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Meduri A, Oliverio G, Severo AA, Camellin U, Rechichi M, Aragona P. Double safe suture during cataract surgery on post radial keratotomy patients using clear corneal incisions. Eur J Ophthalmol 2022; 32:1828-1832. [PMID: 35229692 DOI: 10.1177/11206721221083799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE the aim of this study is to find a safer surgical approach in cataract surgery on eyes previously treated with radial keratotomy using clear corneal incisions. SETTING Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy. DESIGN Prospective study. METHODS A prospective study was conducted on a group of 20 patients, 21 eyes with 16 RK incisions were evaluated for cataract phacoemulsification. Samples were divided into two groups: Group 1 underwent surgery with pre-operative one corneal stitch along radial keratotomy incisions near the main access site whereas Group 2 underwent modified surgery with two corneal stitches. RESULTS After surgery, visual acuity, corneal hysteresis and corneal strength was evaluated. In all cases, an increased visual acuity was observed. Group 1 showed an UCVA of logMAR 0.22 ± 0.14, while group 2 presented a logMAR of 0.1 ± 0.07. Data did not show a statistically significant difference in UCVA after surgery between the two groups (P = 0.133). Instead, a significant difference in corneal hysteresis (CH), respectively with values of 8.65 ± 1.6 mmHg in group 1 and 9.2 ± 1.8 in group 2 (P = 0.031), and a corneal resistance factor (CRF) with values of 7.87 ± 1.4 mmHg in the first group and 8.65 ± 1.6 mmHg in the second one (P = 0.039) was observed. CONCLUSIONS Double safe suture technique offers better stabilization of corneal structure during surgery in patients preventively treated with 16 incisions RK.
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Affiliation(s)
- Alessandro Meduri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | - Giovanni Oliverio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | - Alice Antonella Severo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | - Umberto Camellin
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | | | - Pasquale Aragona
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Regional Referral Center for the Ocular Surface Diseases, 18980University of Messina, Messina, Italy
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Five-Year Changes in Corneal Astigmatism After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy. Am J Ophthalmol 2020; 217:232-239. [PMID: 32437671 DOI: 10.1016/j.ajo.2020.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the long-term stability of corneal astigmatism after combined femtosecond (fs)-assisted phacoemulsification and arcuate keratotomy. DESIGN Retrospective, interventional case series. METHODS Surgery was performed using a Victus (Bausch & Lomb) platform. A single, 450-μm-deep arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism measurements obtained preoperatively and at 2 and 5 years postoperatively were analyzed using vector analysis. RESULTS A total of 44 eyes of 44 patients (mean age 66.0 ± 10.1 years) were included. The mean preoperative corneal astigmatism was 1.40 ± 0.66 diopters (D). This was reduced to 0.74 ± 0.54 D at 2 years and 0.70 ± 0.50 at 5 years postoperatively (P < .001). There were no statistically significant differences between postoperative corneal astigmatism at 2 years and at 5 years (P = .609). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .805). At the end of 5 years, 65% of the eyes were within 15 degrees of the preoperative astigmatic meridian. Comparative analysis showed significantly higher surgically induced astigmatism, lower differences in vector and absolute angles of error for the eyes with preoperative with-the-rule (WTR) astigmatism than eyes with against-the-rule (ATR) astigmatism at 5 years (P < .004). CONCLUSIONS Our study showed the stability of femtosecond (fs)-assisted arcuate keratotomy was well-maintained over 5 years. There was a tendency of increasing overcorrection of preoperative WTR astigmatism and undercorrection of ATR astigmatism over time.
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Yen CY, Tseng GL. Effectiveness and confounding factors of penetrating astigmatic keratotomy in clinical practice: Case report. Medicine (Baltimore) 2018; 97:e9709. [PMID: 29369200 PMCID: PMC5794384 DOI: 10.1097/md.0000000000009709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Penetrating astigmatic keratotomy (penetrating AK) is a well-known method to correct corneal astigmatism but rarely be performed nowadays. This article reevaluated the clinical effectiveness and confounding factors of penetrating AK. PATIENT CONCERNS Penetrating AK has been introduced to serve as one alternative operation for astigmatism correction, and is thought to have the potential advantage of being more affordable and easy to perform. The purpose of our study is to evaluate the effectiveness and confounding factors of penetrating AK. DIAGNOSES The chart of 95 patients with corneal astigmatism (range: 0.75-3.25 diopters [D]) who received penetrating AK from January 2014 to December 2016 was collected. The corneal astigmatism were measured by an autokeratometer (Topcon KR8100PA topographer-autorefractor), and repeated with manual keratometer in low reproducibility cases. INTERVENTIONS All patients received penetrating AK by an experienced ophthalmologist (Dr. Gow-Lieng Tseng, MD, PHD) in the operation room. Among which, 66 patients received penetrating AK with phacoemulsification simultaneously (group A), whereas 29 patients received penetrating AK at least 3 months after phacoemulsification (group B). After excluding the patients combined with other procedures or lost followed up, 79 patients are remaining for analysis. The outcome was evaluated by net correction, the difference between preoperative corneal astigmatism (PCA) and residual corneal astigmatism (RCA). Two sample t tests and Pearson test were used for effectiveness evaluation. For confounding factors, multivariate linear regression was used for statistical analysis. OUTCOMES The mean preoperative and postoperative refractive cylinders were 1.97 ± 0.77 and 1.08 ± 0.64 D, respectively, in group A and 2.62 ± 1.05 and 1.51 ± 0.89 D in group B. There were no statistically significant differences in net correction between these two groups (0.9 ± 0.66 vs. 1.1 ± 0.69, P = .214). Higher PCA were associated with higher net correction in both group A (P = .002) and group B (P = .019). Compound myopic astigmatism caused less net correction than others only in group A (P = 0.031). LESSONS Penetrating AK is an accessible, affordable, and effective way to correct corneal astigmatism. The results of this procedure are comparable to modern methods in patients with low to moderate corneal astigmatism.
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Meduri A, Urso M, Signorino GA, Rechichi M, Mazzotta C, Kaufman S. Cataract surgery on post radial keratotomy patients. Int J Ophthalmol 2017; 10:1168-1170. [PMID: 28730124 DOI: 10.18240/ijo.2017.07.23] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/29/2016] [Indexed: 11/23/2022] Open
Abstract
This study aims to evaluate and to compare three different approaches of cataract surgery to patients with previous radial keratotomy (RK), and to analyze the mechanical properties of the cornea after cataract surgery. Three groups of patients, each one including 8 eyes of patients with 16 RK incisions. The first group includes eyes with the first cataract incision superiorly, the second group in the temporal area, the third group in temporal area and a precautionary stabilizing suture across the RK incision adjacent to the main tunnel. In the first group intraoperative dehiscence occurred in three eyes (37.5%): it required immediate application of a suture. In the second group dehiscence occurred intraoperatively in two radial scars (20%): it required immediate application of a suture. In the third group, no intraoperative dehiscences were observed. The stabilizing suture of the RK incision works safer, with a lower risk of dehiscences and less post-operative astigmatism.
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Affiliation(s)
- Alessandro Meduri
- Department of Surgical Specialties, Ophthalmology Clinic, University of Messina, Messina 98100, Italy
| | - Mario Urso
- Department of Surgical Specialties, Ophthalmology Clinic, University of Messina, Messina 98100, Italy
| | - Giuseppe A Signorino
- Department of Surgical Specialties, Ophthalmology Clinic, University of Messina, Messina 98100, Italy
| | - Miguel Rechichi
- Department of Ophthalmology, University Magna Graecia, Catanzaro 88100, Italy
| | - Cosimo Mazzotta
- Mazzotta Cross-Linking & Refractive Surgery Center, Siena 53100, Italy
| | - Stephen Kaufman
- Department of Ophthalmology, State University of New York-Downstate, Brooklyn and Manhattan, New York 11203, United States
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Chan TC, Ng AL, Cheng GP, Wang Z, Woo VC, Jhanji V. Corneal Astigmatism and Aberrations After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy: Two-Year Results. Am J Ophthalmol 2016; 170:83-90. [PMID: 27496784 DOI: 10.1016/j.ajo.2016.07.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the stability of corneal astigmatism and higher-order aberrations after combined femtosecond-assisted phacoemulsification and arcuate keratotomy. DESIGN Retrospective, interventional case series. METHODS Surgery was performed using a VICTUS (Bausch & Lomb Inc, Dornach, Germany) platform. A single, 450-μm deep, arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism and higher-order aberration measurements obtained preoperatively and at 2 months and 2 years postoperatively were analyzed. RESULTS Fifty eyes of 50 patients (mean age 66.2 ± 10.5 years) were included. The mean preoperative corneal astigmatism was 1.35 ± 0.48 diopters (D). This was reduced to 0.67 ± 0.54 D at 2 months and 0.74 ± 0.53 D at 2 years postoperatively (P < .001). There was no statistically significant difference between postoperative corneal astigmatism over 2 years (P = .392). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .283). At postoperative 2 months and 2 years, 72% and 70% of eyes were within 15 degrees of preoperative meridian of astigmatism, respectively. All wavefront measurements increased significantly at 2 months and 2 years (P < .007), except spherical aberration (P > .150). There was no significant difference in higher-order aberrations between 2 months and 2 years postoperatively (P > .486). CONCLUSIONS Our study showed the stability of femtosecond-assisted arcuate keratotomy. Further studies using other platforms and nomograms are needed to corroborate the findings of this study.
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Gupta I, Oakey Z, Ahmed F, Ambati BK. Spectacle Independence after Cataract Extraction in Post-Radial Keratotomy Patients Using Hybrid Monovision with ReSTOR(®) Multifocal and TECNIS(®) Monofocal Intraocular Lenses. Case Rep Ophthalmol 2014; 5:157-61. [PMID: 24987365 PMCID: PMC4067705 DOI: 10.1159/000363372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background We report 2 patients who have undergone radial keratotomy (RK) preceding ReSTOR® multifocal intraocular lens (IOL; Alcon, Fort Worth, Tex., USA) implantation in their nondominant eyes and TECNIS® monofocal IOL (Abbott Medical Optics, Abbott Park, Ill., USA) in their dominant eyes. Methods Retrospective review of 2 patients who underwent hybrid monovision with ReSTOR® multifocal and TECHNIS® monofocal IOLs at the time of cataract surgery after a remote history of RK. Results Implantation of the ReSTOR® multifocal and the TECHNIS® monofocal IOLs was successful, with no reported adverse events. The patients were able to achieve spectacle freedom. Conclusion We report a novel technique for the management of post-RK patients to optimize their chances for spectacle independence.
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Affiliation(s)
- Isha Gupta
- University of Utah School of Medicine, Salt Lake City, Utah, Calif., USA
| | - Zack Oakey
- Gavin Herbert Eye Institute, University of California, Irvine, Calif., USA
| | - Faisal Ahmed
- University of Utah Moran Eye Center, Salt Lake City, Utah, Calif., USA
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Titiyal JS, Khatik M, Sharma N, Sehra SV, Maharana PK, Ghatak U, Agarwal T, Khokhar S, Chawla B. Toric intraocular lens implantation versus astigmatic keratotomy to correct astigmatism during phacoemulsification. J Cataract Refract Surg 2014; 40:741-7. [PMID: 24684966 DOI: 10.1016/j.jcrs.2013.10.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 10/03/2013] [Accepted: 10/09/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare toric intraocular lens (IOL) implantation and astigmatic keratotomy (AK) in correction of astigmatism during phacoemulsification. SETTING Tertiary care hospital. DESIGN Prospective randomized trial. METHODS Consecutive patients with visually significant cataract and moderate astigmatism (1.25 to 3.00 diopters [D]) were randomized into 2 groups. Temporal clear corneal 2.75 mm phacoemulsification with toric IOL implantation was performed in the toric IOL group and with 30-degree coupled AK at the 7.0 mm optic zone in the keratotomy group. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, keratometry, topography, central corneal thickness, and endothelial cell density were evaluated preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS The study enrolled 34 eyes (34 patients), 17 in each group. There was no difference in UDVA or CDVA between the 2 groups at any follow-up visit. The mean preoperative and postoperative refractive cylinder was 2.00 D ± 0.49 (SD) and 0.33 ± 0.17 D, respectively, in the toric IOL group and 1.95 ± 0.47 D and 0.57 ± 0.41 D, respectively, in the keratotomy group (P=.10). The mean residual astigmatism at 3 months was 0.44 ± 1.89 @ 160 in the toric IOL group and 0.77 ± 1.92 @ 174 in the keratotomy group (P=.61). All eyes in the toric IOL group and 14 eyes (84%) in the keratotomy group achieved a residual refractive cylinder of 1.00 D or less (P=.17). CONCLUSION Toric IOL implantation was comparable to AK in eyes with moderate astigmatism having phacoemulsification.
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Affiliation(s)
- Jeewan S Titiyal
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Khatik
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Sri Vatsa Sehra
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parfulla K Maharana
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Urmimala Ghatak
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sudarshan Khokhar
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavana Chawla
- From Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Roberts TV, Sharwood P, Hodge C, Roberts K, Sutton G. Comparison of Toric Intraocular Lenses and Arcuate Corneal Relaxing Incisions to Correct Moderate to High Astigmatism in Cataract Surgery. Asia Pac J Ophthalmol (Phila) 2014; 3:9-16. [PMID: 26107301 DOI: 10.1097/apo.0b013e3182a0af21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare toric intraocular lens (IOL) implantation with arcuate corneal relaxing incisions for moderate to high corneal astigmatism during cataract surgery. DESIGN A retrospective comparison study. METHODS This 12-month single-surgeon study compared eyes with cataract and preexisting astigmatism of 1.75 diopters (D) or greater (range, 1.75-5.25 D) receiving corneal arcuate relaxing incisions or toric IOL implantation. Main outcome measures were visual acuity, refractive results, and IOL axis determination. RESULTS There were 45 and 20 eyes in the toric IOL and arcuate incision groups, respectively. Preoperative data were not significantly different between the 2 groups; the mean preoperative astigmatism was 2.16 ± 0.93 D in the toric IOL group and 2.41 ± 0.76 D in the incisional group. At 6 months postoperatively, the mean residual astigmatism was 0.75 and 1.33 D (P = 0.000), respectively; 82.2% and 44.4% of eyes were 1.00 D or less (P = 0.000), and 35.7% and 16.7% of eyes were 0.50 D or less (P = 0.000), respectively. Uncorrected distance visual acuity improved in both groups; eyes in the toric IOL group were more likely to be 20/30 or better (87% vs 29%, P = 0.008). Following surgery, all eyes had best corrected visual acuity of 20/40 or greater, and no eye lost a line of vision. The mean toric IOL rotation was 2.6 ± 1.7 degrees (range, 0-6 degrees). CONCLUSIONS Both toric IOLs and arcuate corneal incisions reduce moderate to high preexisting corneal astigmatism during cataract surgery; however, toric IOL implantation was more effective and predictable.
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Affiliation(s)
- Timothy V Roberts
- From the *Vision Eye Institute, Chatswood; and †Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, University of Sydney; and ‡Medical School, University of New South Wales, Sydney, New South Wales, Australia
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