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Cho SY, Yoon JH, Koo MA, Whang WJ, Na KS, Kim EC, Kim HS, Hwang HS. Retrospective Analysis of a New Intrastromal Dissection Technique Using the Retinal Reflex for Deep Anterior Lamellar Keratoplasty. Cornea 2024; 43:1128-1136. [PMID: 38251908 PMCID: PMC11296286 DOI: 10.1097/ico.0000000000003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE The purpose of this study was to describe a new surgical technique for deep anterior lamellar keratoplasty. METHODS All pupils in the recipient eyes were dilated preoperatively. Vertical grooving was performed using a crescent blade with a width of 5 mm and a depth of one-third to half corneal thickness on the temporal side of the limbus. Stromal dissection was performed as close as possible to Descemet membrane by observing the gap between the gold line by retinal reflex and the front edge of the crescent blade. Lamellar dissection was performed along the lamellar plane using corneal dissectors. The ophthalmic viscoelastic device was injected into the intrastromal pocket to separate the anterior and posterior stroma and an anterior corneal lamella was excised. A donor cornea was sutured into the recipient bed. RESULTS In 18 eyes, none of the patients had Descemet membrane rupture during surgery. The mean postoperative residual stromal thickness was 80 ± 31 μm. The mean central corneal thickness after surgery was 660 ± 69 μm. At the last follow-up, the cornea was cleared in all 18 eyes on slit-lamp examination. CONCLUSIONS We estimated the residual stromal thickness based on the gap between the gold line by the retinal reflex and crescent blade, and intrastromal lamellar dissection was performed using a smooth corneal dissector. Consequently, the surface of stromal dissection was smooth, and the residual stromal thickness was even.
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Affiliation(s)
- Soo Yeon Cho
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyun Yoon
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Minjeong A. Koo
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong Joo Whang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Chul Kim
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Seung Kim
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Salvador-Culla B, Afsara A, Roper N, Mulroy J, Galankova L, Duncan H, Tabibian D, Lamarca-Mateu J, Figueiredo FC. Accelerated Corneal Crosslinking to Arrest Progression of Corneal Ectasia: A Prospective Multicenter Study. Eye Contact Lens 2024; 50:126-131. [PMID: 38345049 DOI: 10.1097/icl.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES To report the results of epithelium-off accelerated corneal collagen crosslinking (accelerated corneal crosslinking [ACXL]) in patients with progressive keratoconus. METHODS This prospective, nonrandomized, noncomparative, interventional, multicenter clinical study included all patients who underwent ACXL, either continuous (c-ACXL; 9 mW/cm 2 , 10', 5.4 J/cm 2 ) or pulsed (p-ACXL; 2″ON/1″OFF, 30 mW/cm 2 , 4.5', 5.4 J/cm 2 ) between January 2014 and May 2017. Best-corrected visual acuity, sphere, cylinder, spherical equivalent, and topographical keratometry data were collected preoperatively and at 1, 3, 6, 12, 18, and 24 months postoperatively. RESULTS Ninety-six eyes of 78 patients were included. The mean age was 20.8±4.4 years (14-33) for c-ACXL and 26.7±7.7 years (12-37) for p-ACXL. The mean best-corrected visual acuity was 0.4±0.4 for c-ACXL and 0.01±0.1 for p-ACXL preoperatively, and 0.3±0.3 ( P =0.0014) and -0.01±0.1 ( P =0.1554), respectively, at the last follow-up. The subjective sphere and spherical equivalent did not show statistically significant differences between the time points ( P >0.05). The subjective cylinder showed significant differences ( P =0.0013 for c-ACXL; P =0.0358 for p-ACXL). Keratometric values (K steep , K flat , and SimK) remained stable, with no statistically significant differences ( P >0.05). No major complications were noted. CONCLUSIONS Both c-ACXL and p-ACXL are equally safe and effective ACXL protocols in stabilizing the progression of keratoconus and can be considered alternatives to the conventional Dresden protocol.
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Affiliation(s)
- Borja Salvador-Culla
- Department of Ophthalmology (B.S.-C., A.A., N.R., J.M., L.G., H.D., D.T., F.C.F.), Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Centro de Oftalmología Barraquer (B.S.-C., J.L.-M.), Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Ophthalmology (D.T.), University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland; and Biosciences Institute (F.C.F.), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Hao Y, Zhu B, Wu T, Guo X. Sutureless lamellar keratoplasty with lenticule from small incision lenticule extraction for treating limbal dermoid: A case report. Exp Ther Med 2024; 27:57. [PMID: 38234620 PMCID: PMC10790163 DOI: 10.3892/etm.2023.12345] [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: 11/05/2022] [Accepted: 08/15/2023] [Indexed: 01/19/2024] Open
Abstract
The present study reports the case of a superficial limbal dermoid surgically treated without suture by using a new technique of lamellar keratoplasty with allogenic lenticule from small incision lenticule extraction. The limbal lesion area was circumscribed by a trephine marker and lamellae were peeled off the anterior corneal stroma and sclera. After excision of the dermoid, the liquid on the bed was dried as much as possible and an appropriate stromal lenticule was attached to the implant bed without fibrin glue or suture. A bandage contact lens was applied to fix the graft. During postoperative follow-ups, the anterior segment optical coherence tomography, corneal refractive power, corneal topography and best-corrected visual acuity were examined to evaluate the surgical results. On the first day after the operation, the patient reported tearing and pain at the site. At one week after the operation, the patient reported no discomfort and conjunctival sutures were removed. At one month after the operation, the thickness of the lesion area was similar to that of the adjacent cornea, and the corneal curvature and refractive power of the lesion area were higher than that of the adjacent cornea. At three months after the operation, the patient was satisfied with the cosmetic outcome and no sign of corneal neovascularization, graft rejection or pseudo-pterygium formation was observed. The astigmatic error remained at 2.50 D. The present case provides insights into a potential treatment option for patients who need lamellar keratoplasty and may provide its benefit in contrast to conventional lamellar keratoplasty.
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Affiliation(s)
- Yanjun Hao
- Department of Pediatric Ophthalmology, Tianjin Aier Eye Hospital, Tianjin 300190, P.R. China
| | - Bin Zhu
- Department of Tear Duct Disorders, Shanxi Aier Eye Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Tao Wu
- Department of Tear Duct Disorders, Shanxi Aier Eye Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Xuming Guo
- Department of Ocular Surface and Refraction, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Peng R, Du K, Yuan B, Xiao G, Qu Y, Xu Y, Liu E, Hong J. Deep Anterior Lamellar Keratoplasty-Treated Keratoconic Eyes With Descemet Membrane Rupture. Cornea 2023:00003226-990000000-00443. [PMID: 38147574 DOI: 10.1097/ico.0000000000003448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/30/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE The aim of this study was to evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) and compare it with penetrating keratoplasty (PKP) in keratoconic eyes with Descemet membrane (DM) rupture. METHODS In this comparative retrospective case series, 33 keratoconic eyes with a history of hydrops underwent DALK and 27 received PKP. Baseline and postoperative visual acuity, corneal astigmatism, mean keratometry, endothelial cell density, and complication rates were measured. RESULTS The median follow-up of patients who underwent DALK was 45 months (range, 4-76 months) and that of patients who underwent PKP was 84 months (range, 4-136 months). Both procedures had comparable postoperative visual acuity, astigmatism, and mean keratometry. Significantly higher endothelial cell densities were observed in DALK than in PKP at 2, 3, and 5 years postsurgery (2043 ± 767 vs. 1165 ± 683 cell/mm2, P = 0.007, n = 12 in both groups at 2 years). Intra-DALK, 15 perforations occurred (44.12%) and 1 (2.94%) was converted to PKP. Graft rejection was diagnosed in 1 (3.03%) DALK procedure versus 8 (29.63%) PKP (P = 0.008), and other long-term complication rates were equivalent. Kaplan-Meier survival analysis also revealed a higher rejection-free survival rate for the DALK group (P = 0.012). Subgroup analysis within both groups based on the severity of preoperative DM rupture revealed no significant difference in any major 2-year outcomes. CONCLUSIONS DALK showed similar beneficial visual outcome and safety but significantly better endothelial protection over PKP in eyes with keratoconus and previous hydrops. Therefore, DALK is recommended in posthydrops cases irrespective of the DM rupture severity.
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Affiliation(s)
- Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Kaiyue Du
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Bowei Yuan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Gege Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Yi Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Yonggen Xu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Enshuo Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
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Kemer Atik B, Emul M, Kirgiz A, Cubuk MO, Ahmet S, Kandemir Besek N. Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in Keratoconic Eyes With Previous Hydrops-Related Corneal Scar. Cornea 2023; 42:1446-1450. [PMID: 37126646 DOI: 10.1097/ico.0000000000003297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/25/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to compare the outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) procedures in keratoconic eyes with a previous hydrops-related corneal scar. METHODS In this retrospective study, the medical records of patients who had hydrops-related corneal scarring and underwent keratoplasty surgery were reviewed. Patients treated with DALK were classified as group 1, and patients treated with PK as group 2. Preoperative and postoperative best-corrected visual acuity, central corneal thickness, keratometry (K), and refractive error values of each group were recorded and compared. RESULTS Seventy-eight eyes (41 in group 1 and 37 in group 2) were included in this study. The mean follow-up period of the patients was 37.7 ± 30.0 months in group 1 and 51.2 ± 29.4 months in group 2 ( P = 0.06). The preoperative and postoperative best-corrected visual acuity and central corneal thickness values were statistically similar in both groups (each P value >0.05). Keratometry values (K1 and mean keratometry) were significantly steeper in group 1 ( P1 = 0.02 and P2 = 0.03, respectively). Descemet membrane perforation was experienced in 7 (4 macroperforation and 3 microperforation; 15.6%) of 45 eyes that planned to perform DALK. These 4 eyes with macroperforation underwent PK and were excluded from the study. When all postoperative complications were assessed, although the total complication rate was 21% after DALK, it was 43% after PK ( P = 0.04). CONCLUSIONS DALK with a big-bubble technique is a feasible surgery in eyes with corneal scarring due to previous hydrops and is comparable with PK in terms of visual and refractive outcomes. This study suggests that DALK, which is safer than PK with less postoperative complication rates, should be the primary surgical option to avoid serious complications in keratoconic eyes with hydrops-related corneal scarring.
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Affiliation(s)
- Burcu Kemer Atik
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Bui AD, Truong A, Pasricha ND, Indaram M. Keratoconus Diagnosis and Treatment: Recent Advances and Future Directions. Clin Ophthalmol 2023; 17:2705-2718. [PMID: 37736107 PMCID: PMC10511017 DOI: 10.2147/opth.s392665] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
Keratoconus is a disorder characterized by progressive corneal thinning and steepening that may result in significant visual impairment secondary to high astigmatism, corneal scarring, or even corneal perforation. Early detection and screening of keratoconus are essential for effective management and treatment. Several screening methods, such as corneal topography and tomography, corneal biomechanics, and genetic testing, are being developed to detect keratoconus at an early stage. Once detected, prevention of progression is the mainstay of keratoconus management. Corneal collagen cross-linking is a minimally invasive treatment option that can slow or halt the progression of keratoconus. Additionally, recent studies have investigated the potential use of copper sulfate eye drops (IVMED-80) and extracellular vesicles to prevent the progression of keratoconus as non-invasive treatment options. For visual rehabilitation, currently available treatments include scleral lenses, intracorneal ring segments, corneal allogenic intrastromal ring segments, and deep anterior lamellar keratoplasty. The safety and efficacy of these emerging treatment options for keratoconus are currently being investigated.
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Affiliation(s)
- Anh D Bui
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Angeline Truong
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neel D Pasricha
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Zhao Y, Jablonka AM, Maierhofer NA, Roodaki H, Eslami A, Maier M, Nasseri MA, Zapp D. Comparison of Robot-Assisted and Manual Cannula Insertion in Simulated Big-Bubble Deep Anterior Lamellar Keratoplasty. MICROMACHINES 2023; 14:1261. [PMID: 37374846 DOI: 10.3390/mi14061261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
This study aimed to compare the efficacy of robot-assisted and manual cannula insertion in simulated big-bubble deep anterior lamellar keratoplasty (DALK). Novice surgeons with no prior experience in performing DALK were trained to perform the procedure using manual or robot-assisted techniques. The results showed that both methods could generate an airtight tunnel in the porcine cornea, and result in successful generation of a deep stromal demarcation plane representing sufficient depth reached for big-bubble generation in most cases. However, the combination of intraoperative OCT and robotic assistance received a significant increase in the depth of achieved detachment in non-perforated cases, comprising a mean of 89% as opposed to 85% of the cornea in manual trials. This research suggests that robot-assisted DALK may offer certain advantages over manual techniques, particularly when used in conjunction with intraoperative OCT.
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Affiliation(s)
- Yinzheng Zhao
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Anne-Marie Jablonka
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Niklas A Maierhofer
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Hessam Roodaki
- Translational Research Lab, Carl Zeiss Meditec AG, 81379 München, Germany
| | - Abouzar Eslami
- Translational Research Lab, Carl Zeiss Meditec AG, 81379 München, Germany
| | - Mathias Maier
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Mohammad Ali Nasseri
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Daniel Zapp
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
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Arora R, Gupta I, Sahu J, Vishwanath S, Gupta P, Jain P. Corneal aberrations, densitometry on scheimpflug imaging, and visual acuity after deep anterior lamellar keratoplasty. Eur J Ophthalmol 2022; 33:11206721221128863. [PMID: 36172635 DOI: 10.1177/11206721221128863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate visual acuity, corneal aberrations, and densitometry post deep anterior lamellar keratoplasty (DALK). METHODS Twenty-five eyes of 25 patients who underwent DALK for corneal stromal diseases with normal endothelium were enrolled in a prospective interventional study. Evaluation for corneal aberrations and densitometry postoperatively was performed using Scheimpflug imaging at 6 months. Anterior Segment Optical Coherence Tomography (ASOCT) was done for host-graft morphology. Correlation analysis of postoperative best-corrected visual acuity with corneal aberrations and corneal densitometry (CD) was performed. RESULTS Big bubble deep anterior lamellar keratoplasty (BB-DALK) was successful in 18 patients, while 7 eyes underwent manual dissection due to failed BB (Big Bubble) technique. The mean BSCVA was 1.35 ± 0.46 logMAR units pre-operatively which improved to 0.36 ± 0.19 logMAR units post DALK at 6 months (P < 0.001). The mean Root Mean Square (RMS) (μm) of the magnitude of total corneal aberrations, HOA and LOA from central 6mm zone of cornea were 14.6 ± 9.2, 4.7 ± 2.9, and 13.8 ± 8.8, respectively. The mean anterior (120μm), central and posterior corneal (60μm) densitometry in 0-2mm zone were 25.8 ± 7.7 GSU, 18.7 ± 4.16 GSU and 10.09 ± 3.9 GSU respectively. A statistically significant correlation of postoperative residual stromal bed thickness, total corneal HOA, LOA, total corneal aberrations, HOA front and posterior corneal densitometry (0-2mm zone) with postoperative BSCVA was found. CONCLUSION Though there is a significant improvement in BSCVA after DALK, the quality of vision in terms of aberrometry and densitometry is suboptimal, especially in cases undergoing manual DALK compared to those undergoing big bubble formation.
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Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Isha Gupta
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Jigyasa Sahu
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Shweta Vishwanath
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Palak Gupta
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Parul Jain
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
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Charnock LN, Boveland SD, Groover ES, Moore PA, McMullen RJ. Effects of corneoconjunctival transposition, posterior lamellar keratoplasty and modified deep lamellar endothelial keratoplasty on streak retinoscopy in equine cadaver eyes. Vet Ophthalmol 2022; 25:483-492. [PMID: 36121370 DOI: 10.1111/vop.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evaluate the effects of corneoconjunctival transposition (CCT), posterior lamellar keratoplasty (PLK) and modified deep lamellar endothelial keratoplasty (DLEK) on streak retinoscopy in equine cadaver eyes. METHODS Intraocular pressure (IOP) was maintained at 25 ± 3 mmHg in 35 equine cadaver eyes. Streak retinoscopy was performed prior to (NO VISCO) and following (VISCO) intracameral injection of 1.0 ml of viscoelastic. Following optical coherence tomography (OCT), an axial CCT [n = 11] or PLK [n = 12], or peripheral DLEK [n = 12] was performed. Streak retinoscopy and OCT were repeated postoperatively. RESULTS Postsurgical net meridional and spherical refraction for CCT [Horizontal (H): 3.4 (95% CI 2.4-4.4) diopters (D), p < .001, Vertical (V): 3.5 (95% CI 2.7-4.4) D, p < .001, Spherical: 3.5 (95% CI 2.6-4.3) D, p < .001] and PLK [H: 3.2 (95% CI 2.2-4.1) D, p < .001, V: 2.8 (95% CI 2.0-3.6) D, p < .001, Spherical: 3.0 (95% CI 2.2-3.8) D, p < .001] were significantly increased from presurgical (VISCO) values. No difference between presurgical (VISCO) and postsurgical values were identified for the DLEK. Postoperative OCT revealed space between anterior and posterior corneal grafts and corneal undulation associated with suture placement. CONCLUSION Meridional and spherical refraction had a hyperopic shift following CCT and PLK, with a significantly higher value in the vertical meridian for the CCT. Pre- and postoperative refraction was not significantly different for the DLEK. This supports that the DLEK has a lesser effect on immediate postoperative refraction compared with CCT or PLK.
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Affiliation(s)
- Lauren N Charnock
- College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | | | - Erin S Groover
- College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Phillip A Moore
- College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
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Refractive surgery after deep anterior lamellar keratoplasty: a review of the literature. Int Ophthalmol 2022; 43:1413-1435. [PMID: 36083561 DOI: 10.1007/s10792-022-02507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The main objective of this work is to present an updated review of the different surgical procedures for the correction of residual refractive errors following deep anterior lamellar keratoplasty (DALK) surgery. METHODS A review of the literature was conducted using PubMed, Web of Science, and Scopus databases. The search was conducted in January 2022 and was limited to articles published in peer-reviewed journals. The information extracted from each publication included sample size, mean follow-up time, pre- and post-operative uncorrected (UDVA) and corrected distance visual acuity (CDVA), pre- and post-operative refraction and spherical equivalent (SE), safety and efficacy indexes and complications. RESULTS Residual ametropias, mainly high astigmatism and myopia, and the resulting anisometropia are likely to occur following DALK. They become a limiting factor and may lead to unsatisfactory visual restoration, therefore affecting patients' quality of vision and life. Alternative surgical interventions may be required to treat this residual ametropia, such as corneal refractive surgery or intraocular lens implantation. A total of 47 relevant articles were studied in detail. Different refractive surgery techniques have been shown to be effective and safe for the correction of ametropia following the DALK procedure and to improve the patient's quality of vision, although more research is needed to confirm long-term results. CONCLUSION The final refractive technique will depend on different factors, such as the amount of ametropia, the condition of the cornea or the patient's individual needs, economics, and occupational demands.
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Alfonso-Bartolozzi B, Lisa C, Fernández-Vega-Cueto L, Baamonde B, Madrid-Costa D, Alfonso JF. Three-year follow-up of posterior chamber phakic intraocular lens with a central port design after deep anterior lamellar keratoplasty. EYE AND VISION 2022; 9:34. [PMID: 36068603 PMCID: PMC9450313 DOI: 10.1186/s40662-022-00306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
To evaluate clinical outcomes of the Visian implantable collamer lens (ICL) with a central port to correct myopia and astigmatism after deep anterior lamellar keratoplasty (DALK) for keratoconus throughout 3 years of follow-up.
Methods
This study included 20 eyes of 20 patients that underwent V4c ICL (13 eyes with a spherical ICL and 7 eyes with a toric ICL) implantation after DALK. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), and vault were analyzed.
Results
The mean UDVA improved from the preoperative 1.18 ± 0.33 logMAR to 0.25 ± 0.14 logMAR at 6 months after surgery (P < 0.0001) and remained unchanged throughout the whole follow-up (P = 0.4). All eyes gained lines of CDVA compared to preoperative values. At the last follow-up visit, all eyes achieved CDVA of 0.2 logMAR or better and 13 eyes (65%) 0.1 logMAR or better. At 6 months post-surgery, all eyes (100%) had a spherical equivalent within ± 1.50 D, and 19 (95%) within ± 1.00 D. The mean manifest spherical equivalent was stable over the postoperative follow-up (P = 0.25). No significant increase in IOP occurred in any case throughout the 3 years of follow-up. The loss in ECD from the preoperative baseline at the last follow-up visit was 2.27%.
Conclusions
The clinical outcomes suggest that the V4c ICL implantation for correction of myopia and regular astigmatism in post-DALK eyes was satisfactory in terms of effectiveness, safety, and stability during 3 years of follow-up.
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Alfonso-Bartolozzi B, Lisa C, Fernández-Vega-Cueto L, Madrid-Costa D, Alfonso JF. Femto-LASIK after Deep Anterior Lamellar Keratoplasty to Correct Residual Astigmatism: A Long-Term Case Series Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081036. [PMID: 36013505 PMCID: PMC9412627 DOI: 10.3390/medicina58081036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
Purpose: To evaluate the long-term outcomes of femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) to correct residual astigmatism after deep anterior lamellar keratoplasty (DALK). Methods: This retrospective case series study included 10 eyes that underwent Femto-LASIK after a DALK. The refractive error, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, thinnest corneal thickness (TCT), and central corneal thickness (CCT) were registered. The postoperative follow-up ranged between 36 and 60 months. Results: All surgeries were uneventful, with no intra- or postoperative complications. The mean UDVA (Snellen scale) rose from 0.13 ± 0.05 to 0.47 ± 0.15 six months after Femto-LASIK (p < 0.001). All cases experienced a significant improvement in UDVA. None of the eyes lost lines of CDVA, and seven eyes (70%) improved the CDVA compared to preoperative values. The refractive cylinder changed from a preoperative value of −3.88 ± 1.00 D to −0.93 ± 0.39 six months after Femto-LASIK (p < 0.0001). In eight eyes (80%), the UDVA and refractive outcomes remained stable at postoperative follow-up visits. In contrast, one eye experienced a refractive regression over the follow-up. TCT and CCT were stable at the different postoperative follow-up visits. Conclusions: Our findings suggest that Femto-LASIK might safely and effectively corrects residual astigmatism after DALK. Despite these encouraging results, further long-term studies, including a larger number of cases, are required to confirm the safety of the procedure. The refractive stability in eyes with prior RK might be lower than for other DALK indications.
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Affiliation(s)
| | - Carlos Lisa
- Fernández-Vega Ophthalmological Institute, 33012 Oviedo, Spain; (B.A.-B.); (C.L.); (L.F.-V.-C.)
| | | | - David Madrid-Costa
- Clinical and Experimental Eye Research Group (CEER), Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain;
| | - José F. Alfonso
- Fernández-Vega Ophthalmological Institute, 33012 Oviedo, Spain; (B.A.-B.); (C.L.); (L.F.-V.-C.)
- Correspondence:
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Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus: A Claims-Based Analysis. Cornea 2022; 42:663-669. [PMID: 37146289 DOI: 10.1097/ico.0000000000003072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report 1) demographic and clinical characteristics for US patients with keratoconus undergoing deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK) and 2) complication rates for the 2 procedures. METHODS We performed a retrospective review of 2010 to 2018 health records for patients with keratoconus age younger than 65 years using the IBM MarketScan Database. A multivariable model adjusting for potential confounders was used to determine factors associated with receiving DALK over PK. Rates of complications 90 days and 1 year postoperatively were calculated. For select complications only (repeat keratoplasty, glaucoma surgery, and cataract surgery), Kaplan-Meier survival curves were additionally constructed over a period of up to 7 years. RESULTS A total of 1114 patients with keratoconus (mean age: 40.5 ± 12.6 years) were included in the analysis. Hundred nineteen received DALK, and 995 received PK. Regional differences exist, with patients in the north central United States having greater odds of receiving DALK than northeastern patients (OR = 5.08, 95% confidence interval, 2.37-10.90). Rates of endophthalmitis, choroidal hemorrhage, infectious keratitis, graft failure, graft rejection, postoperative cataract, glaucoma, or retinal surgery were all low at 90 days and 1 year. Complication rates for DALK and PK were both low beyond 1 year for repeat keratoplasty, cataract, and glaucoma surgery. CONCLUSIONS There are regional differences between DALK and PK utilization rates. In addition, DALK and PK complication rates in this nationally representative sample are low at 1 year and beyond, but further studies are needed to assess whether longer-term complications differ by procedure type.
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Zheng Q, Li S, Ren Y, Chen Y, Wang H, Zhao J, Chen J, Jhanji V, Chen W. Impact of cone base diameter on outcomes of deep anterior lamellar keratoplasty in keratoconus. Graefes Arch Clin Exp Ophthalmol 2022; 260:3303-3312. [PMID: 35522294 DOI: 10.1007/s00417-022-05658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in treating keratoconus in relation to cone base diameter (CBD). METHODS A retrospective study. Sixty-one eyes of 49 keratoconus patients who underwent DALK between 2009 and 2018 were enrolled. Preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent, and astigmatism were measured. Scheimpflug tomography (Pentacam) was used to measure the cone base area (CBA) and CBD using MATLAB software. RESULTS The mean age of the patients was 20.8 ± 6.1 years old, and the mean follow-up time was 27.3 ± 15.2 months. Mean UCVA improved from 1.23 ± 0.48 to 0.57 ± 0.27 (LogMAR, 95% CI [0.52, 0.80]; P < 0.001), whereas mean BCVA improved from 0.98 ± 0.55 to 0.18 ± 0.13 (95% CI [0.66, 0.94]; P < 0.001). The mean spherical equivalent decreased by 4.53 ± 5.65 D (95% CI [- 6.25, - 2.82]; P < 0.001), with little change in astigmatism (95% CI [- 1.39, 0.64]; P = 0.457). The postoperative BCVA in the patients with CBD < 5.07 mm and corneal curvature ≥ 55D was significantly better than those whose CBD ≥ 5.07 mm (0.14 ± 0.09 vs 0.25 ± 0.15, P = 0.001). The follow-up time was negatively correlated with the BCVA (P = 0.004). CONCLUSIONS In this study, outcomes of DALK in keratoconus were related to CBD and corneal curvature. Patients with large CBD (≥ 5.07 mm) where the corneal curvature ≥ 55D are more likely to have poor visual outcomes after DALK.
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Affiliation(s)
- Qinxiang Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Saiqing Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yueping Ren
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yunyun Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Haiou Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiawei Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiaojie Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Ophthalmology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
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Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye 2022; 45:101559. [PMID: 34991971 DOI: 10.1016/j.clae.2021.101559] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
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Affiliation(s)
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Asaki Suzaki
- Clinical Research and Development Center, Menicon Co., Ltd., Nagoya, Japan
| | - Cesar Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - James S Wolffsohn
- School of optometry, Health and Life Sciences, Aston University, Birmingham B4 7ET, United Kingdom
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Shams M, Sharifi A, Akbari Z, Maghsoudlou A, Reza Tajali M. Penetrating Keratoplasty versus Deep Anterior Lamellar Keratoplasty for Keratoconus: A Systematic Review and Meta-analysis. J Ophthalmic Vis Res 2022; 17:89-107. [PMID: 35194500 PMCID: PMC8850853 DOI: 10.18502/jovr.v17i1.10174] [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: 03/05/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Keratoconus is the most common form of primary corneal thinning. Different methods have been suggested to deal with the condition, including glasses, contact lenses, and surgical interventions, like penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK), well-known methods of the latter. This study was conducted to compare the outcomes and side effects of the two mentioned keratoplasty techniques. First, we systematically reviewed all original articles studies on PubMed, Scopus, Web of Science, and Embase. Then, the extracted data were pooled and meta-analyzed on each of the intended outcomes. A total of 30 studies were included in which PKP was more commonly performed compared to DALK. We found that adverse outcomes consisting of cataracts, graft rejection, graft failure, High-IOP, and corneal infection, were all more common findings in the PKP groups compared to the DALK groups. However, only for the high-IOP, cataracts, and graft rejection, the analysis of the extracted results demonstrated statistical significance. Overall, the DALK groups demonstrated significantly better results when considering the improvement levels by measuring the Endothelial Cell Count (ECC) and Spherical Equivalent (SE). In addition, though statistically insignificant, the Central Corneal Thickness(CCT), Best Corrected Visual Acuity(BCVA), Topographic Cylinder(TC), Refractive Cylinder values were greater in the PKP groups. Based on our study and with its limitations in mind, we can conclude that DALK can be a relatively safer and more effective procedure. Though, a larger number of high-standard randomized clinical trials still need to be conveyed for more definite conclusions.
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Affiliation(s)
- Majid Shams
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Akbari
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
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17
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The Association between Diabetes Mellitus and Keratoplasty in Poland in the Years 2013-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189767. [PMID: 34574703 PMCID: PMC8470624 DOI: 10.3390/ijerph18189767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study is to assess the incidence and characteristic of corneal grafts and its association with diabetes mellitus in Poland in the years 2013-2017. METHODS The retrospective survey of the National Database of Hospitalizations was performed to identify all the corneal transplantations in Poland between January 2013 and December 2017. The comorbid diseases, in particular diabetes mellitus, were verified in the patients' medical history. The logistic regression was applied to demonstrate the factors related to urgent surgeries. RESULTS In total, 5069 corneal grafts in 4710 patients were reported in the years 2013-2017. The number of CTs gradually increased by 37% from 914 (2.37 surgeries per one hundred thousand population) in the year 2013 to 1250 (3.25 surgeries per one hundred thousand population) in 2017, the final year of the study. CT incidence was the highest in subjects aged 70 years or older: 13.18 per one hundred thousand population in the year 2017. On average, about 22.43% of procedures were performed in patients with DM. The chance of urgent surgery was mostly correlated with full thickness CT and patients' age. CONCLUSIONS Despite the relatively low value of CT in Poland, there was an increasing number of CTs in the analyzed period.
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18
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AlAraj A, AlAmeer A, Al-Swailem S. Medium-Term Clinical Outcomes of Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty for Macular Corneal Dystrophy. Clin Ophthalmol 2021; 15:3139-3145. [PMID: 34326629 PMCID: PMC8315771 DOI: 10.2147/opth.s317971] [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: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the postoperative outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for macular corneal dystrophy (MCD). Design Single-center, retrospective, interventional case series. Methods A chart review was performed of 100 patients (157 eyes) who underwent primary DALK (DALK group) and PKP (PKP group) for histopathologically confirmed MCD for whom at least 12 months of follow-up were available. Between-group comparisons were performed of visual acuity (VA), graft survival, and postoperative complications. Results There were 22 eyes in the DALK group and 135 in the PKP group. Postoperative best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 90.9% of the DALK group and 76.3% of the PKP group (P=0.12). At last visit, graft survival was 95.5% (21 eyes) and 91.1% (123 eyes) in DALK and PKP groups, respectively (P=0.69, Log rank test). Corneal graft rejection episodes occurred in 1 (4.5%) DALK graft and 19 (14.1%) PKP grafts. Five of the 19 graft rejections in the PKP group were irreversible. Microbial keratitis and cataract occurred in 6 (4.5%) and 15 (11.1%) PKP eyes. One (4.5%) eye in the DALK group had cataract and none of the DALK cases developed microbial keratitis. Clinically significant recurrence was observed in 4 (2.9%) PKP eyes and 1 (4.5%) DALK eye (P=0.69), respectively. Conclusion DALK is a viable option for MCD without Descemet membrane involvement. DALK had comparable medium-term visual and survival outcomes to PKP. DALK has the advantage of lower open sky intraoperative complications and lower graft rejection episodes.
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Affiliation(s)
- Ahmad AlAraj
- Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.,Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Ahmad AlAmeer
- Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.,Ophthalmology Division, Surgery Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Samar Al-Swailem
- Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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Bagheri NM, Kadkhodaei M, Pirhadi S, Mosaddegh P. Effects of intracorneal ring segments implementation technique and design on corneal biomechanics and keratometry in a personalized computational analysis. Sci Rep 2021; 11:14433. [PMID: 34257343 PMCID: PMC8277910 DOI: 10.1038/s41598-021-93821-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/30/2021] [Indexed: 11/08/2022] Open
Abstract
The implementation of intracorneal ring segments (ICRS) is one of the successfully applied refractive operations for the treatment of keratoconus (kc) progression. The different selection of ICRS types along with the surgical implementation techniques can significantly affect surgical outcomes. Thus, this study aimed to investigate the influence of ICRS implementation techniques and design on the postoperative biomechanical state and keratometry results. The clinical data of three patients with different stages and patterns of keratoconus were assessed to develop a three-dimensional (3D) patient-specific finite-element model (FEM) of the keratoconic cornea. For each patient, the exact surgery procedure definitions were interpreted in the step-by-step FEM. Then, seven surgical scenarios, including different ICRS designs (complete and incomplete segment), with two surgical implementation methods (tunnel incision and lamellar pocket cut), were simulated. The pre- and postoperative predicted results of FEM were validated with the corresponding clinical data. For the pre- and postoperative results, the average error of 0.4% and 3.7% for the mean keratometry value ([Formula: see text]) were predicted. Furthermore, the difference in induced flattening effects was negligible for three ICRS types (KeraRing segment with arc-length of 355, 320, and two separate 160) of equal thickness. In contrast, the single and double progressive thickness of KeraRing 160 caused a significantly lower flattening effect compared to the same type with constant thickness. The observations indicated that the greater the segment thickness and arc-length, the lower the induced mean keratometry values. While the application of the tunnel incision method resulted in a lower [Formula: see text] value for moderate and advanced KC, the induced maximum Von Mises stress on the postoperative cornea exceeded the induced maximum stress on the cornea more than two to five times compared to the pocket incision and the preoperative state of the cornea. In particular, an asymmetric regional Von Mises stress on the corneal surface was generated with a progressive ICRS thickness. These findings could be an early biomechanical sign for a later corneal instability and ICRS migration. The developed methodology provided a platform to personalize ICRS refractive surgery with regard to the patient's keratoconus stage in order to facilitate the efficiency and biomechanical stability of the surgery.
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Affiliation(s)
- Niksa Mohammadi Bagheri
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Mahmoud Kadkhodaei
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Shiva Pirhadi
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, 14778-93855, Iran
| | - Peiman Mosaddegh
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
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Amar SP, Sinha R, Kalra N, Agarwal T, Sharma N, Titiyal JS. Demographic and clinical profile, surgical outcome, and quality of life in patients who underwent bilateral lamellar corneal grafts. Indian J Ophthalmol 2021; 69:1747-1752. [PMID: 34146020 PMCID: PMC8374770 DOI: 10.4103/ijo.ijo_3194_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: Lamellar corneal grafts have revolutionized the management of corneal blindness by replacing only the disease specific corneal layers. To the best of our knowledge, there is no study in literature describing the outcomes of bilateral lamellar keratoplasty in the Indian population. The aim of this work was to study the demographic profile, surgical outcomes, and quality of life in patients who underwent bilateral lamellar keratoplasty and to assess the correlation between these three. Methods: An observational cross-sectional study was conducted on 47 patients who underwent bilateral deep anterior lamellar keratoplasty (DALK) (n = 31) or descemet stripping automated endothelial keratoplasty (DSAEK) (n = 16) with a minimum follow-up of 6 months after the second surgery. Demographic parameters were collected by interview, surgical outcomes by clinical examination, and quality of life by a questionnaire. Results: A total of 47 patients were evaluated, women 42.56%, (n = 20) and men 57.44% (n = 27) with 38.3% being in 18–30 years age group and 23.4% above 60 years; 17.02% patients had a good socioeconomic status (score >60) and 61.70% had poorer socioeconomic status (score <50). Quality of life score (VR-QoL) was ≥50 in 82.9% patients and ≥70 in 14.89%. No significant association existed between VR-QoL scores and demographic factors. However, statistically significant association existed between VR-QoL and age of patient (P < 0.05), postoperative vision (P ≤ 0.05), and contrast sensitivity (P ≤ 0.01). Conclusion: Bilateral lamellar corneal grafts provide satisfactory visual outcomes compatible with day-to-day functioning. VR-QoL has a direct correlation to the age, visual acuity, contrast sensitivity, and inverse correlation with lenticule thickness in DSAEK and residual bed thickness in DALK.
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Affiliation(s)
- Sreelakshmi P Amar
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Kalra
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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21
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Chen X, Li X, Zhang X, Guo X, Qi X, Li S, Shi W, Gao H. Comparison of complications and visual outcomes between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for fungal keratitis. Clin Exp Ophthalmol 2021; 49:550-559. [PMID: 34032343 DOI: 10.1111/ceo.13951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/01/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To compare the postoperative complications and visual outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PK) for fungal keratitis (FK). METHODS This retrospective study included 94 cases of BB-DALK for FK and 161 cases of PK for FK from a tertiary ophthalmology care centre. RESULTS The most common FK pathogens were Fusarium (n = 84, 32.9%) and Aspergillus (n = 67, 26.3%). The recurrence rates after BB-DALK and PK were 3.2 and 5%, respectively (p = 0.723). The follow-up duration was 31.9 ± 15.8 months in the BB-DALK group and 33.9 ± 15.0 months in the PK group. The immune rejection rate was significantly lower in the BB-DALK group than in the PK group (1.1 vs. 18.6%, p < 0.001), as was the incidence of secondary glaucoma (p = 0.018). Endothelial cell density in the BB-DALK group tended to be stable at postoperative month 6, whereas the PK group still attenuated at a hyper-physiological rate. Postoperative best-corrected visual acuity (BCVA) significantly improved in both groups (p < 0.001). No significant difference between-group was observed in BCVA, refractive cylinder, and spherical equivalent postoperatively. CONCLUSION Big-bubble DALK is a useful and safe alternative to PK for medically uncontrolled FK.
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Affiliation(s)
- Xiunian Chen
- Medical College of Qingdao University, Qingdao, China.,Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
| | - Xiaofeng Li
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaoyu Zhang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaoting Guo
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
| | - Xiaolin Qi
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Suxia Li
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Weiyun Shi
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Hua Gao
- Medical College of Qingdao University, Qingdao, China.,Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
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Aytekin E, Pehlivan SB. Corneal cross-linking approaches on keratoconus treatment. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mudgil T, Fernandes M. Anterior Segment Ischemia After Peripheral Annular Lamellar Sclerokeratoplasty for Advanced Terrien Marginal Degeneration. Eye Contact Lens 2021; 47:378-380. [PMID: 33399413 DOI: 10.1097/icl.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT A man with 360° bilateral peripheral thinning, peripheral vascularization, and lipid deposition diagnosed with Terrien marginal degeneration, underwent a 360° peripheral annular lamellar sclerokeratoplasty (PALK) (tuck-in) in the right eye for 90% peripheral thinning and high astigmatism. One-week postoperatively, a sudden drop in vision to counting fingers 1 m from 20/50 with circumciliary congestion, diffuse corneal edema, intense anterior chamber inflammation, keratic precipitates with fixed dilated pupil, and hypotony led to a diagnosis of suspected anterior segment ischemia. Anterior segment fluorescein angiography was suggestive of ischemia. After intensive topical and systemic steroids tapered over 6 months, his symptoms and signs improved. At the last follow-up 4 years later, his best contact lens-corrected visual acuity was 20/30. Anterior segment ischemia has not been reported after a PALK for advanced corneal ectatic disorders. Prompt diagnosis and commencement of intensive steroids was helpful in reversing this condition.
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Affiliation(s)
- Tanvi Mudgil
- Cornea and Anterior Segment Service, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
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Feizi S, Javadi MA, Moshtaghion SM, Abolhosseini M. Comparison of penetrating keratoplasty and deep anterior lamellar keratoplasty in keratoconus eyes with vernal keratoconjunctivitis. Ther Adv Ophthalmol 2021; 13:25158414211010551. [PMID: 33997608 PMCID: PMC8111270 DOI: 10.1177/25158414211010551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/25/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose of the study is to compare outcomes after penetrating keratoplasty (PK) against deep anterior lamellar keratoplasty (DALK) for keratoconus in patients with vernal keratoconjunctivitis (VKC). Methods: Keratoconic patients with VKC who received PK (n = 55, group 1) or DALK (n = 62, group 2) were retrospectively enrolled. The Student’s t test, Mann–Whitney test, Fisher’s exact test, chi-square test, and Kaplan–Meier survival curve were used to compare outcomes between the groups. Results: The follow-up period was 59.4 ± 44.1 and 62.4 ± 38.9 months in groups 1 and 2, respectively (p = 0.70). Postoperative best spectacle-corrected visual acuity was 0.24 ± 0.18 and 0.29 ± 0.19 logMAR, respectively (p = 0.13). Graft rejection occurred in 34.6% and 25.8% of eyes in groups 1 and 2, respectively (p = 0.30). Groups 1 and 2 were comparable in the rates of cataract (3.6% and 12.9%, respectively, p = 0.07) and high intraocular pressure (3.6% and 8.1%, respectively, p = 0.31). Compared with the eyes with inactive VKC, PK eyes that experienced postoperative disease reactivation had a higher rate of suture abscesses (10.9% versus 50.0%, respectively, p = 0.01) and suture-tract vascularization (6.5% versus 33.3%, respectively, p = 0.03). Similarly, disease reactivation significantly increased suture abscesses from 27.3% to 51.7% (p = 0.03) and suture-tract vascularization from 18.2% to 49.6% (p = 0.005) in the DALK group. The graft survival rates were 95.3% in group 1 and 87.9% in group 2 at the 4-year follow-up, with mean durations of 14.4 and 11.1 months, respectively (p = 0.20). Conclusion: The results indicate no difference in outcomes between PK and DALK for keratoconus in patients with VKC. Postoperative VKC reactivation increased the rate of suture-related problems after both techniques of keratoplasty.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 Street, Pasdaran Avenue, Tehran 16666, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Mohamadmehdi Moshtaghion
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abolhosseini
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Arundhati A, Chew MC, Lim L, Mehta JS, Lang SS, Htoon HM, Tan DT. Comparative Study of Long-term Graft Survival Between Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty. Am J Ophthalmol 2021; 224:207-216. [PMID: 33253665 DOI: 10.1016/j.ajo.2020.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/08/2020] [Accepted: 11/13/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Endothelial failure and immunological graft rejection remain long-term complications leading to late graft failure in penetrating keratoplasty (PK). Deep anterior lamellar keratoplasty (DALK) has emerged as a viable alternative that enables preservation of the host's endothelial cells to eliminate risks of endothelial rejection and failure. The aim of this study was to compare long-term graft survival between PK and DALK. DESIGN Retrospective clinical cohort study. METHODS All consecutive primary grafts of DALKs (n = 362) and PKs (n = 307) performed for optical indications in a tertiary eye center from the ongoing, prospective Singapore Corneal Transplant Study. Ten-year graft survival outcomes were compared. Cases in which endothelial pathologies were diagnosed were excluded, as DALK was not performed for such cases. Main outcome measurements were mean graft survival rate. RESULTS The survival rate for PK was 94.4%, 80.4%, and 72.0% at 1, 5, and 10 years, respectively; and 95.8%, 93.9%, and 93.9% at 1, 5, and 10 years, respectively, for DALK (P = .001). Patients who underwent PK developed more complications of glaucoma (29.3% vs. 11.6%, respectively; P < .001), allograft rejection (16.6% vs. 1.7%, respectively; P < .001), epithelial problems (10.4% vs. 5.5%, respectively; P = .018), and nonimmunological failure (7.8% vs. 1.9%, respectively; P < .001), compared to DALK. Rates of graft failure attributable to rejection (36.7% vs. 5.9%, respectively; P = .015) and endothelial failure (36.7% vs. 5.9%, respectively; P = .015) were lower in DALK. CONCLUSIONS The 10-year graft survival for primary DALK was superior to that for PK for corneal pathologies with functional endothelium. Primary DALK resulted in fewer post-operative complications and lower rates of graft rejection and failure. This study strengthens the case in favor of performing DALK over PK when possible.
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Affiliation(s)
- Anshu Arundhati
- Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore
| | | | - Li Lim
- Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir Singh Mehta
- Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Donald T Tan
- Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore.
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Abdelaal AM, Alqassimi AH, Malak M, Hijazi HT, Hadrawi M, Khan MA. Indications of Keratoplasty and Outcomes of Deep Anterior Lamellar Keratoplasty Compared to Penetrating Keratoplasty. Cureus 2021; 13:e13825. [PMID: 33859889 PMCID: PMC8040744 DOI: 10.7759/cureus.13825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Corneal diseases are a significant cause of visual impairment and blindness. Despite the treatable nature of many corneal diseases before visual demise, many cases of advanced disease necessitating keratoplasty for visual rehabilitation are encountered. A mismatch between the number of corneal donors and potential recipients also exists worldwide, with underutilization of certain types of keratoplasty techniques that may allow more efficient use of this limited resource. Methodology A retrospective cohort study of all cases of optical corneal transplantations performed from January 1, 2015 to October 31, 2020 was performed. Indications for keratoplasty, type of keratoplasty, complications, intraocular pressure elevation, and best corrected visual acuity (BCVA) by category and range at different time intervals were collected and analyzed. Findings were compared between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) for all indications, specifically for keratoconus (KCN). Results A total of 58 corneal transplants meeting our criteria were performed during the study period. PK was performed for 29 eyes, DALK for 28 eyes, and endothelial keratoplasty for one eye. The most frequently encountered indication was KCN (62.1%). The number of eyes with BCVA of 20/100 or better increased from preoperative BCVA, 37/58 eyes had BCVA worse than 20/100 before keratoplasty (63.8%), while at the time of last follow-up 45/58 eyes had BCVA of 20/100 or better (77.6%). At the time of last follow-up 16/58 had BCVA in the range of 20/20 to 20/40 (27.6%) and 29/58 eyes had BCVA in the range of 20/50 to 20/100 (50%). Comparison of all cases of PK to DALK for all indications showed significantly better BCVA by category at one year, at last follow-up, and BCVA range at last follow-up (p = 0.032, 0.001, and 0.014, respectively). Although better visual acuity results by category and range at one year and last follow-up, respectively, were observed in more patients undergoing DALK than PK, for KCN the results were not statistically significant (p = 1.00, 1.00, 0.417, and 0.374, respectively). Overall, 70% of recorded complications, intraocular pressure (IOP) elevations, and graft rejections were seen in eyes that underwent PK; however, these findings were not statistically significant (p = 0.297). Graft failures occurred more frequently with PK than deep anterior keratoplasty when analyzed for all indications of keratoplasty (p = 0.010). Conclusions Despite advancement and improvements in surgical techniques, statistics continue to show underutilization of the invaluable resource of donor corneas, with PK still being performed more than DALK for diseases that do not affect the endothelium. Our study found superior visual acuity outcomes of DALK as well as the advantages of less frequent complications, IOP elevations, graft rejections, and graft failures. We encourage ophthalmologists to utilize DALK in appropriate candidates to more fully utilize the scarce and potentially vision-restoring resource of donor corneal tissue.
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Affiliation(s)
- Ahmed M Abdelaal
- Surgery/Ophthalmology, King Saud Bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Jeddah, SAU.,College of Medicine, Alfaisal University, Riyadh, SAU
| | - Albaraa H Alqassimi
- Department of Ophthalmology/Cornea and Anterior Segment Consultant, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Mohammad Malak
- Department of Ophthalmology/Cornea and Anterior Segment Consultant, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Hassan T Hijazi
- Department of Ophthalmology/Ophthalmologist, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Manal Hadrawi
- Department of Ophthalmology/Pediatric Ophthalmology and Strabismology Consultant, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Muhammad A Khan
- Medical Education, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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McLintock CA, McKelvie J, Miraflores Gomez S, Gatzioufas Z, Elalfy M, Hamada S. Outcomes of sequential intracorneal ring segment and phakic intraocular lens insertion for visual rehabilitation in keratoconus. Eur J Ophthalmol 2020; 31:2219-2226. [PMID: 33135490 DOI: 10.1177/1120672120969600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the visual and refractive outcomes of sequential intracorneal ring segment (ICRS) and toric phakic intraocular lens (IOL) insertion for visual rehabilitation in keratoconus. METHODS A retrospective interventional cohort study was performed through the Corneoplastics unit and Eye Bank, Queen Victoria Hospital, East Grinstead, United Kingdom. RESULTS 14 eyes of 12 patients had sequential ICRS and phakic IOL implantation for visual rehabilitation of keratoconus between June 2014 and February 2018. After at least 6 months follow-up, the number of eyes with an uncorrected distance visual acuity (UDVA) of 20/40 UDVA or better increased from zero (0%) to 10 (71%). 12 (85.7%) eyes achieved a post-operative UDVA equal to or better than the pre-operative corrected distance visual acuity (CDVA). The number percentage of eyes with a CDVA of 20/40 or better increased from 3 (31%) to 14 (100%). The mean final spherical equivalent improved from -4.07 to -0.17 (p ⩽ 0.001). The mean refractive astigmatism magnitude improved from 4.76D to 1.23D (p = 0.002). Seven (50%) eyes had 1.0D or less of refractive astigmatism post-operatively. CONCLUSION In this cohort of eyes with keratoconus, sequential ICRS and phakic IOL implantation resulted in excellent visual and refractive outcomes after at least 6 months.
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Affiliation(s)
- Cameron A McLintock
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - James McKelvie
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Zisis Gatzioufas
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Department of Ophthalmology, University Hospital Basel, Basel, BS, Switzerland
| | - Mohamed Elalfy
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Cornea Unit, The Research Institute of Ophthalmology, Giza, Egypt
| | - Samer Hamada
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK
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Sheludchenko VM, Voronin GV, Osipyan GA, Djalili RA. [Methods of surgical treatment of keratectasia and analysis of postsurgical quality of vision]. Vestn Oftalmol 2020; 136:308-316. [PMID: 33063982 DOI: 10.17116/oftalma2020136052308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Keratectasias are non-inflammatory dystrophic diseases of the cornea characterized by progressive bilateral thinning of the cornea that lead to deterioration in the quantitative and qualitative characteristics of vision reducing patient's quality of life. The changes can be asymmetrical and destructive. A number of surgeries have been proposed to reduce the negative effects of keratectasia including penetrating keratoplasty and its modifications, implantation of corneal ring segments, corneal cross-linking - alone and in combination with other methods, intrastromal keratoplasty. These methods can improve visual acuity to a certain degree and help slow the progression of keratectasia. This article studies various surgical methods used for treating keratectasia and analyses possible assessment of the quality of vision before and after the treatment.
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Affiliation(s)
| | - G V Voronin
- Research Institute of Eye Diseases, Moscow, Russia
| | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | - R A Djalili
- Research Institute of Eye Diseases, Moscow, Russia
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Preliminary Results of a Novel Standardized Technique of Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus. J Ophthalmol 2020; 2020:5496162. [PMID: 32963820 PMCID: PMC7491466 DOI: 10.1155/2020/5496162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the feasibility and the initial outcomes of a novel standardized surgical technique of femtosecond laser- (FSL-) assisted big-bubble deep anterior lamellar keratoplasty (BBDALK) for eyes with keratoconus. Methods This prospective interventional case series included 11 consecutive FSL-assisted BBDALK procedures performed for the eyes with keratoconus from September 2019 to December 2019. The FSL was used to create (i) an intrastromal channel incision (1.7 mm in length, 4.6 mm in width, 80% depth, and cut energy of 1.70 μJ) and (ii) a 9.0 mm diameter circular lamellar side cut 65 μm above the endothelium (cut energy of 0.90 μJ) intersecting the intrastromal incision. In the operating room, a blunt dissector was used to open the intrastromal channel incision, through which a blunt spatula was inserted, tangentially advanced towards the center of the cornea, and replaced with a blunt cannula for pneumatic dissection. The subsequent surgical steps did not differ from the conventional technique. Main outcome measures were the success rate of pneumatic dissection and the percentage of intraoperative complications. Results Eleven eyes of 11 patients (6 males and 5 females; mean age: 34.54 ± 13.23 years) underwent FSL-assisted DALK. Using the FSL, both corneal incisions (lamellar side cut and intrastromal channel incision) were successfully created in all cases without the need for repeat docking or additional dissection. Pneumatic dissection with type 1 bubble formation succeeded in all 11 eyes (100%). DALK surgery was completed uneventfully in all cases. Descemet membrane perforation did not occur in any case, and no procedure was converted to penetrating keratoplasty. Conclusion Using standardized FSL parameters for both incision design and cut energy in BBDALK surgery, pneumatic dissection can be achieved in a very high rate of cases with minimal risk of intraoperative complications.
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Complications of accelerated corneal collagen cross-linking: review of 2025 eyes. Int Ophthalmol 2020; 40:3269-3277. [PMID: 32715365 DOI: 10.1007/s10792-020-01512-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the early- and late-stage complications of accelerated cross-linking (A-CXL) in a large case series and investigate the relationship of A-CXL complications with ocular and systemic conditions accompanying keratoconus. METHODS Retrospectively, records of 2025 eyes of 1184 patients diagnosed with keratoconus between March 2013 and 2020 who underwent A-CXL (18 mW/cm2 for 5 min) treatment were reviewed. Comorbid ocular and systemic diseases other than keratoconus were recorded. In the postoperative follow-up, early and late complications and their association with accompanying diseases were examined. RESULTS The mean age of patients was 26.16 ± 6.05 (range 18-42), and the mean follow-up time was 3.40 ± 1.63 years (range 1-8 years). Vernal keratoconjunctivitis (3.7%) was the most common disease accompanying keratoconus. Less frequently, systemic allergic diseases (2.9%) and Down syndrome (2.3%) were observed. The most common complication in the early postoperative period was haze formation (9.1%), while failure of the treatment (4.2%) occurred in the late period. Other common complications were loss of two or more Snellen lines (2.4%) and delayed epithelial healing (1.8%). There was a significant relationship between vernal keratoconjunctivitis and delayed epithelial healing (p = 0.011). Statistically significant relationships were found between Down syndrome and haze formation (p < 0.001) and sterile infiltrate formation (p = 0.041). CONCLUSION Although A-CXL complication rates are low, vernal keratoconjunctivitis following A-CXL might increase the risk of delayed epithelial healing, and similarly corneal haze and sterile infiltrates might be observed more frequently in patients with Down syndrome.
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Feizi S, Azari AA. Appropriate stage of Descemet membrane removal during donor preparation in deep anterior lamellar keratoplasty. Int Ophthalmol 2020; 40:1825-1830. [PMID: 32246302 DOI: 10.1007/s10792-020-01352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the appropriate surgical stage for Descemet membrane (DM) removal during donor preparation in deep anterior lamellar keratoplasty (DALK). METHODS This study included 83 corneoscleral buttons that were used for DALK. The donor DM was removed randomly either before (group 1; 43 eyes) or after (group 2; 40 eyes) trephination. The time required for DM removal was recorded, and the geometric properties of cut buttons were evaluated after trephination. The intraoperative video recordings were reviewed to determine if the dissections were performed at the stroma-DM plane as it was intended. The time needed to remove the DM, the rate of correct dissection at the intended stroma-DM plane, and the roundness and precision of the donor cuts were compared between the groups. RESULTS The two groups were comparable in donor characteristics, including age, quality of the tissue, and trephination size. Time spent to remove DM was significantly shorter in group 1 (68.9 ± 48.2 s) than group 2 (117.7 ± 52.7 s, P = 0.001). DM stripping was performed incorrectly in 2 corneas (4.7%) in group 1 and in 12 corneas (30%) in group 2 (P = 0.01). No difference was found between the groups in the roundness and precision of donor button cuts. CONCLUSIONS DM removal before trephination did not detrimentally affect the geometric properties of punched donor tissues. When DM stripping was performed before trephination, the donor tissue was less traumatized and posterior graft surface was more likely to be regular; therefore, it is advisable to remove DM before trephination during donor preparation for DALK.
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Affiliation(s)
- Sepehr Feizi
- Department of Ophthalmology, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St., Pasdaran Ave., Tehran, 16666, Iran.
| | - Amir A Azari
- Department of Ophthalmology, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St., Pasdaran Ave., Tehran, 16666, Iran
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Clinical Properties and Risk Factors for Descemet Membrane Folds After Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus. Cornea 2019; 38:1222-1227. [PMID: 31369462 DOI: 10.1097/ico.0000000000002075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical properties and risk factors for corneal Descemet membrane (DM) folds after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. METHODS This is a retrospective case-control study. Study participants-experimental group: 44 eyes with DM folds after DALK; control group: 135 eyes without DM folds after DALK. RESULTS Forty eyes with DM folds were displayed as 1 or 2 translucent lines in the DM layer. Three eyes appeared as several arcuate shape lines, and 1 eye presented as a radial shape. DM folds impaired corrected visual acuity after DALK (P = 0.018). Age older than 20.5 years at surgery and disease duration longer than 5.5 years were independent risk factors for DM fold formation after DALK surgery (odds ratio 5.39, 95% confidence interval: 2.11-13.73, P < 0.001; 6.60, 95% confidence interval: 2.92-14.94, P < 0.001). Preoperative Kmean, Kmax, central corneal thickness, anterior chamber depth, sex, history of rigid gas permeable contact lens wearing, Vogt striae, stromal scar, and intraoperative microperforation had no influence on the occurrence of DM folds (P1 = 0.775, P2 = 0.896, P3 = 0.555, P4 = 0.182, P5 = 0.656, P6 = 0.237, P7 = 1.000, P8 = 0.587, and P9 = 0.798). CONCLUSIONS DM folds impaired postoperative corrected visual acuity. The risk factors for DM folds included age older than 20.5 years and disease duration longer than 5.5 years.
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Nasr Hashem A, Tolees SS, Samir A. Novel Technique For The Management Of Macroperforation During Deep Anterior Lamellar Keratoplasty. Clin Ophthalmol 2019; 13:2075-2080. [PMID: 31695320 PMCID: PMC6815759 DOI: 10.2147/opth.s229249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/08/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the outcomes of a case series of patients who underwent a novel technique for managing macroperforation during deep anterior lamellar keratoplasty (DALK). Methods Nine eyes of 9 patients with advanced keratoconus who underwent DALK comprised the case series. A macroperforation occurred in all eyes during DALK. The stromal patch suturing technique was used to manage all cases; a large piece of the previously excised stromal tissue was sutured to the edge of the trephine to seal the perforation. The technical aspects of the procedure are described and data are presented on the visual outcomes, endothelial microscopy, and postoperative complications at last postoperative visit (average 18 months; range, 7 to 23 months). Results All 9 cases were managed successfully with the stromal patch suturing technique. Postoperatively, the graft was clear in all cases. At day 1, seven eyes had a Descemet’s membrane detachment, 3 of these eyes resolved spontaneously within 2 weeks and 4 required air bubble injection for successful reattachment. At last follow up seven eyes had a corrected distance visual acuity of 20/30 or better and 2 eyes had 20/40 vision. The average endothelial cell count was 2162 cell/mm2. There were no cases with excessive inflammation or vascularisation during the postoperative follow-up. Conclusion The stromal patch suturing technique was successfully used to manage intraoperative macroperforation during DALK. This technique resulted in endothelial changes that were consistent with uncomplicated DALK and function visual acuity of 20/40 or better in all cases with no postoperative sequelae.
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Affiliation(s)
| | | | - Ahmed Samir
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
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D’Oria F, Galeone A, Pastore V, Cardascia N, Alessio G. Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty: A case report and review of the literature. Medicine (Baltimore) 2019; 98:e17140. [PMID: 31517855 PMCID: PMC6750735 DOI: 10.1097/md.0000000000017140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Interface keratitis after lamellar keratoplasty is one of the causes of graft failure. We report the first case of microbiologically proven Enterococcus faecium infection following deep anterior lamellar keratoplasty (DALK) and review the available literature. PATIENT CONCERNS A 37-years-old Caucasian man presented with pain, redness and severe vision loss in his right eye. Five weeks before, he underwent DALK using the FEMTO LDV Z8 in the same eye for the surgical correction of keratoconus. DIAGNOSES Upon presentation, slit-lamp biomiscroscopy revealed corneal graft edema with multiple infiltrates located in the graft-host interface. INTERVENTIONS Therapeutic penetrating keratoplasty (PKP) was carried out in addition with cultures of the donor lenticule removal. Laboratory results isolated a multi-resistant Enterococcus faecium interface infection. According to the antibiogram, the patient was treated with systemic Tigecycline and Linezolid for 7 days. OUTCOMES During the following weeks, clinical features improved over time and no signs of active infection were visible seven months postoperatively. LESSONS Early PKP showed to be a good therapeutic option with great anatomic and functional outcomes.
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Coelho RP, Messias A. Phacoemulsification with big-bubble deep anterior lamellar keratoplasty: Variant of the triple procedure. J Cataract Refract Surg 2019; 45:1064-1066. [DOI: 10.1016/j.jcrs.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
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Abstract
Corneal blindness is one of the major causes of reversible blindness, which can be managed with transplantation of a healthy donor cornea. It is the most successful organ transplantation in the human body as cornea is devoid of vasculature, minimizing the risk of graft rejection. The first successful transplant was performed by Zirm, and since then, corneal transplantation has seen significant evolution. It has been possible because of the relentless efforts by researchers and the increase in knowledge about corneal anatomy, improvement in instruments and advancements in technology. Keratoplasty has come a long way since the initial surgeries wherein the whole cornea was replaced to the present day where only the selective diseased layer can be replaced. These newer procedures maintain structural integrity and avoid catastrophic complications associated with open globe surgery. Corneal transplantation procedures are broadly classified as full-thickness penetrating keratoplasty and partial lamellar corneal surgeries which include anterior lamellar keratoplasty [sperficial anterior lamellar keratoplasty (SALK), automated lamellar therapeutic keratoplasty (ALTK) and deep anterior lamellar keratoplasty (DALK)] and posterior lamellar keratoplasty [Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)] broadly.
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Affiliation(s)
- Rashmi Singh
- Cornea, Cataract & Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea, Cataract & Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - M. Vanathi
- Cornea, Cataract & Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Cornea, Cataract & Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Alharbi SS, Alameer A. Use of Fibrin Glue in the Management of Descemet Membrane Perforation during Deep Anterior Lamellar Keratoplasty. Middle East Afr J Ophthalmol 2019; 26:168-171. [PMID: 31619906 PMCID: PMC6788313 DOI: 10.4103/meajo.meajo_97_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/28/2019] [Accepted: 09/15/2019] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To describe the use of fibrin glue to seal Descemet membrane (DM) microperforation and macroperforation during deep anterior lamellar keratoplasty (DALK). METHODS A retrospective chart review was performed on patients who had DM perforation managed by fibrin glue during DALK at King Khaled Eye Specialist Hospital (KKESH) between June 2014 and February 2019. RESULTS One thousand two hundred and eighty-eight DALK surgeries were performed at KKESH during the study period. Fibrin glue was used to seal DM perforations in four cases of DALK for keratoconus. CONCLUSION Fibrin glue is an effective method to seal DM microperforations and macroperforations during DALK, which reduces the rate of conversion to penetrating keratoplasty (PK), preserving the advantage of DALK over PK.
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Affiliation(s)
- Saad S. Alharbi
- Department of Ophthalmology, Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ahmad Alameer
- Division of Ophthalmology, Department of Surgery, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
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Rafati S, Hashemi H, Nabovati P, Doostdar A, Yekta A, Aghamirsalim M, Khabazkhoob M. Demographic profile, clinical, and topographic characteristics of keratoconus patients attending at a tertiary eye center. J Curr Ophthalmol 2019; 31:268-274. [PMID: 31528760 PMCID: PMC6742613 DOI: 10.1016/j.joco.2019.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose To evaluate the demographic profile, clinical, and topographic characteristics of keratoconus (KCN) patients attending at a subspecialty eye hospital in Tehran, Iran. Methods In this cross-sectional study, all patients who attended Noor Eye Hospital between March 2011 and March 2017 and had a diagnosis of KCN were identified, and the required number of patients was randomly selected. The following data were extracted from patient's records: age, sex, visual acuity, refraction, keratometry, pachymetry, and treatment procedures. The data of KCN laterality, severity, morphology, and cone location were also extracted by analyzing the corneal imaging maps. Results The records of 1080 eyes of 540 patients were evaluated. The mean age of the participants was 31.04 ± 8.54 years (range, 13–63 years), and 69.3% of the patients were male. The highest and lowest frequency of KCN was seen in the age group 20–30 years and above 50 years, respectively. Bilateral KCN was detected in 93.3% [95% confidence interval (CI): 91.68–94.75] of the subjects. 43.7% (95%CI: 32.88–54.48), 55.6% (95%CI: 44.73–66.38), and 0.8% (95%CI: 0.75–0.78) of the cases had nipple, oval, and globus cones, respectively. The cone was central in 52.1% (95%CI: 41.10–63.11), paracentral in 43.6% (95%CI: 36.13–51.04), and peripheral in 4.3% (95%CI: 00.76–7.86) of the cases. The frequency percentage of KCN according to severity was 15.2% (95%CI: 13.09–17.46), 56.4% (95%CI: 53.37–59.37), and 28.4% (95%CI: 25.75–31.21) for mild, moderate, and severe KCN, respectively. Among different parameters, only cone location had a significant association with age as the frequency of paracentral and peripheral cones increased with ageing (P = 0.002). Conclusions The mean age of KCN patients in our study was higher than similar studies in other Asian countries. KCN was bilateral in most cases with an oval morphology and central cone location. Most of the patients had moderate to severe KCN.
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Affiliation(s)
- Shokoofeh Rafati
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Asgar Doostdar
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbasali Yekta
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rafati-Rahimzadeh M, Rafati-Rahimzadeh M, Kazemi S, Moghadamnia AA. Therapeutic options to treat mustard gas poisoning - Review. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:241-264. [PMID: 31558985 PMCID: PMC6729161 DOI: 10.22088/cjim.10.3.241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 11/14/2022]
Abstract
Among the blistering (vesicant) chemical warfare agents (CWA), sulfur mustard is the most important since it is known as the "King of chemical warfare agents". The use of sulfur mustard has caused serious damages in several organs, especially the eyes, skin, respiratory, central and peripheral nervous systems after short and long term exposure, incapacitating and even killing people and troops. In this review, chemical properties, mechanism of actions and their effects on each organ, clinical manifestations, diagnostic evaluation of the actions triage, and treatment of injuries have been described.
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Affiliation(s)
- Mehrdad Rafati-Rahimzadeh
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Akbar Moghadamnia
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Prediction of Descemet Membrane Perforation During Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus With Stromal Scar. Eye Contact Lens 2018; 44 Suppl 2:S176-S179. [PMID: 29023312 DOI: 10.1097/icl.0000000000000434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To report big-bubble deep anterior lamellar keratoplasty (DALK) in patients with keratoconus with corneal stromal scar, and to investigate factors that can influence intraoperative Descemet membrane (DM) perforation. METHODS A retrospective study included patients with keratoconus with central stromal scar that underwent DALK using the big-bubble technique. Best spectacle-corrected visual acuity (BSCVA), keratometry, minimum corneal thickness (MCT), stromal scar depth, and endothelial cell density (ECD) were recorded. Receiver operating characteristic (ROC) curves were analyzed to predict an intraoperative perforation related to stromal scar. RESULTS Thirty-eight eyes of 38 patients with keratoconus (mean age: 30.0±9.2 years) were included in this study. Thirty-four eyes had successful DALK; in four eyes, the procedure was converted to penetrating keratoplasty because of DM macroperforations. Successful big-bubble formation was achieved in 24 of 38 (63.2%) eyes, whereas in 10 eyes, manual dissection was used to complete the DALK. Mean preoperative and postoperative second year BSCVA were 1.3 (±0.4) and 0.5 (±0.2) logarithm of the minimum angle of resolution (P<0.001), keratometry values were 65.5±7.4 and 42.8±7.8 diopters (P<0.001), and ECD were 2,740±359 and 2,279±452 cells/mm (P<0.001), respectively. Using ROC analysis, the area under curve value to predict DM perforation was found to be 0.792 (scar/MCT ratio, P=0.04) and the best cutoff point for scar depth/MCT ratio was 53%. CONCLUSION Big-bubble DALK is effective in patients with keratoconus with stromal scars. Scar depth/MCT ratio seems to predict the DM perforation.
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Evaluation of Big Bubble Technique for Deep Anterior Lamellar Keratoplasty in Patients With Radial Keratotomy. Cornea 2018; 38:194-197. [PMID: 30431472 DOI: 10.1097/ico.0000000000001811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the outcome of deep anterior lamellar keratoplasty (DALK) and success rates of the big-bubble (BB) technique or manual dissection after a failed use of the BB technique in eyes that underwent prior radial keratotomy (RK). METHODS A retrospective chart review of patients who underwent DALK after RK at Toronto Western Hospital, Canada, between 1999 and 2017 was performed. Demographic characteristics, success rates of the BB technique and manual dissection, intraoperative and postoperative complications, and best spectacle-corrected visual acuity before and after corneal transplant were analyzed. RESULTS Ten eyes of 9 patients were included in the analysis. The average age was 64 ± 10 years (range 49-82). The average time between the RK surgery and the corneal transplant was 20 ± 5 years (range 8-24). Indications for corneal transplant were significant irregular astigmatism in 5 eyes (50%), central scarring or haze in 4 eyes (40%), and progressive hyperopia with visual fluctuation in one eye (10%). BB was successfully achieved in one eye (10%). In 6 eyes (60%), manual dissection was performed, and in 3 eyes (30%), DALK surgery was converted to penetrating keratoplasty. The average best spectacle-corrected visual acuity on the last follow-up visit was 0.26 ± 0.08 logMAR (Snellen equivalent 20/36). One eye that underwent manual DALK and one eye that underwent penetrating keratoplasty developed a rejection episode 4 and 2 months after keratoplasty, respectively. In both cases, rejection resolved with topical steroids. CONCLUSIONS In eyes that underwent prior RK, DALK by manual dissection should be considered as a preferable surgical technique.
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Impact of Corneal Higher-Order Aberrations on Visual Acuity After Deep Anterior Lamellar Keratoplasty in Treating Keratoconus. Eye Contact Lens 2018; 45:238-245. [PMID: 30362972 DOI: 10.1097/icl.0000000000000561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the incidence of the Descemet membrane (DM) folds after deep anterior lamellar keratoplasty (DALK) in treating keratoconus. We also evaluated the influence of DM folds and corneal higher-order aberrations (HOAs) on visual acuity after DALK. METHODS This retrospective study included 89 consecutive eyes of 87 patients who underwent DALK for the treatment of keratoconus at Tokyo Dental College Ichikawa General Hospital from April 2002 to June 2017. The presence or absence of DM folds was determined by slitlamp microscopy. Visual acuity after DALK was compared between the eyes with and without DM folds. Corneal HOAs of the anterior and posterior surfaces and the total cornea were measured by anterior segment optical coherence tomography. Correlations among the presence of DM folds, corneal HOAs, and visual acuity were analyzed. RESULTS The Descemet membrane folds developed in 28.1% (25/89) eyes after DALK for the treatment of keratoconus. However, there were no significant differences in postoperative visual acuity between the eyes with and without DM folds at 1, 3, 6, and 12 months (P=0.739, P=0.106, P=0.223, and P=0.186, respectively). The visual acuity at 12 months was significantly correlated with corneal HOAs within a 4-mm diameter (anterior surface: R=0.546, P=0.003; total cornea: R=0.506, P=0.007). CONCLUSIONS Larger corneal HOAs, but not the presence of DM folds, were associated with poor visual acuity after DALK. In treating advanced keratoconus with DALK, it is important to minimize postoperative corneal HOAs, although DALK improves visual acuity by reducing HOAs due to keratoconus.
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Customized Toric Intraocular Lens Implantation in Eyes with Cataract and Corneal Astigmatism after Deep Anterior Lamellar Keratoplasty: A Prospective Study. J Ophthalmol 2018; 2018:1649576. [PMID: 30057802 PMCID: PMC6051070 DOI: 10.1155/2018/1649576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/19/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the effectiveness of toric intraocular lenses (IOLs) for treating corneal astigmatism in patients with cataract and previous deep anterior lamellar keratoplasty (DALK). Setting San Giovanni-Addolorata Hospital, Rome, Italy. Design Prospective interventional case series. Methods Patients undergoing cataract surgery after DALK for keratoconus were enrolled. Total corneal astigmatism (TCA) was assessed by a rotating Scheimpflug camera combined with Placido-disk corneal topography (Sirius; CSO, Firenze, Italy). A customized toric IOL (FIL 611 T, Soleko, Rome, Italy) was implanted in all eyes. One year postoperatively, refraction was measured, the IOL position was recorded, and vectorial and nonvectorial analyses were performed to evaluate the correction of astigmatism. Results Ten eyes of 10 patients were analyzed. The mean preoperative TCA magnitude was 4.92 ± 1.99 diopters (D), and the mean cylinder of the IOL was 6.18 ± 2.44. After surgery, the difference between the planned axis of orientation of the IOL and the observed axis was ≤10° in all eyes. The mean surgically induced corneal astigmatism was 0.35 D at 20°. The mean postoperative refractive astigmatism power was 1.13 ± 0.94 D; with respect to preoperative TCA, the reduction was statistically significant (p < 0.0001). The mean change in astigmatism power was 3.80 ± 1.60 D, corresponding to a correction of 77% of preoperative TCA power. Nine eyes out of 10 had a postoperative refractive astigmatism power ≤ 2D. Conclusions Toric IOLs can effectively correct corneal astigmatism in eyes with previous DALK. The predictability of cylinder correction is partially lowered by the variability of the surgically induced changes of TCA. This trial is registered with NCT03398109.
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Nanavaty MA, Vijjan KS, Yvon C. Deep anterior lamellar keratoplasty: A surgeon's guide. J Curr Ophthalmol 2018; 30:297-310. [PMID: 30555961 PMCID: PMC6276733 DOI: 10.1016/j.joco.2018.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/27/2018] [Accepted: 06/09/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose To review and highlight important practical aspects of deep anterior lamellar keratoplasty (DALK) surgery and provide some useful tips for surgeons wishing to convert to this procedure from the conventional penetrating keratoplasty (PK) technique. Methods In this narrative review, the procedure of DALK is described in detail. Important pre, intra, and postoperative considerations are discussed with illustrative examples for better understanding. A comprehensive literature review was conducted in PubMed/Medline from January 1995 to July 2017 to identify original studies in English language regarding DALK. The primary endpoint of this review was the narrative description of surgical steps for DALK, its pitfalls, and management of common intraoperative complications. Results A standard DALK procedure can be successfully performed taking into consideration factors such as age, ophthalmic co-morbidities, status of the crystalline lens, retina, and intraocular pressure. Careful trephination and dissection of the host cornea employing appropriate technique (such as big bubble technique, manual dissection, visco-dissection, etc.) suitable for the specific case is important to achieve good postoperative outcomes. Prompt identification of intraoperative complications such as double bubble, micro and macroperforations, etc. are vital to change the management strategies. Conclusion Although there is a steep learning curve for DALK procedure, considering details and having insight into the management of intraoperative issues facilitates learning and reduces complication rates.
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Affiliation(s)
- Mayank A Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Kanwaldeep Singh Vijjan
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Camille Yvon
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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46
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Garrido C, Cardona G, Güell JL, Pujol J. Visual outcome of penetrating keratoplasty, deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty. JOURNAL OF OPTOMETRY 2018; 11:174-181. [PMID: 29146479 PMCID: PMC6039585 DOI: 10.1016/j.optom.2017.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/12/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE A single-center, cross-sectional study was designed to assess and compare objective and subjective quality of vision of patients intervened with penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS Forty-six patients previously intervened with PK (22 eyes), DALK (7 eyes) and DMEK (17 eyes) were recruited. Visual evaluation included spherical and cylindrical refraction, distance corrected visual acuity (DCVA), photopic contrast sensitivity (CS), optical quality, measured with the HD Analyzer (objective scattering index [OSI], MTF cut-off and Strehl ratio), and ocular and corneal aberrometry, measured with the KR-1W Wavefront Analyzer. RESULTS Statistically significant between-group differences were found in age (p=0.006, DMEK patients were older) and time since surgery (p<0.001, longest time for PK patients). No statistically significant differences were found in DCVA between the techniques. Between-group differences were encountered in CS at 12 (p=0.007) and 18 (p<0.001) cycles per degree, with DMEK and DALK obtaining the best and worst outcomes, respectively. Differences in optical quality were found between the techniques (OSI, p=0.004; MTF cut-off, p=0.048; Strehl ratio p=0.022), with DMEK displaying the best outcomes. Highest and lowest values in ocular and corneal aberrations were for DALK and DMEK patients, respectively. Between-group differences were found in corneal astigmatism (p<0.001; -3.31±2.00 D in PK; -2.68±0.94 D in DALK; -1.09±0.62 D in DMEK). CONCLUSION Overall, DMEK proved superior over PK and DALK in terms of quality of vision, with PK offering slightly better outcomes than DALK in most visual function parameters under evaluation.
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Affiliation(s)
- Clàudia Garrido
- Refractive and Optometry Department, Instituto de Microcirugía Ocular, Barcelona, Spain
| | - Genís Cardona
- Department of Optics and Optometry, Universitat Politècnica de Catalunya · BarcelonaTech, Terrassa, Spain.
| | - Josep L Güell
- The Cornea, Cataract and Refractive Surgery Department, Instituto de Microcirugía Ocular, Barcelona, Spain; Department of Ophthalmology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Pujol
- Department of Optics and Optometry, Universitat Politècnica de Catalunya · BarcelonaTech, Terrassa, Spain; Centre for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya · BarcelonaTech, Terrassa, Spain
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Guan M, Zhao W, Zhang Y, Geng Y, Chen Z, Feng L, Li D, Yuan L. Graft survival rate of deep anterior lamellar keratoplasty for keratoconus: A meta-analysis. Medicine (Baltimore) 2018; 97:e11404. [PMID: 29995786 PMCID: PMC6076204 DOI: 10.1097/md.0000000000011404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Deep anterior lamellar keratoplasty (DALK) is an optional treatment for patients with keratoconus, and the associated graft survival rate varies. Herein, we aimed to explore the graft survival rate of DALK in patients with keratoconus. METHODS PubMed, Web of Science, and ProQuest databases were searched to retrieve the related articles. General data, clinical characters, and graft survival rates were obtained directly from the included studies and analyzed by meta-analysis. RESULTS A total of 12 articles were included. The merged 1-, 3-, and 5-year graft survival rates were 100% (99.9-100%, P < .001), 92.9% (89.8-95.9%, P < .001), and 90.4% (86.0-0.948%, P < .001), respectively. Lower heterogeneity was shown in each subgroup that was divided neither according to the sample number nor number of surgeons. CONCLUSION The survival rate slightly decreases year by year, but the overall trend seems relatively stable. Ensuring that all DALK procedures are performed by a single surgeon might be helpful to improve the graft survival rate after surgery.
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Affiliation(s)
| | - Weijia Zhao
- Department of Dermatology, The First Affiliated Hospital of Kunming Medical University
| | | | | | - Zonghan Chen
- Office of Educational Administration, Yunnan College of Traditional Chinese Medicine
| | - Liuyan Feng
- Library, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Fuest M, Liu YC, Arundhati A, Li L, Tan D, Mehta JS. Long-term outcomes of hemi-automated lamellar keratoplasty. Clin Exp Ophthalmol 2018; 46:1017-1027. [PMID: 29855131 DOI: 10.1111/ceo.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE To describe long-term outcomes of hemi-automated lamellar keratoplasty (HALK). BACKGROUND HALK is a hybrid anterior lamellar keratoplasty technique for corneas with anterior to mid-stromal scars and topographical irregularities. DESIGN Prospective interventional case series. PARTICIPANTS Thirty-five eyes of 35 consecutive patients undergoing HALK at a single tertiary referral centre from 2007 to 2016. METHODS Patients were followed up for a mean period of 61.4 ± 29.2 months. MAIN OUTCOME MEASURE Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) and cylinder, endothelial cell density (ECD), central corneal thickness (CCT), graft survival and complications were analysed. RESULTS The most common indications for HALK were scars because of contact lens associated infectious keratitis (29%), unknown origin (26%) or corneal dystrophies (14%). Five patients had a previous keratoplasty (n = 4; deep anterior lamellar keratoplasty, n = 1). Two HALKs failed at 22 and 32 months follow-up. No graft rejections occurred. UCVA improved from 0.91 ± 0.31 to 0.58 ± 0.35 and BSCVA from 0.66 ± 0.30 to 0.21 ± 0.20 logMAR (P < 0.001) at the last follow-up. Astigmatism (P = 0.2), SE (P = 0.8) and ECD (P = 0.4) did not change significantly during follow-up. CCT increased from 490 to 560 μm (P = 0.004). Kaplan-Meier estimated survival for all HALK cases was 90.6 (95% confidence interval 82.6-98.5) months with a survival probability of 96% at 12 months and 92% at 3, 5 and 7 years of follow-up. CONCLUSIONS AND RELEVANCE HALK provides excellent graft survival in primary cases and in patients with prior keratoplasty as well as significant improvement in visual acuity with low complication rates.
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Affiliation(s)
- Matthias Fuest
- Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Yu-Chi Liu
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore
| | - Anshu Arundhati
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore
| | - Lim Li
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore
| | - Donald Tan
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Eye-ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Eye-ACP, Duke-NUS Graduate Medical School, Singapore, Singapore.,School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
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de Macedo JP, de Oliveira LA, Hirai F, de Sousa LB. Femtosecond laser-assisted deep anterior lamellar keratoplasty in phototherapeutic keratectomy versus the big-bubble technique in keratoconus. Int J Ophthalmol 2018; 11:807-812. [PMID: 29862180 DOI: 10.18240/ijo.2018.05.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/01/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the functional and anatomic results of femtosecond laser (FSL)-assisted deep anterior lamellar keratoplasty (DALK) associated with phototherapeutic keratectomy (PTK) and FSL-assisted DALK performed using the big-bubble technique in keratoconus. METHODS During the first phase of the study, an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups: in FSL group, FSL lamellar cuts were performed on two corneas and in FSL+PTK group, PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made. During the second phase of the study, a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus: group 1 (n=14 eyes) underwent FSL-assisted DALK associated with PTK and group 2 (n=12 eyes) underwent FSL-assisted DALK associated with the big-bubble technique. The main outcome measures were the postoperative visual acuity (VA) and optical coherence tomography (OCT) measurements, confocal microscopic findings, and contrast sensitivity. RESULTS In the pilot study, histopathology showed a more regular stromal bed in the FSL+PTK group. In the clinical trial, group 1 had significantly worse best spectacle-corrected VA and contrast sensitivity (P<0.05 for both comparisons). The residual stromal bed measured by OCT was significantly (P<0.05) thicker in group 1. Confocal microscopy detected opacities only at the donor-receptor interface in group 1. CONCLUSION Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.
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Affiliation(s)
- Jarbas Pereira de Macedo
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Lauro Augusto de Oliveira
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Flavio Hirai
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Luciene Barbosa de Sousa
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
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