microscopy]. J Fr Ophtalmol 2015; 38:388-94. [PMID: 25922226 DOI: 10.1016/j.jfo.2014.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/07/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the usefulness of en face Optical Coherence Tomography (OCT) for evaluation of corneal dystrophies and to describe correlations with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS Thirty-two eyes of 16 patients with 4 types of corneal dystrophies (epithelial basement membrane dystrophy, Fuchs dystrophy, Reis-Bücklers corneal dystrophy and Crocodile Shagreen dystrophy) were enrolled in this study. Axial and reconstructed en face scans were acquired using OCT. Images were then correlated to IVCM findings. RESULTS En face OCT provided new insights into the structure, size and depth of corneal tissue alterations in various corneal dystrophies. OCT en face images were well correlated with IVCM features. Despite lower resolution than IVCM, en face OCT offers the advantages of being non-invasive and allowing the analysis of larger corneal areas. CONCLUSION En face OCT provides useful new information in corneal dystrophies. This imaging technique will probably increase in popularity in the near future for the assessment of various anterior segment diseases.
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Affiliation(s)
- W Ghouali
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - R Tahiri Joutei Hassani
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigation clinique, CIC Inserm 503, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - H Liang
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigation clinique, CIC Inserm 503, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, 75012 Paris, France; Université UPMC Paris 06, UMR S 968, Institut de la Vision, 75012 Paris, France; CNRS, UMR 7210, 75012 Paris, France
| | - S Dupont-Monod
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - F Auclin
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigation clinique, CIC Inserm 503, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - C Baudouin
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigation clinique, CIC Inserm 503, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, département hospitalo-universitaire vision et handicaps, université de Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne Billancourt, France; Inserm, U968, 75012 Paris, France; Université UPMC Paris 06, UMR S 968, Institut de la Vision, 75012 Paris, France; CNRS, UMR 7210, 75012 Paris, France
| | - A Labbé
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigation clinique, CIC Inserm 503, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, département hospitalo-universitaire vision et handicaps, université de Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne Billancourt, France; Inserm, U968, 75012 Paris, France; Université UPMC Paris 06, UMR S 968, Institut de la Vision, 75012 Paris, France; CNRS, UMR 7210, 75012 Paris, France.
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Nanji AA, Sayyad FE, Galor A, Dubovy S, Karp CL. High-Resolution Optical Coherence Tomography as an Adjunctive Tool in the Diagnosis of Corneal and Conjunctival Pathology. Ocul Surf 2015; 13:226-35. [PMID: 26045235 DOI: 10.1016/j.jtos.2015.02.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/01/2015] [Accepted: 02/01/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the use of a commercially available, high-resolution, spectral-domain optical coherence tomography (HR-OCT) device in the diagnosis of corneal and conjunctival pathologies, with a focus on malignant lesions. METHODS Eighty-two eyes of 71 patients were enrolled in this prospective case series, including 10 normal eyes, 21 with ocular surface squamous neoplasia (OSSN), 24 with a pterygium or pingueculum, 3 with lymphoma, 18 with pigmented conjunctival lesions (nevus, flat melanosis, or melanoma), and 6 with Salzmann nodular degeneration. Subjects were imaged using photography and HR-OCT (RTVue, Optovue, Fremont, CA). When clinically indicated, surgery was performed and histopathologic specimens were correlated with OCT images. RESULTS HR-OCT was useful in differentiating among various lesions based on optical signs. Specifically, in OSSN, HR-OCT findings included epithelial thickening and hyper-reflectivity, whereas pterygia and pinguecula showed a subepithelial mass under thinner epithelium. In lymphoma, a hypo-reflective, homogenous subepithelial mass was observed. Differentiating between pigmented lesions with HR-OCT was more difficult, but certain characteristics could be identified. Eyes with nevi and melanoma both displayed intensely hyper-reflective basal epithelial layers and discrete subepithelial lesions, but could be differentiated by the presence of cysts in nevi and intense shadowing of sublesional tissue in most melanomas. CONCLUSION We found that a commercially available HR-OCT was a useful noninvasive adjunctive tool in the diagnosis of ocular surface lesions.
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Affiliation(s)
- Afshan A Nanji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Fouad E Sayyad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Miami Veteran Affairs Medical Center, Miami, FL, USA
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
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Clinical applications of anterior segment optical coherence tomography. J Ophthalmol 2015; 2015:605729. [PMID: 25821589 PMCID: PMC4363581 DOI: 10.1155/2015/605729] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/21/2015] [Indexed: 11/18/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) was recently developed and has become a crucial tool in clinical practice. AS-OCT is a noncontact imaging device that provides the detailed structure of the anterior part of the eyes. In this review, the author will discuss the various clinical applications of AS-OCT, such as the normal findings, tear meniscus measurement, ocular surface disease (e.g., pterygium, pinguecula, and scleromalacia), architectural analysis after cataract surgery, post-LASIK keratectasia, Descemet's membrane detachment, evaluation of corneal graft after keratoplasty, corneal deposits (corneal dystrophies and corneal verticillata), keratitis, anterior segment tumors, and glaucoma evaluation (angle assessment, morphological analysis of the filtering bleb after trabeculectomy, or glaucoma drainage device implantation surgery). The author also presents some interesting cases demonstrated via AS-OCT.
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60
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Bucher F, Hos D, Müller-Schwefe S, Steven P, Cursiefen C, Heindl LM. Spontaneous long-term course of persistent peripheral graft detachments after Descemet's membrane endothelial keratoplasty. Br J Ophthalmol 2014; 99:768-72. [PMID: 25527695 DOI: 10.1136/bjophthalmol-2014-305562] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/30/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Peripheral corneal graft detachment after Descemet's membrane endothelial keratoplasty (DMEK) is a frequently occurring postoperative complication. The natural course of these persistent peripheral detachments over time is not known. METHODS 166 patients were surveyed by slit-lamp-adapted optical coherence tomography (SL-OCT) directly after surgery, during first postoperative week, 4 weeks, 3, 6 and 12 months, postoperatively. Patients with a persistent peripheral graft detachment 4 weeks after DMEK (n=16) were observed for their spontaneous course up to 1 year postoperatively. RESULTS Persistent graft detachments could be characterised into two phenotypes: peripheral roll (n=11; 69%) and laminar detachment (n=5; 31%). Maximal length of the detachment did not change in peripheral rolls during observation period (12 months vs 4 weeks, 578±122 µm vs 593±106 µm, p=0.74), whereas laminar detachments spontaneously attached to the host's stroma (12 months vs 4 weeks, 0 µm vs 1088±295 µm, p≤0.001). Central corneal thickness and (peripheral) corneal thickness above the detached area did not significantly change in either group. CONCLUSIONS Persistent peripheral graft detachments after DMEK occurred in 10% of patients and had two distinct OCT-phenotypes. Peripheral rolls did not change during the first 12 months, postoperatively. By contrast, peripheral laminar detachments attached spontaneously even months after surgery. Corneal thickness reduction was only observed above peripheral laminar detachment, but not above peripheral rolls.
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Affiliation(s)
- Franziska Bucher
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Philipp Steven
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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Brockmann T, Brockmann C, Maier AK, Schroeter J, Pleyer U, Bertelmann E, Joussen AM, Torun N. Clinicopathology of graft detachment after Descemet's membrane endothelial keratoplasty. Acta Ophthalmol 2014; 92:e556-61. [PMID: 24725459 DOI: 10.1111/aos.12419] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 03/16/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate pathomechanisms involved in graft detachment after Descemet's membrane endothelial keratoplasty (DMEK) and its clinical implications. METHODS In a prospective case series, 30 eyes with Fuchs' endothelial dystrophy underwent DMEK. Intraoperatively obtained recipients' endothelium-Descemet's membranes (EDMs) were investigated histologically and immunohistochemically. The postoperative donor graft status was categorized as attached or detached. Clinical and morphological parameters were analysed between the study groups. RESULTS The detachment rate was 40% (12/30). There was no significant difference in postoperative visual acuity between the groups, but visual recovery was delayed in eyes with initially detached grafts. Gender, age, preoperative central corneal thickness or best corrected visual acuity did not influence the detachment rate. However, separation and disruption of the anterior banded layer (ABL) were frequently observed in patients with graft detachment, and ABL thickness was identified as a significant predictor for graft detachment. The ABL thickness was 2.5 ± 0.9 μm and 3.5 ± 1.6 μm in patients with attached and detached grafts, respectively. Immunohistologically, a deficiency of fibronectin and cytokeratin was observed within the ABL of patients with detached grafts. In contrast, a complete removal of the EDM with residual stromal collagen fragments was observed in patients with adherent grafts. CONCLUSIONS Incomplete removal of the EDM, with residual ABL fragments on the recipients' corneal stroma, may be a risk factor for graft detachment after DMEK. The separation and disruption of the ABL might be promoted by a deficiency of matrix proteins, stronger biomechanical properties and a firm adherence to the posterior corneal stroma.
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Affiliation(s)
- Tobias Brockmann
- Department of Ophthalmology; Charité - University Medicine Berlin; Berlin Germany
| | - Claudia Brockmann
- Department of Ophthalmology; Charité - University Medicine Berlin; Berlin Germany
| | - Anna-Karina Maier
- Department of Ophthalmology; Charité - University Medicine Berlin; Berlin Germany
| | - Jan Schroeter
- Institute of Transfusion Medicine; Charité - University Medicine Berlin; University Tissue Bank; Berlin Germany
| | - Uwe Pleyer
- Department of Ophthalmology; Charité - University Medicine Berlin; Berlin Germany
| | - Eckart Bertelmann
- Department of Ophthalmology; Charité - University Medicine Berlin; Berlin Germany
| | - Antonia M. Joussen
- Department of Ophthalmology; Charité - University Medicine Berlin; Berlin Germany
| | - Necip Torun
- Department of Ophthalmology; Charité - University Medicine Berlin; Berlin Germany
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Rodríguez-Calvo-de-Mora M, Quilendrino R, Ham L, Liarakos VS, van Dijk K, Baydoun L, Dapena I, Oellerich S, Melles GRJ. Clinical outcome of 500 consecutive cases undergoing Descemet's membrane endothelial keratoplasty. Ophthalmology 2014; 122:464-70. [PMID: 25439596 DOI: 10.1016/j.ophtha.2014.09.004] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 08/11/2014] [Accepted: 09/01/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the clinical outcome of 500 consecutive cases after Descemet's membrane endothelial keratoplasty (DMEK) and the effect of technique standardization. DESIGN Prospective, interventional case series at a tertiary referral center. PARTICIPANTS A total of 500 eyes of 393 patients who underwent DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, or previous corneal transplant failure. METHODS Best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications were evaluated before and 1, 3, and 6 months after DMEK. MAIN OUTCOME MEASURES Comparison between 2 groups (group I: cases 1-250, outcome of "early surgeries" during transition to technique standardization; group II: cases 251-500, outcome of "late surgeries" after technique standardization). RESULTS At 6 months, 75% of eyes reached a BCVA of ≥20/25 (≥0.8), 41% of eyes achieved ≥20/20 (≥1.0), and 13% of eyes achieved ≥20/18 (≥1.2) (n=418) when excluding eyes with ocular comorbidities (n=57). When including all available eyes at 6 months (n=475), 66% of eyes reached a BCVA of ≥20/25 (≥0.8), and 36% of eyes achieved ≥20/20 (≥1.0). Mean ECD decreased by 37% (±18%) to 1600 (±490) cells/mm2 (n=447) at 6 months (P<0.001). Postoperative pachymetry averaged 525 (±46) μm compared with 667 (±92) μm preoperatively (P<0.001). None of these parameters differed among the 2 groups (P>0.05). (Partial) graft detachment presented in 79 eyes (15.8%), and 26 eyes (5.2%) required a secondary surgery within the first 6 months (re-bubbling in 15, secondary keratoplasty in 11). With technique standardization, the postoperative complication rate decreased from 23.2% to 10% (P<0.001) and the rate of secondary surgeries decreased from 6.8% to 3.6% (P=0.10). CONCLUSIONS In comparison with earlier endothelial keratoplasty techniques, DMEK may consistently give higher visual outcomes and faster visual rehabilitation. When used for the extended spectrum of endothelial pathologies, DMEK proved feasible with a relatively low risk of complications. Technique standardization may have contributed to a lower graft detachment rate and a relatively low secondary intervention rate. As such, DMEK may become the first choice of treatment in corneal endothelial disease.
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Affiliation(s)
- Marina Rodríguez-Calvo-de-Mora
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Ruth Quilendrino
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Lisanne Ham
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Vasilios S Liarakos
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
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63
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Steven P, Le Blanc C, Lankenau E, Krug M, Oelckers S, Heindl LM, Gehlsen U, Huettmann G, Cursiefen C. Optimising deep anterior lamellar keratoplasty (DALK) using intraoperative online optical coherence tomography (iOCT). Br J Ophthalmol 2014; 98:900-4. [PMID: 24590554 PMCID: PMC4078709 DOI: 10.1136/bjophthalmol-2013-304585] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To describe the use of intraoperative online optical coherence tomography (iOCT) for improving deep anterior lamellar keratoplasty (DALK) surgery. METHODS Retrospective case series of 6 eyes of 6 male patients with keratokonus, corneal dystrophy or herpetic stromal scars undergoing DALK were investigated using intraoperative optical coherence tomography and postsurgical image/video analysis. Main outcome measures were: visibility of surgical steps, especially, assessment of placement depth of injection needle, preparation of bare Descemet's membrane and drainage of interface fluid. RESULTS iOCT enables real-time visualisation of all surgical steps of DALK procedure in all patients. Placement of air injection needle above Descemet's membrane was reliably monitored as was presence of bare Descemet's membrane and potential interface fluid. CONCLUSIONS iOCT assists with visualisation of injection needle placement and with assessment of bare Descemet's membrane as well as interface fluid during the DALK procedure. Overall iOCT may be a helpful device that supports surgeons in all steps of DALK procedure.
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Affiliation(s)
- Philipp Steven
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Carolin Le Blanc
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Marc Krug
- OptoMedical Technologies GmbH, Luebeck, Germany
| | | | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Uta Gehlsen
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Gereon Huettmann
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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Fujimoto M, Ogino K, Miyazaki C, Hirose M, Matsuyama H, Moritera T, Yoshimura N. Evaluation of dacryocystorhinostomy using optical coherence tomography and rebamipide ophthalmic suspension. Clin Ophthalmol 2014; 8:1441-5. [PMID: 25120350 PMCID: PMC4128840 DOI: 10.2147/opth.s65654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the surgical outcome of dacryocystorhinostomy (DCR) by measuring the tear meniscus, using optical coherence tomography and rebamipide ophthalmic suspension. Methods Patients with nasolacrimal obstruction and chronic dacryocystitis who were scheduled for an endonasal DCR underwent tear meniscus examinations before and 2 months after surgery. Vertical scans of the inferior menisci were performed before and at 1, 3, 5, 7, and 10 minutes after the instillation of rebamipide ophthalmic suspension. The tear menisci areas were measured with imaging software. Ten young adults without epiphora formed the control group. Results Anatomical success was achieved on 22 sides of 21 patients. The patients’ postoperative tear menisci were significantly smaller than the preoperative menisci at all points during the test, and the response to volume loading in the postoperative patients was corrected to nearly that of the young, healthy adults. Nevertheless, the postoperative meniscus area tended to be larger than that of the young adults at all points. Conclusion The reduced tear meniscus area after DCR reflected the success of the surgical procedure. However, incomplete recovery of the meniscus after the test might suggest a residual disorder of the lacrimal drainage system after DCR.
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Affiliation(s)
- Masahiro Fujimoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Ogino
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Chika Miyazaki
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Department of Ophthalmology, Hyogo Prefectural Tsukaguchi Hospital, Hyogo, Japan
| | - Miou Hirose
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Department of Ophthalmology, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Hiroko Matsuyama
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Department of Ophthalmology, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Takeshi Moritera
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Moritera Eye Clinic, Shiga, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kruse FE, Schrehardt US, Tourtas T. Optimizing outcomes with Descemet's membrane endothelial keratoplasty. Curr Opin Ophthalmol 2014; 25:325-34. [PMID: 24871356 DOI: 10.1097/icu.0000000000000072] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW To review recent advances in posterior lamellar keratoplasty and to describe strategies that enhance the outcome of Descemet's membrane endothelial keratoplasty (DMEK) and should lead to a more widespread use of this technique. RECENT FINDINGS DMEK offers significant advantages over Descemet's stripping automated endothelial keratoplasty (DSAEK) such as less immune reaction and better visual acuity because of less higher order aberrations. Donor selection should exclude donors under 50 years because of tissue elasticity; several advanced techniques now allow donor preparation from both cold and organ-cultured tissue in about 99% minimizing the risk of graft loss. Oversizing the area of Descemet's stripping in relationship to graft size enhances graft attachment and use of a standardized approach for graft delivery. Air bubble-driven nontouch unfolding techniques and, possibly, gas tamponade in the anterior chamber further enhance graft attachment and reduce surgery-induced endothelial cell loss. Graft orientation is made earlier by marking, slit beam and optical coherence tomography. Novel understanding of the functional anatomy of Descemet's membrane as well as migration of endothelial cells will allow to further refine DMEK and improve its outcome. SUMMARY Although the superiority of DMEK over Descemet's stripping automated endothelial keratoplasty in terms of safety and functionality had been further elucidated, remarkable progress has been made in the recent past regarding tissue preparation, insertion and intraoperative manipulation that will foster the more widespread use of DMEK among corneal surgeons.
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Affiliation(s)
- Friedrich E Kruse
- Department of Ophthalmology, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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De Benito-Llopis L, Mehta JS, Angunawela RI, Ang M, Tan DTH. Intraoperative anterior segment optical coherence tomography: a novel assessment tool during deep anterior lamellar keratoplasty. Am J Ophthalmol 2014; 157:334-341.e3. [PMID: 24332371 DOI: 10.1016/j.ajo.2013.10.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the use of high-resolution anterior segment optical coherence tomography (AS-OCT) during deep anterior lamellar keratoplasty (DALK). DESIGN Prospective case series. METHODS At the Singapore National Eye Centre we performed sequential intraoperative AS-OCT scans using iVue 100-2 (Optovue, Fremont, CA, USA) during various DALK techniques. RESULTS In case 1 (corneal scarring) the OCT images helped to guide manual dissection, showed the depth of the needle track before air injection, and identified the location of a small bubble when the big bubble failed. In cases 2 (macular dystrophy) and 3 (lattice), viscodissection was undertaken, but in case 2 the OCT showed the viscoelastic trapped intrastromally, compared to case 3, in which the viscobubble dissection was successful. In case 4 (irregular corneal thinning and scarring), AS-OCT enabled accurate decision on initial trephination and guided dissection. In case 5 (keratoconus), the OCT showed the achieved big-bubble and detached Descemet membrane. Case 6 was a repeat DALK; the OCT guided the manual dissection of the residual stroma underlying the failed graft. In case 7, the OCT showed an intrastromal retention of fluid that was not detectable by the operating microscope due to diffuse scarring following alkaline injury. The OCT helped to assess the location of the Descemet membrane and guided the manual dissection. CONCLUSIONS Intraoperative high-definition AS-OCT obtained good-quality images of the cornea during DALK and proved useful in various cases of DALK to help the surgeon decide on a number of surgical steps.
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Affiliation(s)
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, National University Health System, Singapore; Duke-NUS Graduate Medical School, Singapore
| | | | - Marcus Ang
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, National University Health System, Singapore
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Chew ACY, Mehta JS, Tan DTH. One Year of Cornea Research in Review-2012. Asia Pac J Ophthalmol (Phila) 2013; 2:401-13. [PMID: 26107152 DOI: 10.1097/apo.0000000000000022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to provide an update of significant cornea literature published in the past 1 year. DESIGN This was a literature review. METHODS The authors conducted a 1-year English-language literature search on PubMed, from January 1, 2012, to December 31, 2012, using the following terms: corneal transplantation, anterior lamellar keratoplasty, penetrating keratoplasty, endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, Descemet membrane endothelial transfer, ocular surface epithelial transplantation, limbal epithelial transplantation, cultivated oral mucosal epithelial transplantation, keratoprosthesis, infectious keratitis, cross-linking, keratoconus, corneal neovascularization, corneal imaging, optical coherence tomography, Pentacam Scheimpflug imaging, and in vivo confocal microscopy. RESULTS This review includes original articles and review articles that contain significant updates and novel aspects in the field of cornea from the following journals: American Journal of Ophthalmology, British Journal of Ophthalmology, Ophthalmology, Investigative Ophthalmology and Visual Science, and Cornea. Letters to the editor, unpublished work, manuscripts not in English, and abstracts were not included. CONCLUSIONS This review highlights significant literature that is applicable to the practicing ophthalmologist.
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Affiliation(s)
- Annabel C Y Chew
- From the *Singapore National Eye Centre, †Singapore Eye Research Institute, ‡Duke-NUS Graduate Medical School, and §Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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