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Hamon L, Weinstein I, Quintin A, Safi T, Bofferding M, Daas L, Seitz B. Review for special issue: Corneal lamellar surgery: Present outcomes and future perspectives. Taiwan J Ophthalmol 2024; 14:3-14. [PMID: 38655001 PMCID: PMC11034684 DOI: 10.4103/tjo.tjo-d-23-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 04/26/2024] Open
Abstract
Since the establishment of the first eye bank in the 1940s, their role has evolved to face new challenges. With the recent development of lamellar keratoplasties, eye banks play an even bigger role in the selection and preparation of donor tissues. The increasing number of keratoplasty techniques and the high demand for "ready-to-use" tissues are challenging eye banks to improve and develop new preparation techniques. Besides necessary examinations, new approaches of tissue analysis in eye banks allow a better/optimized selection of corneal tissues. These new challenges in tissue preservation, preparation, and selection are propelling eye banks into a new era of modern eye banking.
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Affiliation(s)
- Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Isabel Weinstein
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Adrien Quintin
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Tarek Safi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Max Bofferding
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
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Berger T, Flockerzi E, Daas L, Hamon L, Khattabi Z, Berger M, Seitz B. [Modern corneal diagnostics as the key for the correct classification of the disease and optimal treatment decisions]. DIE OPHTHALMOLOGIE 2023; 120:1238-1250. [PMID: 37707672 DOI: 10.1007/s00347-023-01919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
Corneal diseases include a wide spectrum of different manifestations (inflammatory/noninflammatory) that need to be accurately classified for precise diagnosis and targeted treatment. In addition to the anamnesis and slit lamp biomicroscopy, further device-based examinations can be performed to narrow down the diagnosis. Nowadays, modern corneal imaging provides a variety of technologies, such as topography, tomography, in vivo confocal microscopy and analysis of biomechanics, which are able to reliably classify different pathologies. Knowledge of the available examination modalities helps to guide differential diagnostic considerations, facilitating the indication for stage-appropriate microsurgical intervention.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland.
| | - Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Zaynab Khattabi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Maximilian Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
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Seitz B, Maier PC, Geerling G. [Cutting Edge Keratokonus]. Klin Monbl Augenheilkd 2023; 240:749-750. [PMID: 37348511 DOI: 10.1055/a-2065-2736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
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Suffo S, El Halabi M, Seitz B, Abdin AD, Munteanu C, Daas L. Penetrating Excimer Laser Keratoplasty with vs without the Homburg Cross-Stitch Marker in Inexperienced Surgeons. Clin Ophthalmol 2021; 15:4607-4614. [PMID: 34908829 PMCID: PMC8665866 DOI: 10.2147/opth.s320513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Homburg cross-stitch marker, according to Suffo, was developed in 2017 in the Department of Ophthalmology at Saarland University Medical Center. With this instrument, a surgeon can precisely define and mark the points of the first and second continuous cross-stitch sutures, according to Hoffmann. The aim of this retrospective study was to compare the functional outcomes of Hoffmann's double continuous cross-stitch suture in penetrating keratoplasty (PKP) with vs without the Homburg cross-stitch marker in inexperienced surgeons. METHODS A total of 130 eyes from 130 patients with central corneal scars, corneal dystrophies and advanced keratoconus were included. All eyes underwent elective excimer laser-assisted penetrating keratoplasty (excimer laser PKP) with a diameter of 8.0/8.1mm. In 65 eyes each, surgery was performed without (group 1) or with (group 2) the Homburg cross-stitch marker. Corrected distance visual acuity, topographic astigmatism, and refractive cylinder were obtained 6 weeks, 10 months post-PKP as well as 6 weeks after the first and after the second suture removal, respectively. The rate of early postoperative single interrupted suture addition was compared between the two groups. RESULTS Visual acuity, astigmatism and refractive cylinder values were significantly more favorable in group 2 (with device) compared to group 1 (without device) before and after suture removal. Postoperative single interrupted suture addition was performed in 34.4% of patients in group 1 compared to 10.6% in group 2 (P = 0.001, Fisher's Exact Test). CONCLUSION The use of the Homburg cross-stitch marker for excimer laser PKP in young cornea specialists results in significantly better visual acuity before and after suture removal, significantly lower astigmatism and cylinder value before suture removal, as well as a reduced necessity of early postoperative single interrupted suture addition.
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Affiliation(s)
- Shady Suffo
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Saar, Germany
| | - Mohammed El Halabi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Saar, Germany
| | - Alaa Din Abdin
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Saar, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Saar, Germany
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Deshmukh R, Nair S, Vaddavalli PK, Agrawal T, Rapuano CJ, Beltz J, Vajpayee RB. Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 2021; 67:1200-1228. [PMID: 34808143 DOI: 10.1016/j.survophthal.2021.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.
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Affiliation(s)
| | - Sridevi Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Tushar Agrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
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Seitz B, Daas L, Hamon L, Xanthopoulou K, Goebels S, Spira-Eppig C, Razafimino S, Szentmáry N, Langenbucher A, Flockerzi E. [Stage-appropriate treatment of keratoconus]. Ophthalmologe 2021; 118:1069-1088. [PMID: 34181061 PMCID: PMC8492599 DOI: 10.1007/s00347-021-01410-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
Keratoconus (KC) is a progressive cone-shaped corneal protrusion that causes paracentral thinning at the apex of the cone and typically occurs asymmetrically on both sides. After a careful anamnesis and classification of the degree of severity a targeted treatment appropriate to the stage of the disease is available. If the visual acuity is no longer sufficient, rigid gas-permeable contact lenses (CL) are fitted by a specialist. Riboflavin UVA cross-linking (CXL) is recommended in cases of progression and visual acuity that is still useful for the patient. Intracorneal ring segments (ICRS) are indicated for CL intolerance in cases of reduced visual acuity and a clear central cornea. If the stage is more advanced, deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) is recommended. A PKP is contraindicated in acute KC but deep stromal sutures for readaptation of the Descemet tear with gas filling of the anterior chamber can considerably shorten the course. Almost no other eye disease is nowadays as easily accessible for an early instrument-based diagnosis and stage-appropriate treatment as KC.
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Affiliation(s)
- B Seitz
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - L Hamon
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - K Xanthopoulou
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Goebels
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - C Spira-Eppig
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Razafimino
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - N Szentmáry
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - E Flockerzi
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
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Daas L, Hamon L, Ardjomand N, Safi T, Seitz B. [Excimer laser-assisted DALK: a case report from the Homburg Keratoconus Center (HKC)]. Ophthalmologe 2021; 118:1245-1248. [PMID: 33630150 PMCID: PMC8648704 DOI: 10.1007/s00347-021-01342-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 01/20/2023]
Abstract
Indikationen Ziel der Excimerlaser-gestützten DALK (Excimer-DALK) ist, wie bei der mechanischen DALK, die Behandlung von Keratektasien (Keratokonus und pellucide marginale Degeneration), stromalen Narben oder stromalen Hornhautdystrophien. Voraussetzung für die Operation ist die Abwesenheit von (prä)descemetalen Narben sowie ein gesundes Endothel. Operationstechnik Nach der Excimerlaser-gestützten Trepanation auf 80 % der kornealen Dicke an der Trepanationsstelle, einer intrastromalen Lufteingabe (sog. „Big-Bubble“) sowie einer lamellären Hornhautpräparation erfolgt eine lamelläre anteriore Transplantation des endothelfreien Spendergewebes. Diese Technik kombiniert die Vorteile einer DALK und einer Excimerlaser-Trepanation. Wir beschreiben die Schritte einer Excimer-DALK aus unserem Homburger Keratokonus Center (HKC). Schlussfolgerungen Die Excimer-DALK stellt bei Patienten mit gutem Endothel eine gute Behandlungsmöglichkeit dar. Bei einer intraoperativen Perforation bleibt die Möglichkeit einer sog. Konversion zur Excimer-PKP mit allen Vorteilen der Excimerlaser-Trepanation. Video online Die Online-Version dieses Beitrags (10.1007/s00347-021-01342-3) enthält ein Video.
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Affiliation(s)
- Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrbergerstr. 100, Geb. 22, 66421, Homburg/Saar, Deutschland.
| | - Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrbergerstr. 100, Geb. 22, 66421, Homburg/Saar, Deutschland
| | - Navid Ardjomand
- Sehzentrum für Augenlaser und Augenchirurgie, Graz, Österreich
| | - Tarek Safi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrbergerstr. 100, Geb. 22, 66421, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrbergerstr. 100, Geb. 22, 66421, Homburg/Saar, Deutschland
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Suffo S, Seitz B, Daas L. The Homburg Cross-Stitch Marker for Double-Running Sutures in Penetrating Keratoplasty. Klin Monbl Augenheilkd 2020; 238:808-814. [PMID: 33285596 DOI: 10.1055/a-1275-0807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Until now, the double-running cross-stitch according to Hoffmann used in penetrating keratoplasty (PKP) has been routinely carried out by simply using a sense of proportion. As a result, the estimation of the precisely defined entry and exit points of the sutures and, by extension, the success of the running cross-stitch suture was completely dependent on the practical experience of the surgeon. Therefore, we introduced the cross-stitch marker as a supporting instrument for PKP surgery. METHODS Description of the Homburg cross-stitch marker with an exact step-by-step guide on how the instrument is implemented while performing a PKP to mark entry and exit points for sutures including a video to demonstrate the use of this instrument. RESULTS The new Homburg cross-stitch marker ensures the precise localisation of the entry and exit points of the suture. This new instrument allows inexperienced surgeons in particular to feel very confident when performing the running sutures. CONCLUSION Surgeons with little experience can completely avoid using their still imprecise sense of proportion and significantly shorten the learning curve for this procedure.
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Affiliation(s)
- Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg (Saar), Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg (Saar), Germany
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg (Saar), Germany
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Seitz B, Daas L, Flockerzi E, Suffo S. [Descemet membrane endothelial keratoplasty DMEK - Donor and recipient step by step]. Ophthalmologe 2020; 117:811-828. [PMID: 32561987 DOI: 10.1007/s00347-020-01134-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 2020 Descemet membrane endothelial keratoplasty (DMEK) has become the gold standard in Germany for the treatment of corneal endothelial diseases; however, the widespread use of DMEK was initially limited due to problems with donor preparation and the difficulty of correctly and gently unfolding the endothelial Descemet membrane (EDM) in the anterior chamber. Following the situational donor selection, the safe single-handed donor preparation of the cornea without tearing or even rupturing the EDM, including the indispensable peripheral semicircular orientation marking. Also presented is a step by step atraumatic loading of the glass cartridge, the introduction of the EDM roll into the anterior chamber, and its safe step by step unfolding based on (1) the sequential use of jets of fluid, (2) repeated tapping on the peripheral/central cornea, (3) controlled flattening of the anterior chamber, (4) use of air bubbles of defined size and finally, the fixation of the EDM in correct orientation to the back of the host cornea with a gas bubble. Since every wrong step with DMEK can have far-reaching consequences for patient and surgeon, this step by step pragmatic approach should minimize the incidence of donor tissue damage and failure in patient maneuvers.
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Affiliation(s)
- Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland.
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
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Szentmáry N, Shi L, Daas L, Seitz B. Diagnostics and management approaches for Acanthamoeba keratitis. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1791081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lei Shi
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
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