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Villarrubia Cuadrado A, Sánchez-Ventosa Á, Villalba-González M, Palacín Miranda E, López Pérez MD, Castillo Eslava R, González-Cruces T, Cano-Ortiz A. Femtosecond-Assisted Mushroom Deep Anterior Lamellar Keratoplasty. Cornea 2024; 43:1291-1299. [PMID: 38692690 DOI: 10.1097/ico.0000000000003551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/13/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The aim of this study was to describe our technique for performing femtosecond laser (FSL)-assisted mushroom configuration in deep anterior lamellar keratoplasty (DALK). METHODS We describe our surgical technique for a mushroom-configuration DALK using a femtosecond laser (FSL) both to prepare the graft and to perform a precut of the recipient cornea, as well as the steps for the dissection of the recipient cornea and for donor cornea implantation. Moreover, we show the parameters of energy and spot separation and the external and internal diameters as well as the thickness of the external and internal keratotomy. RESULTS We performed a retrospective case series study of 20 patients with a mean follow-up of 4.36 ± 2.54 years. The indication for surgery was leukoma in 15 cases (75%), keratoconus in 4 cases (20%), and stromal corneal dystrophy in 1 case (5%). Four cases had to be converted to penetrating keratoplasty. The overall results were as follows: The mean preoperative corrected distance visual acuity increased from 0.11 ± 0.09 (0.01-0.30) to 0.78 ± 0.22 (0.30-1.0) with spectacles and to 0.92 ± 0.13 (0.5-1.0) with a gas permeable contact lens. The mean final cylinder was 3.90 ± 1.86 (1.25-7.0). The mean endothelial cell count at 6 months was 2033.83 ± 570.53 cells/mm 2 (930-3207), and the mean final spherical equivalent was -4.67 ± 2.91 (-0.25 to -9.00). CONCLUSIONS FSL-assisted technology is useful to achieve a predictable and safe procedure when using mushroom configuration to perform DALK. Our conversion rate from DALK to penetrating keratoplasty was similar to or even lower than that reported in the literature. In the successful DALK cases, the visual and refractive results were similar to those reported in other studies using FSL-assisted DALK (with a standard or mushroom configuration).
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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 2024; 43:1223-1230. [PMID: 38147574 DOI: 10.1097/ico.0000000000003448] [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] [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/mm 2 , 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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Rodríguez-Calvo-de-Mora M, Giménez-Almenara-Amo J, Mataix-Albert B, Arias-Alcalá M, García-Montesinos-Gutiérrez J, Rocha-de-Lossada C, Villalba-Montoro R, Díaz-Gallardo MS, Cuende N, Álvarez-Márquez A. Andalusian Public Eye-Banks: a decade of continuous improvement. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:383-391. [PMID: 38909891 DOI: 10.1016/j.oftale.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/05/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES To show donation data, number of keratoplasties and the changes in transplant indications and techniques that occurred in Andalusia in the period from 2013 to 2022. MATERIALS AND METHODS The present work is a retrospective and descriptive study that included all keratoplasties performed between January 2013 and December 2022 in Andalusia, as well as the evolution of the cornea donation and transplant activity of the public and private hospitals pertaining to the waiting list management system of the Public Health System of Andalusia. Transplants performed in private centers with corneas from outside Andalusia were excluded. RESULTS Cornea donation activity in Andalusia in the decade 2013-2022 has experienced a growth of more than 126%, while overall transplant activity has increased by 157% in public hospitals. Penetrating keratoplasty has decreased from 83% in 2013 to 43% in 2022, while lamellar techniques have increased from 17% to 57% in this same period. Since 2018, more lamellar transplants are performed than penetrating transplants. Regarding indications, endothelial conditions already represent the first cause of transplantation. In 2022 alone, the public Andalusian Eye Banks evaluated 1,054 corneas and prepared 281 endothelial grafts. CONCLUSION In the decade from 2013 to 2022 in Andalusia there has been an increase in donation activity and the number of keratoplasties. The public Eye Banks implementation in this period has played a key role in the widespread adoption of lamellar keratoplasty techniques and has enabled the transition to perform a greater number of lamellar keratoplasties compared to penetrating keratoplasty.
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Affiliation(s)
- M Rodríguez-Calvo-de-Mora
- Qvision, Departmento Oftalmología, VITHAS Almería Hospital, Almería, Spain; Unidad de Córnea y Superficie Ocular, Departamento Oftalmología, VITHAS Málaga. Málaga, Spain; Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain.
| | - J Giménez-Almenara-Amo
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain; Unidad de Córnea y Cirugía Refractiva, Clínica Baviera Córdoba, Córdoba, Spain
| | - B Mataix-Albert
- Unidad de Córnea y Superficie Ocular, Hospital Universitario Virgen Macarena, Sevilla, Spain; Unidad de Córnea y Superficie Ocular, Hospital Quirón Ave María, Sevilla, Spain
| | - M Arias-Alcalá
- Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - J García-Montesinos-Gutiérrez
- Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Unidad de Córnea y Superficie Ocular, Miranza Málaga, Málaga, Spain; HM Hospitales Málaga, Málaga, Spain
| | - C Rocha-de-Lossada
- Qvision, Departmento Oftalmología, VITHAS Almería Hospital, Almería, Spain; Unidad de Córnea y Superficie Ocular, Departamento Oftalmología, VITHAS Málaga. Málaga, Spain; Unidad de Córnea y Superficie Ocular, Departmento Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Universidad de Sevilla, Departamento de Cirugía, Área de Oftalmología, Sevilla, Spain
| | | | | | - N Cuende
- Coordinación Autonómica de Trasplantes de Andalucía, Spain
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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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Lucchino L, Visioli G, Scarinci F, Colabelli Gisoldi RAM, Komaiha C, Marenco M, Pocobelli G, Lambiase A, Pocobelli A. Tomographic and topographic predictive factors of big bubble formation during deep anterior lamellar keratoplasty in keratoconus. Br J Ophthalmol 2024:bjo-2024-325810. [PMID: 39197954 DOI: 10.1136/bjo-2024-325810] [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: 05/17/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE To identify preoperative predictors of big bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in patients with keratoconus (KC). METHODS DESIGN: Retrospective cohort study in an Italian tertiary centre. STUDY POPULATION Consecutive patients with KC undergoing DALK from January 2021 to July 2023. OBSERVATION PROCEDURE Tomographic and topographic data including K-max, K-mean, keratometric astigmatism, thinnest point, mean peripheral corneal thickness, difference between the mean peripheral corneal thickness and the thinnest point (peripheral-minimal corneal thickness), position (central/paracentral) and cone area (%), Amsler-Krumeich classification and anterior segment optical coherence tomography (AS-OCT) analysis to assess the severity stage. MAIN OUTCOME MEASURES Rate of BB formation and type; multivariate logistic regression analysis was used to analyse all preoperative parameters in patients with BB formation versus failure. RESULTS Pneumatic dissection succeeded in 98 of 140 eyes (70.0%), with 94 type 1 bubbles (67.1%) and four type 2 bubbles (2.9%). BB formation succeeded more frequently in patients with lower K-max (p=0.032), lower K-mean (p=0.010), higher thinnest point (p=0.017), lower peripheral-minimal corneal thickness (p=0.009) and lower Amsler-Krumeich stages (p=0.021). According to the AS-OCT analysis, BB formation was more frequent in the lower stages (p<0.001). After the logistic regression (pseudo-R²=0.176, constant=3.21, 95% CI 1.14 to 5.29, p=0.002), AS-OCT classification was found to be the only factor that predicted BB formation (coefficient=-0.81, 95% CI -1.18 to -0.43, p<0.001). CONCLUSIONS AS-OCT classification is a reliable predictor for BB formation. Tomographic and topographic analyses indicated that a steeper and more ectatic cornea is more prone to BB failure.
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Affiliation(s)
- Luca Lucchino
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giacomo Visioli
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Fabio Scarinci
- UOC Oftalmologia - Banca degli Occhi, San Giovanni Addolorata Hospital, Rome, Italy
| | | | - Chiara Komaiha
- UOC Oftalmologia - Banca degli Occhi, San Giovanni Addolorata Hospital, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giulio Pocobelli
- Department of Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome Tor Vergata, Rome, Italy
| | | | - Augusto Pocobelli
- UOC Oftalmologia - Banca degli Occhi, San Giovanni Addolorata Hospital, Rome, Italy
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Kasamatsu H, Yamaguchi T, Yagi-Yaguchi Y, Nishisako S, Tomida D, Akiyama M, Murata T, Shimazaki J. Incidence and Clinical Features of Immunologic Rejection After Deep Anterior Lamellar Keratoplasty. Cornea 2024; 43:1008-1014. [PMID: 38049155 DOI: 10.1097/ico.0000000000003444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE The aim of this study was to investigate the incidence and clinical features of immunologic rejection after deep anterior lamellar keratoplasty (DALK). METHODS This study included 411 patients (464 eyes, median age [interquartile range; IQR] 55.8 years [36.1-69.5]) who underwent DALK at Tokyo Dental College between June 1997 and 2021. Of 411 patients, 24 (24 eyes [5.2%], 51.9 years [IQR 31.6-65.4]) developed immunologic rejection. We characterized the clinical features, risk factors associated with immunologic rejection, and prognosis. RESULTS The interval between DALK and immunologic rejection was 14.5 (range, 5-78) months. Immunologic rejection occurred after cessation/reduction of topical steroid in 9 (47.4%) and suture removal in 4 eyes (21.1%). The postoperative duration of topical steroid use in eyes with immunologic rejection was significantly shorter (10.0 months, [IQR 6.0-14.0]) than those without immunologic rejection (28.3 [IQR 15.8-42.7], P = 0.001). Immunologic rejection manifested as stromal edema in 19 (100.0%), ciliary hyperemia in 17 (89.5%), keratic precipitates in 13 (68.4%), epithelial edema in 13 (68.4%), infiltration in 9 (47.4%), corneal opacity in 4 (21.1%), and Descemet membrane detachment in 2 eyes (10.5%). After treatment, corneal clarity was restored in 17 eyes (89.5%); however, immunologic rejection led to corneal endothelial decompensation in 2 eyes (10.5%). Endothelial cell density decreased from 1795.7 ± 722.6 to 1651.6 ± 655.6 cells/mm 2 after immunologic rejection ( P = 0.074). CONCLUSIONS Post-DALK immunologic rejection was associated with specific clinical triggers such as reduction/cessation of topical steroids or suture removal.
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Affiliation(s)
- Hirotsugu Kasamatsu
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Yukari Yagi-Yaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Sota Nishisako
- Cornea Center and Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; and
| | - Daisuke Tomida
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masato Akiyama
- Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Hakata, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Ng Yin Ling C, He F, Lang S, Sabanayagam C, Cheng CY, Arundhati A, Mehta JS, Ang M. Interpretable Machine Learning-Based Risk Score for Predicting Ten-Year Corneal Graft Survival After Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Asian Eyes. Cornea 2024:00003226-990000000-00635. [PMID: 39046776 DOI: 10.1097/ico.0000000000003641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To predict 10-year graft survival after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) using a machine learning (ML)-based interpretable risk score. METHODS Singapore Corneal Transplant Registry patients (n = 1687) who underwent DALK (n = 524) or PK (n = 1163) for optical indications (excluding endothelial diseases) were followed up for 10 years. Variable importance scores from random survival forests were used to identify variables associated with graft survival. Parsimonious analysis using nested Cox models selected the top factors. An ML-based clinical score generator (AutoScore) converted identified variables into an interpretable risk score. Predictive performance was evaluated using Kaplan-Meier (KM) curves and time-integrated AUC (iAUC) on an independent testing set. RESULTS Mean recipient age was 51.8 years, 54.1% were male, and majority were Chinese (60.0%). Surgical indications included corneal scar (46.5%), keratoconus (18.3%), and regraft (16.2%). Five-year and ten-year KM survival was 93.4% and 92.3% for DALK, compared with 67.6% and 56.6% for PK (log-rank P < 0.001). Five factors were identified by ML algorithm as predictors of 10-year graft survival: recipient sex, preoperative visual acuity, choice of procedure, surgical indication, and active inflammation. AutoScore stratified participants into low-risk and high-risk groups-with KM survival of 73.6% and 39.0%, respectively (log-rank P < 0.001). ML analysis outperformed traditional Cox regression in predicting graft survival beyond 5 years (iAUC 0.75 vs. 0.69). CONCLUSIONS A combination of ML and traditional techniques identified factors associated with graft failure to derive a clinically interpretable risk score to stratify PK and DALK patients-a technique that may be replicated in other corneal transplant programs.
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Affiliation(s)
| | - Feng He
- Singapore Eye Research Institute, Singapore; and
| | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore; and
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore; and
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore
| | - Anshu Arundhati
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore; and
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore; and
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore; and
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore
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Lucchino L, Visioli G, Scarinci F, Colabelli Gisoldi RAM, Komaiha C, Giovannetti F, Marenco M, Pocobelli G, Lambiase A, Pocobelli A. Influence of Opacity Depth on Big Bubble Formation During Deep Anterior Lamellar Keratoplasty in Corneal Stromal Scars. Cornea 2024:00003226-990000000-00626. [PMID: 39023329 DOI: 10.1097/ico.0000000000003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE To identify the key preoperative predictors of big bubble (BB) formation during deep anterior lamellar keratoplasty in patients with corneal stromal scars (CSS). METHODS This retrospective cohort study included consecutive patients with CSS after infective keratitis who underwent BB-deep anterior lamellar keratoplasty between January 2021 and July 2023 at a tertiary referral center. Topographic and tomographic data were collected to compare the rates and types of BB formations. Anterior segment optical coherence tomography (AS-OCT) was employed to assess the maximum depth of opacity by dividing the stroma into 3 zones of equal thickness: anterior (stage A), mid (stage B), and posterior stroma (stage C). Multivariate logistic regression analysis was performed to identify the potential preoperative predictors of bubble formation. RESULTS Pneumatic dissection was achieved in 13 of 33 eyes (39.4%), with 11 BB type 1 eyes (33.3%) and 2 BB type 2 eyes (6.1%). According to AS-OCT grading, bubble formation was more frequent with CSS involving more superficial stromal layers (P <0.032). In the eyes with stage C, bubble formation failed 12 out of 14 times (85.7%, P <0.026). Spearman correlation showed that bubble formation was inversely associated with the AS-OCT grading (rho = -0.443, P = 0.001). After logistic regression analysis, AS-OCT grading was found to be the sole factor that predicted bubble formation (coeff. -1.58, confidence interval 95% -3.03 to -0.12, P = 0.034). CONCLUSIONS Depth of opacity in CSS was the key determinant for predicting the success of pneumatic dissection, as advanced AS-OCT stages are strongly associated with BB failure.
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Affiliation(s)
- Luca Lucchino
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giacomo Visioli
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Fabio Scarinci
- San Giovanni Addolorata Hospital, UOC Oftalmologia-Banca degli Occhi, Rome, Italy; and
| | | | - Chiara Komaiha
- San Giovanni Addolorata Hospital, UOC Oftalmologia-Banca degli Occhi, Rome, Italy; and
| | | | - Marco Marenco
- Department of Sense Organs, Sapienza - University of Rome, Rome, Italy
| | - Giulio Pocobelli
- Department of Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome Tor Vergata, Rome, Italy
| | | | - Augusto Pocobelli
- San Giovanni Addolorata Hospital, UOC Oftalmologia-Banca degli Occhi, Rome, Italy; and
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Zhao Y, Du K, Peng R, Hong J. Outcomes of Donor Corneas of Different Thicknesses From Endothelial Keratoplasty in Deep Anterior Lamellar Keratoplasty for Keratoconus. Cornea 2024:00003226-990000000-00619. [PMID: 39010268 DOI: 10.1097/ico.0000000000003580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE To evaluate the outcomes of divided residual donor corneas obtained from endothelial keratoplasty in keratoconus with deep anterior lamellar keratoplasty (DALK). METHODS In this retrospective, comparative, clinical study, 103 keratoconic eyes that underwent DALK were enrolled; 67 eyes received thin grafts from Descemet stripping automated endothelial keratoplasty, and 36 received thick grafts from Descemet membrane endothelial keratoplasty. Baseline and postoperative central corneal thickness (CCT), inferior corneal thickness, uncorrected distance visual acuity, corrected distance visual acuity, corneal astigmatism, mean keratometry, biomechanical properties, and complication rates were measured. RESULTS Six months after transplantation, the group receiving thin grafts had a CCT of only 455.1 ± 43.0 μm, whereas that of the group receiving thick grafts was 546.7 ± 44.2 μm. Both CCT and inferior corneal thickness in the thin group were significantly lower than those in the thick group (measured with Pentacam at 36 months, P < 0.001) and remained throughout the 5-year follow-up period. Both procedures had comparable postoperative logarithm of the minimum angle of resolution UDVAs, logarithm of the minimum angle of resolution corrected distance visual acuity, astigmatism, and mean keratometry values (36 months; P = 0.335, 0.286, 0.680, and 0.365, respectively). Corneal biomechanical analysis revealed that the thin group had a significantly higher stiffness parameter at the first applanation than the thick group at the 2-year follow-up (P = 0.036) while other parameters were equivalent. CONCLUSIONS The outcomes of keratoplasty with donor tissue are comparable regardless of the thickness of the graft, which suggests that transplantation with either type of the split corneal procedure for DALK in patients with keratoconus is feasible.
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Affiliation(s)
- Yinghan Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Kaiyue Du
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Deshmukh RS, Das AV, Vaddavalli PK. Evolving Trends in the Diagnosis and Management of Keratoconus Over 3 Decades. Cornea 2024:00003226-990000000-00623. [PMID: 39012335 DOI: 10.1097/ico.0000000000003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE To report the trends in the clinical presentation, diagnosis, and management of keratoconus (KC) in patients presenting to a multitier hospital network over 33 years. METHODS This retrospective study included patients with KC presenting from 1987 to 2020. Patients with KC in at least 1 eye were included. The data of 20,576 patients included in this study were retrieved from the electronic medical record database. Data on patient demographics, ocular diagnosis, contact lens usage, and surgical history were collected and exported for analysis. Descriptive statistics and chi square test were used for statistical analysis. RESULTS A total of 20,576 KC cases were seen from 1987 to 2020. Mean age at diagnosis reduced from 29.3 years (1987-1991) to 22.2 years (2016-2020). Adults (76.64%) were commonly affected with a majority being male (61.25%). Use of contact lenses increased from 4.34% (2002-2006) to 11.23% (2016-2020). Of the total number of surgical interventions, collagen crosslinking (CXL) constituted more than 1/5th (22.28%) between 2007 and 2011, which increased to more than half between 2012 and 2016 (53.61%) and almost 3/4th (72.53%) between 2017 and 2020. Advances in lamellar surgery have led to more patients undergoing deep anterior lamellar keratoplasty (DALK) as compared with penetrating keratoplasty. In the last 8 years, 17.2% patients underwent surgery and the most common was CXL (14.77%) followed by DALK (1.72%) and penetrating keratoplasty (1.04%). CONCLUSIONS We report the trends in the clinical presentation and management of KC over 3 decades. In the last 33 years, advances in diagnostics have helped diagnose KC earlier. Contact lenses and advances in CXL have reduced the number of keratoplasties in KC, DALK being more common.
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Affiliation(s)
- Rashmi S Deshmukh
- Refractive Surgery & Cataract Service, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of EMR & AEye, L V Prasad Eye Institute, Hyderabad, India; and
| | - Pravin Krishna Vaddavalli
- Refractive Surgery & Cataract Service, L V Prasad Eye Institute, Hyderabad, India
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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11
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Aljundi W, Daas L, Munteanu C, Seitz B, Abdin AD. Subfoveal choroidal thickness increases after excimer laser-assisted penetrating keratoplasty but not after excimer laser-assisted deep anterior lamellar keratoplasty. Sci Rep 2024; 14:15319. [PMID: 38961236 PMCID: PMC11222455 DOI: 10.1038/s41598-024-66225-4] [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: 01/28/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024] Open
Abstract
To evaluate the impact of excimer laser-assisted deep anterior lamellar keratoplasty (Exc-DALK) and excimer laser-assisted penetrating keratoplasty (Exc-PKP) on subfoveal choroidal thickness (SFCT) in eyes with advanced keratoconus. A retrospective comparative clinical study, which compares the outcomes of 24 eyes treated with Exc-DALK (G1) against matched group of 43 eyes treated with Exc-PKP (G2) at both 2 months (T1) and 2 years (T2) postoperatively. Main outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), and SFCT. Preoperatively, there were no significant differences between both groups regarding BCVA, CMT or SFCT (p > 0.05). There were no significant differences between both groups regarding BCVA at both follow-ups (p > 0.05). There were no significant differences between both groups regarding CMT at both follow-ups (p > 0.05). SFCT was higher in G2 than G1 at both follow-ups (p < 0.01). Compared to preoperative SFCT, there were no significant changes in SFCT in G1 at both follow-ups (p > 0.05). In G2, SFCT increased significantly at T1 (p < 0.01) and did not differ significantly at T2 (p = 0.17). SFCT increased significantly after Exc-PKP but not after Exc-DALK, which might indicate that Exc-DALK affects the choroid less and thus could represent a less traumatic approach to ocular tissue than Exc-PKP.
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Affiliation(s)
- Wissam Aljundi
- Department of Ophthalmology, Saarland University Medical Center UKS, Kirrberger Street 100, Building 22, 66421, Homburg/Saar, Germany.
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center UKS, Kirrberger Street 100, Building 22, 66421, Homburg/Saar, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, Saarland University Medical Center UKS, Kirrberger Street 100, Building 22, 66421, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Kirrberger Street 100, Building 22, 66421, Homburg/Saar, Germany
| | - Alaa Din Abdin
- Department of Ophthalmology, Saarland University Medical Center UKS, Kirrberger Street 100, Building 22, 66421, Homburg/Saar, Germany
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12
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Elalfy M, Negm A, Soliman S, Naveed H, Hamada S, Matsou A, Hassan M, Atef A, Gatzioufas Z, Mahran W. Surgical Outcomes of Different Deep Anterior Lamellar Keratoplasty Techniques-A Single-Centre UK Study. J Clin Med 2024; 13:3644. [PMID: 38999210 PMCID: PMC11242575 DOI: 10.3390/jcm13133644] [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: 03/20/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Anterior lamellar keratoplasty (ALK) is a less invasive procedure than PK, and thus avoids many of the intraocular complications associated with PK. DALK can be performed using several different techniques, with either a manual dissection, a keratome or femtosecond-laser assisted dissection, or with a big bubble technique. To analyse the outcomes and compare the results of three deep anterior lamellar keratoplasty (DALK) techniques. Methods: This study included 105 DALK cases performed at Queen Victoria Hospital, East Grinstead, UK, in the period between January 2016 and May 2022. Cases were classified into four groups based on technique: BB-DALK, manual DALK, FS-DALK and 'converted to PK group'. Results: There was significant improvement in VA and Kmax compared to the preoperative values in all groups. There was no significant difference detected in VA and Kmax between all groups. Conclusions: Performing DALK surgery with any suitable technique (manual, big-bubble or femtosecond-assisted) is effective and causes significant improvements in VA and Kmax, even in cases where a conversion to penetrating keratoplasty is required. However, every technique has its pros and cons and should be tailored according to surgeon preference and individual case pathology.
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Affiliation(s)
- Mohamed Elalfy
- Queen Victoria Hospital Foundation Trust, East Grinstead RH19 3DZ, UK
- Maidstone and Tunbridge Wells NHS Trust, Maidstone TN24QJ, UK
- Research Institute of Ophthalmology, Giza 3724827, Egypt
| | - Ahmed Negm
- Research Institute of Ophthalmology, Giza 3724827, Egypt
| | - Shady Soliman
- Research Institute of Ophthalmology, Giza 3724827, Egypt
| | - Hasan Naveed
- Queen Victoria Hospital Foundation Trust, East Grinstead RH19 3DZ, UK
| | - Samer Hamada
- Queen Victoria Hospital Foundation Trust, East Grinstead RH19 3DZ, UK
| | - Artemis Matsou
- Queen Victoria Hospital Foundation Trust, East Grinstead RH19 3DZ, UK
| | - Mansour Hassan
- Department of Ophthalmology, Faculty of Medicine, Beni Suef University, Beni Suef 62514, Egypt
| | - Ahmed Atef
- Research Institute of Ophthalmology, Giza 3724827, Egypt
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, 4031 Basel, Switzerland
| | - Waleed Mahran
- Department of Ophthalmology, Faculty of Medicine, Beni Suef University, Beni Suef 62514, Egypt
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13
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Opfermann JD, Wang Y, Kaluna J, Suzuki K, Gensheimer W, Krieger A, Kang JU. Design and Evaluation of an Eye Mountable AutoDALK Robot for Deep Anterior Lamellar Keratoplasty. MICROMACHINES 2024; 15:788. [PMID: 38930758 PMCID: PMC11205909 DOI: 10.3390/mi15060788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
Partial-thickness corneal transplants using a deep anterior lamellar keratoplasty (DALK) approach has demonstrated better patient outcomes than a full-thickness cornea transplant. However, despite better clinical outcomes from the DALK procedure, adoption of the technique has been limited because the accurate insertion of the needle into the deep stroma remains technically challenging. In this work, we present a novel hands-free eye mountable robot for automatic needle placement in the cornea, AutoDALK, that has the potential to simplify this critical step in the DALK procedure. The system integrates dual light-weight linear piezo motors, an OCT A-scan distance sensor, and a vacuum trephine-inspired design to enable the safe, consistent, and controllable insertion of a needle into the cornea for the pneumodissection of the anterior cornea from the deep posterior cornea and Descemet's membrane. AutoDALK was designed with feedback from expert corneal surgeons and performance was evaluated by finite element analysis simulation, benchtop testing, and ex vivo experiments to demonstrate the feasibility of the system for clinical applications. The mean open-loop positional deviation was 9.39 µm, while the system repeatability and accuracy were 39.48 µm and 43.18 µm, respectively. The maximum combined thrust of the system was found to be 1.72 N, which exceeds the clinical penetration force of the cornea. In a head-to-head ex vivo comparison against an expert surgeon using a freehand approach, AutoDALK achieved more consistent needle depth, which resulted in fewer perforations of Descemet's membrane and significantly deeper pneumodissection of the stromal tissue. The results of this study indicate that robotic needle insertion has the potential to simplify the most challenging task of the DALK procedure, enable more consistent surgical outcomes for patients, and standardize partial-thickness corneal transplants as the gold standard of care if demonstrated to be more safe and more effective than penetrating keratoplasty.
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Affiliation(s)
- Justin D. Opfermann
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (J.K.); (K.S.); (A.K.)
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; (Y.W.); (J.U.K.)
| | - Yaning Wang
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; (Y.W.); (J.U.K.)
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - James Kaluna
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (J.K.); (K.S.); (A.K.)
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; (Y.W.); (J.U.K.)
| | - Kensei Suzuki
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (J.K.); (K.S.); (A.K.)
| | - William Gensheimer
- Ophthalmology Section, White River Junction Veterans Affairs Medical Center, White River Junction, VT 05009, USA;
- Ophthalmology Section, Dartmouth—Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (J.K.); (K.S.); (A.K.)
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; (Y.W.); (J.U.K.)
| | - Jin U. Kang
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA; (Y.W.); (J.U.K.)
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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14
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Chatterjee S, Parmar GS, Kapur N, Gomase SN, Khurana A, Borde P, Acharya M, Sangwan V, Majumdar A. Trends in keratoplasty from central and northern India. Part II: Types of keratoplasty. Indian J Ophthalmol 2024; 72:831-837. [PMID: 38153377 PMCID: PMC11232872 DOI: 10.4103/ijo.ijo_724_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 12/29/2023] Open
Abstract
PURPOSE To report the types of keratoplasty and analyze trends over a period of two decades in central and northern India. METHODS This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and north India from 2005 to 2021. The indications and various keratoplasty procedures were compared between 2005-2012 and 2013-2021 to analyze the trend. RESULTS A total of 13,223 corneal grafts were performed, of which therapeutic penetrating keratoplasty (TPK) (5719, 43.3%) was the most common procedure, followed by optical penetrating keratoplasty (OPK) (5528, 41.8%), Descemet stripping endothelial keratoplasty (DSEK) (1279, 9.7%), deep anterior lamellar keratoplasty (DALK) (376, 2.8%), Descemet membrane endothelial keratoplasty (DMEK) (215, 1.6%), patch grafts (75, 0.6%), and keratoprostheses (31, 0.2%). Overall, OPK procedures decreased (-14.1%, P < 0.001), but TPK (+3.1%, P < 0.019), DSEK (+7.1%, P < 0.001), and DMEK (+1.9%, P < 0.001) procedures increased. Although there was an increasing trend in the use of DALK (+0.8%, P < 0.083) and keratoprostheses (+0.3%, P = 0.074) procedures, the trends were not statistically significant. CONCLUSION In keeping with worldwide trends, an increasing trend in lamellar keratoplasties was observed in central and northern India during the past decade. The trend was significant for DSEK. However, as corneal ulcers and scars were the major indications for keratoplasty, TPK and OPK remained the most common procedures.
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Affiliation(s)
- Samrat Chatterjee
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Gautam Singh Parmar
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Neha Kapur
- Department of Cornea and Anterior Segment, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Sharad Nivruti Gomase
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Ashi Khurana
- Department of Cornea and Anterior Segment, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Prashant Borde
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Acharya
- Department of Cornea and Anterior Segment, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Virendra Sangwan
- Department of Cornea and Anterior Segment, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Department of Biostatistics, Dr Shroff's Charity Eye Hospital, New Delhi, India
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15
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Milovanova E, Gomon S, Rocha G. Classic lattice corneal dystrophy: a brief review and summary of treatment modalities. Graefes Arch Clin Exp Ophthalmol 2024; 262:1667-1681. [PMID: 37934291 DOI: 10.1007/s00417-023-06297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE To provide a brief summary and comparison of the most recent literature on available and theorized treatment modalities for classic lattice corneal dystrophy (LCD). This paper aims to support practitioners in their management of this disease. METHODS A search was carried out on available literature through PubMed and Google Scholar of English language articles up to January 2023 that relate to the treatment of LCD. Due to scarcity of literature regarding specific novel therapies for LCD, results from other corneal pathologies (granular corneal dystrophy, corneal scarring) are sometimes included for contrast, which is clearly denoted. RESULTS LCD is a slowly progressive disease that leads to recurrent epithelial corneal erosions, stromal haze, corneal opacification, substantial discomfort, and visual impairment. Due to its autosomal-dominant inheritance pattern, this disease can persist throughout ancestral lines and requires consistent treatment and follow-up. An optimal management plan is necessary to (1) prolong years of life with best achievable visual acuity; (2) treat painful recurrent corneal erosions as they occur; (3) ensure proper follow-up throughout the life of a patient, as well as monitor at-risk offspring; and (4) monitor efficacy of treatment. CONCLUSIONS This paper addresses (1) treatment for early disease including corneal epithelial debridement, photo therapeutic keratectomy (PTK), femtosecond laser-assisted lamellar keratectomy (FLK), and others; (2) treatment for late disease including full thickness keratoplasties and anterior lamellar keratoplasties; and (3) potential future treatment considerations including a wide variety of topical/systemic, genetic, and regenerative approaches.
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Affiliation(s)
- Ekaterina Milovanova
- Department of Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Stanislav Gomon
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Guillermo Rocha
- Department of Ophthalmology & Visual Sciences, McGill University, Montréal, Canada
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16
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Flockerzi E, Turner C, Seitz B, Collaborators GSG. Descemet's membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry. Br J Ophthalmol 2024; 108:646-653. [PMID: 37586835 PMCID: PMC11137454 DOI: 10.1136/bjo-2022-323162] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/12/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND/AIMS This retrospective multicentric panel study provides absolute numbers, types of and indications for corneal transplantation in Germany from 2011 to 2021 and sets them into the international context. METHODS A questionnaire was sent to the 104 German ophthalmologic surgery departments and 93 (89%) provided their data. RESULTS The number of reported keratoplasties more than doubled from 2011 (n=4474) to 2021 (n=8998). Lamellar keratoplasties (49% posterior (n=2883), 4% anterior (n=231)) surpassed penetrating keratoplasty (PKP, 47%, n=2721) for the first time in 2014. Since 2016, Descemet's membrane endothelial keratoplasty (DMEK) has become the predominant keratoplasty procedure in Germany. Its number increased by 1.5-fold from 3850 (2016) to 5812 (2021). Main indications in 2021 were Fuchs' endothelial corneal dystrophy (FECD, 43%), pseudophakic corneal decompensation (12%), repeated keratoplasty (11%), infections (7%), keratoconus (6%) and corneal scarring (4%, others: 9%). The PKP percentage decreased from 70.2% in 2011 (n=3141) to 31.7% in 2021 (n=2853). Descemet's stripping (automated) endothelial keratoplasties (DSAEKs) decreased to 1% in 2021 (n=74). 98.6% of all posterior lamellar keratoplasties were DMEKs in Germany in 2021. The number of deep anterior lamellar keratoplasties (DALKs) remained comparable from 2011 (n=269) to 2021 (n=251, 2.8%). CONCLUSION Main indications for corneal transplantation in Germany (2021) were FECD and pseudophakic corneal decompensation. DMEK is by far the predominant corneal transplantation procedure since 2016 followed by PKP, whose absolute number decreased only slightly during the decade from 2011 to 2021. DALK proportions remain low, but stable, whereas DSAEK decreased annually and plays a minor role in Germany. TRIAL REGISTRATION NUMBER NCT03381794.
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Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Christina Turner
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - GeKeR Study Group Collaborators
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
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17
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Li D, Tian LE, Wang X, Zhang F, Liu T, Dong Y, Lin P, Li D, Sun D, Chen M. Recurrence Characteristics on Optical Coherence Tomography and Treatments of Reis-Bücklers Corneal Dystrophy After Phototherapeutic Keratectomy or Penetrating Keratoplasty. Am J Ophthalmol 2024; 266:37-45. [PMID: 38735449 DOI: 10.1016/j.ajo.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To evaluate the recurrence characteristics on optical coherence tomography and clinical outcomes after phototherapeutic keratectomy (PTK) or penetrating keratoplasty (PKP) in patients with Reis-Bücklers corneal dystrophy (RBCD). DESIGN Retrospective interventional case series. METHODS Seventeen patients with RBCD (31 eyes, including 6 surgery-naïve eyes and 25 surgical eyes) received 44 surgical interventions from 1996 through 2022. PTK or PKP was performed as the initial surgical procedure. Significant recurrence was determined when best spectacle-corrected visual acuity decreased at least 2 lines with increased opacity in the superficial cornea. Repeated PTK or PTK on the corneal graft (CG-PTK) was considered if patients could not endure poor vision due to significant recurrence. Recurrence depth and annual increase in thickness of the central cornea and subepithelial deposits were assessed by anterior segment optical coherence tomography. RESULTS The mean follow-up time was 12.8 ± 8.5 years (range, 2.0-25.5 years). The mean logMAR best spectacle-corrected visual acuity improved from 1.24 ± 0.48 preoperatively to 0.27 ± 0.09 postoperatively in the initial PTK group (13 eyes, P < .001), from 1.84 ± 0.69 to 0.40 ± 0.13 in the PKP group (12 eyes, P < .001), from 1.04 ± 0.46 to 0.30 ± 0.07 in the repeated PTK group (12 times in 7 eyes, P < .001), and from 1.29 ± 0.43 to 0.39 ± 0.11 in the CG-PTK group (7 times in 5 eyes, P = .001). The median significant recurrence time was 27 months (95% confidence interval 23.9-30.1), 96 months (84.1-107.9), 31 months (28.8-33.1), and 24 months (19.8-28.2), respectively (P < .001). The depth of superficial deposits located between the epithelium and the anterior stroma was approximately 115 µm (85-159 µm). The annual thickening of subepithelial deposits was 14 ± 2 µm after initial PTK, 7 ± 3 µm after PKP, 14 ± 3 µm after repeated PTK, and 30 ± 11 µm after CG-PTK, compared to 4 ± 2 µm in surgery-naïve eyes (P = .002, .515, .002, <.001). The thickness of the central cornea increased by 15 ± 2 µm, 7 ± 2 µm, 15 ± 3 µm, and 31 ± 10 µm per year in the 4 surgery groups, respectively, compared to 5 ± 2 µm in surgery-naïve eyes (P = .001, .469, .001, <.001). CONCLUSIONS Better visual acuity can be achieved after PTK than PKP for treatment of RBCD. The annual thickening of subepithelial deposits may approximate an increase in central corneal thickness. The superficial distribution of subepithelial deposits makes it feasible to perform repeated PTK, even on the corneal allograft, for recurrent RBCD.
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Affiliation(s)
- Dewei Li
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - L E Tian
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Xiaochuan Wang
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Feifei Zhang
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China
| | - Ting Liu
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Yanling Dong
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Ping Lin
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Dongfang Li
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Dapeng Sun
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China
| | - Min Chen
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China.
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18
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D’Souza S, Shetty R. Spike sign - To predict the formation of big bubble in deep anterior lamellar keratoplasty in advanced keratoconus. Indian J Ophthalmol 2024; 72:745-747. [PMID: 38389247 PMCID: PMC11168540 DOI: 10.4103/ijo.ijo_1205_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/06/2023] [Accepted: 11/07/2023] [Indexed: 02/24/2024] Open
Abstract
Lamellar surgeries have revolutionized our understanding and practice of keratoplasties. However, the learning curve in deep anterior lamellar keratoplasty (DALK) makes it daunting for novice surgeons. This paper describes a unique intraoperative sign - the radial "spike sign," which heralds the commencement of a big bubble in some cases of advanced keratoconus in eyes that have not undergone any previous surgery. The spike sign was noted during big bubble DALK surgery and was then retrospectively looked for in recorded DALK surgical videos and correlated with the formation of a big bubble. The movement of air after injection was classified into the direct formation of a big bubble, stromal emphysema with no big bubble, and emphysema with the spike sign followed by a big bubble. In total, 104 surgical videos of big bubble attempts were evaluated and classified as such. The spike sign helps reduce the number of unnecessary attempts at big bubble formation during DALK, thus improving surgical outcomes.
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Affiliation(s)
- Sharon D’Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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19
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Kodavoor SK, Soundarya B, Dandapani R. Outcomes of deep anterior lamellar keratoplasty in eyes with healed hydrops - A retrospective interventional analysis. Oman J Ophthalmol 2024; 17:210-213. [PMID: 39132099 PMCID: PMC11309547 DOI: 10.4103/ojo.ojo_242_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/25/2023] [Accepted: 05/15/2024] [Indexed: 08/13/2024] Open
Abstract
AIM The aim of the study was to analyze the techniques and outcomes of deep anterior lamellar keratoplasty (DALK) done in eyes with healed hydrops. METHODS Thirty-one eyes with paracentral scars following acute hydrops underwent DALK and were included in the study. Manual layer-by-layer dissection with stromal air injection was done in all cases, keeping dissection of the site of preexisting perforation to the end. RESULTS Out of the 31 eyes, in 28 eyes, DALK could be completed, and in 3 eyes, procedure had to be converted to penetrating keratoplasty. Visual outcomes in all cases were good, with 26 out of 28 eyes (92.8%) achieving a best-corrected visual acuity (BCVA) of 6/12 or better. Preoperative mean BCVA of LogMAR 1.19 ± 0.27 improved to a postoperative mean BCVA of LogMAR 0.23 ± 0.08 (P < 0.00001). Postoperative mean refractive astigmatism at the last follow-up was -2.69 ± 0.82 D with postoperative a spherical equivalent of -2.31 ± 0.7 D. Complications included double anterior chamber in one eye and secondary angle closure in two eyes. Stromal rejection in one eye was managed with steroids and one eye with suture infiltrate needed selective suture removal. CONCLUSION Layer-by-layer dissection with limited air injection into the stroma has shown good visual outcomes in patients undergoing DALK following healed hydrops, and DALK can very well be the primary treatment option even in such cases with a paracentral posthydrops scar.
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Affiliation(s)
| | - B. Soundarya
- Cornea, Cataract and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Ramamurthy Dandapani
- Cornea, Cataract and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
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20
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Nicholson M, Singh VM, Murthy S, Gatinel D, Pereira S, Pradhan A, Vasavada S, Dandekar P, Naik M, Sharma S. Current concepts in the management of cataract with keratoconus. Indian J Ophthalmol 2024; 72:508-519. [PMID: 38389251 PMCID: PMC11149527 DOI: 10.4103/ijo.ijo_1241_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/22/2023] [Indexed: 02/24/2024] Open
Abstract
This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative management, with the aim of providing a simplified overview of treating such patients. Preoperatively, the use of corneal cross-linking, intrastromal corneal ring segments, and topo-guided corneal treatments can help stabilize the cornea and improve the accuracy of biometric measurements. It is important to consider the advantages and disadvantages of traditional techniques such as penetrating keratoplasty and deep anterior lamellar keratoplasty, as well as newer stromal augmentation techniques, to choose the most appropriate surgical approach. Obtaining reliable measurements can be difficult, especially in the advanced stages of the disease. The choice between toric and monofocal intraocular lenses (IOLs) should be carefully evaluated. Monofocal IOLs are a better choice in patients with advanced disease, and toric lenses can be used in mild and stable KCN. Intraoperatively, the use of a rigid gas permeable (RGP) lens can overcome the challenge of image distortion and loss of visual perspective. Postoperatively, patients may need updated RGP or scleral lenses to correct the corneal irregular astigmatism. A thorough preoperative planning is crucial for good surgical outcomes, and patients need to be informed regarding potential postoperative surprises. In conclusion, managing cataracts in KCN patients presents a range of challenges, and a comprehensive approach is essential to achieve favorable surgical outcomes.
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Affiliation(s)
- Maneck Nicholson
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Vivek M Singh
- Department of Cataract and Refractive Surgery, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Telangana, India
| | - Somasheila Murthy
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
- Department of Cataract and Refractive Surgery, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Telangana, India
| | - Damien Gatinel
- Department of Cataract and Refractive Surgery, Rothschild Foundation, Paris, France
| | - Savio Pereira
- Department of Cataract and Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, India
| | | | - Shail Vasavada
- Department of Cataract and Refractive Surgery, Raghudeep Eye Clinic, Ahmedabad, India
| | - Prajakta Dandekar
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Mekhla Naik
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Supriya Sharma
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
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21
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Gómez-Calleja V, Burgos-Blasco B, Méndez-Fernández R, Pérez-García P, Ariño-Gutiérrez M, Borrego-Sanz L, Colino Gallardo AM, Díaz-Valle D. Congenital stromal corneal dystrophy in a Spanish family: Clinical, genetic and histological analysis. J Fr Ophtalmol 2024; 47:104138. [PMID: 38484481 DOI: 10.1016/j.jfo.2024.104138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/10/2023] [Accepted: 11/21/2023] [Indexed: 04/08/2024]
Abstract
PURPOSE To present the clinical, genetic, and histopathological features of the ninth family affected by congenital stromal corneal dystrophy (CSCD) to date. METHODS Twelve cases of a Spanish family affected by CSCD were analyzed regarding history, visual acuity (VA, decimal scale), an ophthalmologic exam and specular microscopy. Five eyes were treated by deep anterior lamellar keratoplasty (DALK), and thirteen eyes by penetrating keratoplasty (PK). In the two last generations, a genetic study was performed. RESULTS Most of the patients affected were born with opaque corneas except for three, whose corneas were clear at birth. Biomicroscopy showed a whitish diffuse stromal opacity with an unaltered epithelium, causing poor VA (from hand motions to 0.4). Patients treated with PK presented mean postoperative VA of 0.19±0.20 over a follow-up time of 235.3±101.4months with 38% recurrences. Patients who underwent DALK experienced VA improvement to 0.17±0.11 over a follow-up time of 10.8±2.6months without signs of recurrence. In the latter, the big bubble technique was not achieved, so a manual technique was performed. The genetic study showed heterozygosis for a 1-bp deletion at nucleotide 962 in exon 8 of the decorin gene. CONCLUSIONS CSCD is a rare entity, which should be treated by DALK whenever possible, obtaining better results than PK. Close monitoring of children of affected individuals is important, because CSCD can progress during the early years of life.
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Affiliation(s)
- V Gómez-Calleja
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - B Burgos-Blasco
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - R Méndez-Fernández
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - P Pérez-García
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - M Ariño-Gutiérrez
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L Borrego-Sanz
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A M Colino Gallardo
- Anatomic Pathology Departament of Hospital Clínico San Carlos, Madrid, Spain
| | - D Díaz-Valle
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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22
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Alfonso-Bartolozzi B, Fernández-Vega-Cueto L, Fernández-Vega L, Martínez-Alberquilla I, Madrid-Costa D, Alfonso JF. Triple Procedure: A Stepwise Combination of Deep Anterior Lamellar Keratoplasty and Cataract Surgery. Cornea 2024; 43:301-306. [PMID: 37603699 DOI: 10.1097/ico.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE The aim of this study was to evaluate clinical outcomes of the combined surgery (triple procedure) of deep anterior lamellar keratoplasty (DALK), phacoemulsification, and intraocular lens (IOL) implantation using a new surgical strategy. METHODS The study included 43 eyes of 43 patients who underwent a triple procedure. Twenty-six eyes with good visibility through the cornea underwent phacoemulsification before the stromal dissection. Seventeen eyes with bad visibility underwent the DALK procedure first until achieving enough visibility to perform the lensectomy. IOL power calculation was performed for a postoperative estimated flat keratometry of 43.5 and aiming to avoid hyperopic postoperative refraction. The postoperative visual examination included uncorrected and corrected distance visual acuity (CDVA) measurements and manifest refraction. RESULTS The mean follow-up time after suture removal was 3.06 ± 2.14 years. Mean CDVA significantly changed from 0.86 ± 0.56 logMAR preoperatively to 0.37 ± 0.28 logMAR in the last visit ( P < 0.0001). The percentage of eyes with CDVA ≤0.3 logMAR changed from 6.9% preoperatively to 62.8%. No eyes lost lines of vision after surgery, and 80% experienced an improvement of 2 or more lines. The safety index was 2.2. The mean postoperative refractive sphere was +0.13 ± 2.04 D, and the postoperative refractive cylinder was -4.02 ± 2.24 D. Only 2 cases (4.65%) obtained postoperative hyperopic astigmatism. No intraoperative complications were found. CONCLUSIONS Combined surgery of DALK, phacoemulsification, and IOL implantation is an effective and safe procedure. Depending on the corneal transparency, different surgical strategies can be established to provide more efficacy and safety.
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Affiliation(s)
| | | | | | - Irene Martínez-Alberquilla
- Clinical and Experimental Eye Research Group (CEER), Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - David Madrid-Costa
- Clinical and Experimental Eye Research Group (CEER), Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - José F Alfonso
- Fernández-Vega Ophthalmological Institute, Oviedo, Spain; and
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23
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Sarnicola E, Sarnicola C, De Bernardo M, Rosa N, Sarnicola V. Cataract surgery in setting of ocular surface disease. Curr Opin Ophthalmol 2024; 35:155-162. [PMID: 38018802 DOI: 10.1097/icu.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the available strategies to successfully identify and manage ocular surface disease (OSD) pre, intra and post-cataract surgery. RECENT FINDINGS Cataract surgery and OSD have an intricate relationship: the surgical procedure can induce or exaggerate OSD symptoms, while OSD can negatively impact surgical refractive outcomes and increase the rate of postoperative complications. SUMMARY Improving the health and stability ocular surface is the key to enhance post cataract surgery refractive outcomes and avoid complications. This is pivotal for patients affected by severe OSD, but is also important for patients with minimal signs or symptoms. A correct diagnosis and a stepwise approach are the keys to improve the quality of life of such patients.
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Affiliation(s)
- Enrica Sarnicola
- Ambulatorio di Chirurgia Oculare Santa Lucia
- Clinica degli Occhi Sarnicola, Grosseto
- Università degli Studi di Salerno, Salerno
| | - Caterina Sarnicola
- Clinica degli Occhi Sarnicola, Grosseto
- Ophthalmology department, Ospedale San Donato AUSL Toscana Sud-Est, Arezzo, Italy
| | | | | | - Vincenzo Sarnicola
- Ambulatorio di Chirurgia Oculare Santa Lucia
- Clinica degli Occhi Sarnicola, Grosseto
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24
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Arun K, Georgoudis P. Pseudomonas Keratitis: From Diagnosis to Successful Deep Anterior Lamellar Keratoplasty. Cureus 2024; 16:e56154. [PMID: 38495968 PMCID: PMC10940118 DOI: 10.7759/cureus.56154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 03/19/2024] Open
Abstract
Pseudomonas keratitis is an aggressive form of bacterial keratitis that can have devastating consequences, such as corneal perforation, if not promptly identified and appropriately managed. The aim of this case report is to highlight key clinical features of Pseudomonas keratitis and evaluate the initial and long-term management options for this condition. We report a case of a 32-year-old female who presented with a large corneal abscess and hypopyon following contact lens wear. Corneal cultures confirmed Pseudomonas as the causative organism and she was treated with topical levofloxacin and gentamycin. Following sterilisation of the corneal ulcer, the patient was left with deep stromal scarring, peripheral corneal thinning as well as four-quadrant deep corneal vascularisation. She was listed for deep anterior lamellar keratoplasty surgery to clear her visual axis. We highlight some of the challenges that were faced both intra-operatively and post-operatively and how they were managed.
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25
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Pagano L, Borgia A, Alfaqawi F, Makuloluwa A, Coco G, Giannaccare G, Messina M, Romano V, Gadhvi K. Endothelial Migration and Regeneration after Penetrating Trauma Injury in a Deep Anterior Lamellar Keratoplasty Graft: Case Presentation and Literature Overview. J Clin Med 2024; 13:1424. [PMID: 38592231 PMCID: PMC10931994 DOI: 10.3390/jcm13051424] [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: 10/30/2023] [Revised: 11/29/2023] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Traumatic injuries in eyes previously treated with Deep Anterior Lamellar Keratoplasty (DALK) can lead to ruptures in the Descemet Membrane (DM) and damage to the corneal endothelium, a crucial layer for maintaining corneal clarity. Due to cell cycle constraints, the human corneal endothelium cannot proliferate; instead, it compensates for injury through cell enlargement and migration from adjacent areas. Methods: This study examines a notable case of corneal endothelial cell migration following a penetrating eye injury in a patient previously treated with DALK for keratoconus, supplemented by a review of relevant literature to contextualize the regenerative response. Results: A 39-year-old male with a history of DALK suffered a traumatic eye injury, resulting in damage to the Descemet Membrane and loss of the crystalline lens. After primary repair and considerations for further surgery, the patient's cornea cleared remarkably, with an improved visual acuity. This demonstrates the DM's potential for self-repair through endothelial cell migration. Conclusions: The outcomes suggest that delaying corneal transplant surgery for up to 3 months following Descemet Membrane injury due to ocular trauma could be advantageous. Allowing time for natural healing processes might eliminate the need for further invasive surgeries, thereby improving patient recovery outcomes.
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Affiliation(s)
- Luca Pagano
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK; (L.P.); (F.A.); (A.M.); (V.R.); (K.G.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alfredo Borgia
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK; (L.P.); (F.A.); (A.M.); (V.R.); (K.G.)
- Eye Unit, Humanitas-Gradenigo Hospital, 10153 Turin, Italy
| | - Fadi Alfaqawi
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK; (L.P.); (F.A.); (A.M.); (V.R.); (K.G.)
| | - Aruni Makuloluwa
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK; (L.P.); (F.A.); (A.M.); (V.R.); (K.G.)
| | - Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Marco Messina
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 61029 Perugia, Italy;
| | - Vito Romano
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK; (L.P.); (F.A.); (A.M.); (V.R.); (K.G.)
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, 25121 Brescia, Italy
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Kunal Gadhvi
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK; (L.P.); (F.A.); (A.M.); (V.R.); (K.G.)
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK
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26
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Spadea L, Di Genova L, Trovato Battagliola E, Scordari S. Descemetic Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty in Advanced Keratoconus: Comparison of Visual and Refractive Outcomes. Ther Clin Risk Manag 2024; 20:127-138. [PMID: 38379850 PMCID: PMC10878317 DOI: 10.2147/tcrm.s441577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To assess and contrast the visual and refractive results of Descemetic deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in the treatment of advanced keratoconus. Design Retrospective, comparative, interventional study. Methods This study enrolled eyes affected by keratoconus with preoperative mean keratometry ≥60 diopters (D) that were treated with either Descemetic DALK (30 eyes) or PK (29 eyes) by using always the same corneal diameters (8.00mm recipient; 8.25mm donor cornea) and the same suture technique (10-0 nylon double-running 12-bites continuous suture). The outcome measures were postoperative uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), subjective refractive astigmatism (SRAst), and keratometric astigmatism at 3mm area (SimK), spherical equivalent (SEq). Results Postoperative visual acuity significantly improved in both groups. Mean CDVA was higher in the DALK group 3 months (DALK 0.61, PK 0.42, p<0.05), 6 months (DALK 0.69, PK 0.44, p<0.05), and 12 months (DALK 0.72, PK 0.45, p<0.05) postoperatively. However, 6 months after suture removal, CDVA was not statistically different between the two groups (DALK 0.71, PK 0.75, p>0.05). Final SRAst and SimK also were comparable between the two groups (respectively DALK 2.97, PK:2.81, p>0.05; DALK 3.91, PK 2.37, p>0.05). No significant statistical differences were noted for UCVA and SEq data during the entire follow-up period between the two groups. Conclusion Both methods of corneal transplantation resulted in a notable enhancement of visual and refractive outcomes in eyes afflicted by advanced keratoconus. Descemetic DALK demonstrated superior visual acuity before suture removal, whereas DALK and PK exhibited comparable results in terms of visual acuity, refractive correction, and keratometric astigmatism after suture removal.
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Affiliation(s)
- Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Lucia Di Genova
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | | | - Stefano Scordari
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
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27
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Schöneberger V, Tahmaz V, Matthaei M, Roters S, Schlereth SL, Schaub F, Cursiefen C, Bachmann BO. Allogeneic limbo-deep anterior lamellar keratoplasty (Limbo-DALK)-A novel surgical technique in corneal stromal disease and limbal stem cell deficiency. PLoS One 2024; 19:e0298241. [PMID: 38346049 PMCID: PMC10861080 DOI: 10.1371/journal.pone.0298241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/21/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE To describe a novel corneal surgical technique combining Deep Anterior Lamellar Keratoplasty (DALK) with grafting of allogeneic limbus (Limbo-DALK) for the treatment of eyes with corneal stromal pathology and limbal stem cell deficiency (LSCD). METHODS Clinical records of six Limbo-DALKs performed in five patients diagnosed with LSCD and corneal stromal pathology requiring keratoplasty were retrospectively reviewed. All patients were diagnosed with LSCD due to various pathologies including thermal and chemical burns, congenital aniridia or chronic inflammatory ocular surface disease. Parameters analysed included demographics, diagnoses, clinical history, thickness measurements using anterior segment OCT, visual acuity, and epithelial status. Regular follow-up visits were scheduled at 6 weeks as well as 3, 6, 9, and 12 and 18 months postoperatively. Main outcome measures were time to graft epithelialisation and the occurrence of corneal endothelial decompensation. RESULTS Two grafts showed complete epithelial closure at 2 days, two at 14 days. In one eye, complete epithelial closure was not achieved after the first Limbo-DALK, but was achieved one month after the second Limbo-DALK. No endothelial decompensation occurred except in one patient with silicone oil associated keratopathy. Endothelial graft rejection was not observed in any of the grafts. CONCLUSION Based on the data from this pilot series, limbo-DALK appears to be a viable surgical approach for eyes with severe LSCD and corneal stromal pathology, suitable for emergency situations (e.g. corneal ulceration with impending corneal perforation), while minimising the risk of corneal endothelial decompensation.
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Affiliation(s)
- Verena Schöneberger
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Volkan Tahmaz
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mario Matthaei
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sigrid Roters
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simona L. Schlereth
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Ophthalmology, University Medical Centre Rostock, Rostock, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Björn O. Bachmann
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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28
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Pellegrini M, Yu AC, Spena R, Bovone C, Zauli G, Busin M. Outcomes of large-diameter deep anterior lamellar keratoplasty and converted two-piece mushroom penetrating keratoplasty for herpetic corneal scars. Eye (Lond) 2024; 38:614-619. [PMID: 37726333 PMCID: PMC10858060 DOI: 10.1038/s41433-023-02744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE To report the clinical outcomes of large diameter deep anterior lamellar keratoplasty (DALK) and converted two-piece microkeratome-assisted mushroom keratoplasty (MK) for herpetic corneal scars. METHODS In this single-centre study, large diameter (9 mm) DALK was attempted in consecutive patients with herpetic corneal scars. In case of macroperforation or unsatisfactory clearance of the optical zone, the procedure was intraoperatively converted to two-piece microkeratome-assisted MK. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, endothelial cell density (ECD), immunologic rejection, herpetic recurrence and graft failure rates in the two groups. RESULTS DALK was successfully performed in 98 of 120 eyes, while the remaining 22 eyes required intraoperative conversion to MK. At 5 years, mean logMAR BSCVA was 0.10 ± 0.12 in the DALK group and 0.09 ± 0.15 in the MK group (P = 0.75). Refractive astigmatism at 5 years was 2.8 ± 1.4 D in the DALK group and 3.0 ± 1.7 D in the MK group (P = 0.67). ECD was higher in the DALK group than in the MK group at all time points (P < 0.001), with a mean annual cell loss of 10.9% after MK and 4.2% after DALK. The 5-year risk for immunologic rejection (DALK: 3%, MK: 5%, P = 0.38), herpetic recurrence (DALK: 6%, MK: 9%, P = 0.38), and graft failure (DALK: 4%, MK: 5%, P = 0.75) were comparable in both groups. CONCLUSION Large diameter (9 mm) DALK yields excellent visual and clinical outcomes in eyes with herpetic corneal scars. In case of intraoperative complications, DALK can be converted to two-piece microkeratome-assisted MK to maximize the refractive benefit of a large diameter graft while minimizing the risk of endothelial failure.
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Affiliation(s)
- Marco Pellegrini
- University of Ferrara, Department of Translational Medicine, Ferrara, Italy
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Angeli Christy Yu
- University of Ferrara, Department of Translational Medicine, Ferrara, Italy
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Rossella Spena
- University of Ferrara, Department of Translational Medicine, Ferrara, Italy
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Cristina Bovone
- University of Ferrara, Department of Translational Medicine, Ferrara, Italy
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Giorgio Zauli
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Massimo Busin
- University of Ferrara, Department of Translational Medicine, Ferrara, Italy.
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.
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Navia JC, Carletti P, Camacho M, Dubovy SR, Martinez JD. Quintuple Procedure for Ocular Surface Reconstruction and Visual Rehabilitation. Cornea 2024; 43:265-268. [PMID: 37603688 PMCID: PMC10841305 DOI: 10.1097/ico.0000000000003365] [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: 03/07/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE The aim of this study was to describe a combined surgical approach for ocular surface and visual rehabilitation in patients with limbal stem cell deficiency, corneal scarring, and cataract. We aimed to introduce this combined approach as an alternative to a staged approach and to describe the intraoperative use of a diamond ophthalmic burr (DOB) and optical coherence tomography (OCT) to achieve and confirm a smooth graft-host interface during the anterior lamellar keratoplasty (ALK) portion of the procedure. METHODS The quintuple procedure described herein consists of a modified ALK, cataract extraction, intraocular lens implantation, simple limbal epithelial transplantation, and temporal tarsorrhaphy. Intraoperative OCT and DOB were used to guide the creation of the stromal bed during the ALK. The procedure was performed in a patient with limbal stem cell deficiency and corneal scarring after a chemical ocular burn. RESULTS The tarsorrhaphy was removed at 3 months postoperatively once complete corneal epithelialization was observed. The best-corrected visual acuity improved from light perception preoperatively to 20/30 at 16 months postoperatively with the use of scleral contact lenses. At this postoperative time point, the cornea was clear and compact, and the ocular surface was stable. CONCLUSIONS The quintuple procedure allowed for visual and ocular surface rehabilitation in cases in which follow-up for a staged approach was not possible. Intraoperative OCT allowed for real-time visualization and dissection of the stromal bed, whereas the use of the DOB helped achieve a smooth stromal surface for an optimal graft-host interface.
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Affiliation(s)
- Juan Carlos Navia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Piero Carletti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Matthew Camacho
- Florida Lions Ocular Pathology Laboratory, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Florida Lions Ocular Pathology Laboratory, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Jaime D. Martinez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Naples, FL, USA
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Mudaraddi N, Radhakrishnan N, Prajna NV, Kochar P. A rare case of acute stromal rejection following deep anterior lamellar keratoplasty in a steroid responder with keratoconus and vernal keratoconjunctivitis. Indian J Ophthalmol 2024; 72:145-147. [PMID: 38131596 PMCID: PMC10841782 DOI: 10.4103/ijo.ijo_1799_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Ninad Mudaraddi
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Naveen Radhakrishnan
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - N Venkatesh Prajna
- Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Prabhleen Kochar
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Kapur N, Chatterjee S, Gomase SN, Khurana A, Parmar G, Sangwan VS. Preferred practice patterns for keratoconus: An e-survey among Indian cornea specialists. Indian J Ophthalmol 2024; 72:111-117. [PMID: 38131580 PMCID: PMC10841772 DOI: 10.4103/ijo.ijo_817_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE This study aimed to report practice patterns in the management of keratoconus in India. METHODS An e-survey was conducted among members of the Cornea Society of India to assess preferred practice patterns for keratoconus. RESULTS Of the 912 members, 234 (25.7%) completed the survey. About 88.4% worked in private eye care facilities and 76.1% in cities. Of all the respondents, 91.5% had access to a Scheimpflug-based device or an Orbscan II®; 71.4% of the respondents dispensed scleral contact lenses, and 66.7% dispensed Rose K contact lenses; 92.7% of the respondents performed corneal cross-linking (CXL); and 73.1% of the respondents performed deep anterior lamellar keratoplasty (DALK). A Scheimpflug device or Orbscan II®, Rose K or scleral contact lenses, and CXL were more readily available (P < 0.05) in private eye care facilities. The diagnostic criteria for keratoconus followed by the majority of the respondents (52.1%) were increase in corneal curvature, elevation, and thickness. An increase in keratometry values greater than 0.5 or 1.0D in a 6-month to 1-year period was considered the most favored criterion for keratoconus progression. Epithelium-off, 0.1% riboflavin solution in dextran, and accelerated protocol were the more commonly reported techniques in CXL. About 77.2% of the respondents routinely performed CXL in corneas <400 microns thick. Spectacles (91.0% of the respondents) and topography-guided photorefractive keratectomy (37.6% of the respondents) were, respectively, the preferred optical and surgical methods used to improve vision. CONCLUSION While keratoconus management in India is comparable to other developed healthcare systems, the concentration of trained corneal surgeons in cities and private eyecare facilities may lead to less equitable distribution of treatment across the country.
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Affiliation(s)
- Neha Kapur
- Department of Cornea and Anterior Segment, Dr Shroff’s Charity Eye Hospital, New Delhi, India
| | - Samrat Chatterjee
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Sharad Nivrutti Gomase
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Ashi Khurana
- Department of Cornea and Anterior Segment, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Gautam Parmar
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Virendra Singh Sangwan
- Department of Cornea and Anterior Segment, Dr Shroff’s Charity Eye Hospital, New Delhi, India
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Yu AC, Sollazzo A, Bovone C, Busin M. Large-diameter deep anterior lamellar keratoplasty: A narrative review. Taiwan J Ophthalmol 2024; 14:27-33. [PMID: 38654986 PMCID: PMC11034690 DOI: 10.4103/tjo.tjo-d-23-00161] [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: 10/23/2023] [Accepted: 01/01/2024] [Indexed: 04/26/2024] Open
Abstract
Deep anterior lamellar keratoplasty (DALK) involves the selective replacement of diseased corneal stroma while preserving healthy unaffected endothelium. While DALK has failed to gain widespread popularity, improved visual and refractive outcomes of large-diameter grafts, which patients directly perceive following suture removal, may represent a compelling reason to shift toward DALK. Since the unaffected host endothelium is retained, DALK offers the opportunity to use large-diameter grafts, which reliably achieves maximum visual potential without an increased risk of immune-mediated stromal rejection. In this narrative review, we evaluate the current evidence on large-diameter DALK including surgical technique and clinical outcomes.
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Affiliation(s)
- Angeli Christy Yu
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Andrea Sollazzo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Cristina Bovone
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Massimo Busin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
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Soiberman US, Jun AS. More support for deep anterior lamellar keratoplasty over penetrating keratoplasty for keratoconus, but questions remain. Br J Ophthalmol 2023; 108:1-2. [PMID: 37890881 DOI: 10.1136/bjo-2023-324685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Du YL, Wang JS, Geng W, Duan CY, Wang XH, Xie HT, Zhang MC. Amniotic membrane transplantation combined with conjunctival flap covering surgery for the treatment of corneal perforations in fungal keratitis. Heliyon 2023; 9:e22693. [PMID: 38107269 PMCID: PMC10724658 DOI: 10.1016/j.heliyon.2023.e22693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To investigate the efficiency of amniotic membrane transplantation (AMT) combined with conjunctival flap covering surgery (CFCS) for patients with corneal perforations in fungal keratitis (FK). Methods In this non-comparative, retrospective case series, 16 participants of corneal perforation in FK were successfully treated by a combination of multilayer AMT and bipedicle conjunctival flap with partial tenon's capsule. Corneal healing, recurrence of FK, visual acuity, and relevant complications were reported as outcome measures. Results Sixteen patients (13 male, 3 female) had a mean age of 58.8 ± 10.3 (range 29-72) years. The mean diameter of corneal perforation was 1.9 ± 0.7 (range 0.5-2.8) mm. Corneal perforations healed and all the patients preserved their eyeballs. During the 11.0 ± 4.4 (range 6-18) months of follow-up, there was no recurrence of FK in any of these cases. Visual acuity improved in 15 eyes (93.8 %) and remained unchanged in 1 patient (6.3 %) who had no light perception when first admitted. All 6 patients who accepted secondary keratoplasty showed improved best corrected visual acuity of more than 4 lines. The most frequently found fungi were Aspergillus species (6 of 16, 37.5 %) and Fusarium species (4 of 16, 25.0 %), followed by 1 Scedosporium apiospermum (1 of 16, 6.3 %). Conclusions Combination AMT with CFCS is a safe and effective surgery for patients with corneal perforations in FK, particularly where eye banks and fresh corneas are not available. This surgery could preserve the integrity of the eyeball and avoid the recurrence of FK. Besides, it provides a greater opportunity for further optical keratoplasty.
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Affiliation(s)
- Ya-Li Du
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wen Geng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chao-Ye Duan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xing-Hua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Du K, Liu E, Li N, Yuan B, Peng R, Hong J. Comparison of Femtosecond Laser Assistance and Manual Trephination in Deep Anterior Lamellar Keratoplasty in the Treatment of Keratoconus: A Meta-Analysis. Am J Ophthalmol 2023; 256:126-137. [PMID: 37553035 DOI: 10.1016/j.ajo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To compare the efficacy and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) with those of manual-trephination DALK (M-DALK) in treating keratoconus. DESIGN Systematic review and meta-analysis. METHODS Through November 2022, we comprehensively searched PubMed, EMBASE, the Cochrane Library, and 4 Chinese databases. Studies that involved comparisons between F-DALK and M-DALK groups and that reported on relevant efficacy and/or safety parameters were included. Primary outcomes were uncorrected- and corrected-distance visual acuity and intraoperative complication rates. Secondary outcomes were spherical equivalent, topographic astigmatism, refractive cylinder, mean keratometry, endothelial cell density, suture removal time, and postoperative complication rates. These data were analyzed using Cochrane Review Manager software version 5.3. RESULTS This meta-analysis included 9 nonrandomized controlled studies involving 1713 eyes. In eyes treated with F-DALK, corrected-distance visual acuity at 1 to 6 months (weighted mean difference = -0.07 [95% confidence interval {CI} -0.10 to -0.03]; I2 = 0%; P < .001) after surgery was better and intraoperative Descemet membrane perforation occurred less often (odds ratio = 0.53 [95% CI 0.31-0.92]; I2 = 6%; P = .02) than in eyes treated with M-DALK. No clinically significant differences in other outcomes were found among the groups. CONCLUSIONS Both F-DALK and M-DALK are safe and efficacious for patients with keratoconus. Compared with M-DALK, F-DALK can provide better early visual acuity and reduce the intraoperative perforation rate, and its likely improvements to long-term visual quality and endothelial cell preservation warrant further investigation. In addition, the 2 techniques seem to be comparable regarding refractive outcomes and other complications.
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Affiliation(s)
- Kaiyue Du
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Enshuo Liu
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Nan Li
- Peking University Third Hospital (N.L.), Beijing, China
| | - Bowei Yuan
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Rongmei Peng
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China
| | - Jing Hong
- Department of Ophthalmology (K.D., E.L., B.Y., R.P., J.H.), Peking University Third Hospital, Beijing, China; Key Laboratory of Vision Loss and Restoration (K.D., E.L., B.Y., R.P., J.H.), Ministry of Education, Beijing, China.
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Dua HS, Freitas R, Mohammed I, Ting DSJ, Said DG. The pre-Descemet's layer (Dua's layer, also known as the Dua-Fine layer and the pre-posterior limiting lamina layer): Discovery, characterisation, clinical and surgical applications, and the controversy. Prog Retin Eye Res 2023; 97:101161. [PMID: 36642673 DOI: 10.1016/j.preteyeres.2022.101161] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
The pre-Descemet's layer/Dua's layer, also termed the Dua-Fine layer and the pre-posterior limiting lamina layer, lies anterior to the Descemet's membrane in the cornea, is 10 μm (range 6-16) thick, made predominantly of type I and some type VI collagen with abundant elastin, more than any other layer of the cornea. It has high tensile strength (bursting pressure up to 700 mm of Hg), is impervious to air and almost acellular. At the periphery it demonstrates fenestrations and ramifies to become the core of the trabecular meshwork, with implications for intraocular pressure and glaucoma. It has been demonstrated in some species of animals. The layer has assumed considerable importance in anterior and posterior lamellar corneal transplant surgery by improving our understanding of the behaviour of corneal tissue during these procedures, improved techniques and made the surgery safer with better outcomes. It has led to the innovation of new surgical procedures namely, pre-Descemet's endothelial keratoplasty, suture management of acute hydrops, DALK-triple and Fogla's mini DALK. The discovery and knowledge of the layer has introduced paradigm shifts in our age old concepts of Descemet's membrane detachment, acute corneal hydrops in keratoconus and Descemetoceles, with impact on management approaches. It has been shown to contribute to the pathology and clinical signs observed in corneal infections and some corneal dystrophies. Early evidence suggests that it may have a role in the pathogenesis of keratoconus in relation to its elastin content. Its contribution to corneal biomechanics and glaucoma are subjects of current investigations.
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Affiliation(s)
- Harminder S Dua
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Rui Freitas
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal.
| | - Imran Mohammed
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Darren S J Ting
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Dalia G Said
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK; Research Institute of Ophthalmology, Cairo, Egypt.
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Romano D, Aiello F, Parekh M, Levis HJ, Gadhvi KA, Moramarco A, Viola P, Fontana L, Semeraro F, Romano V. Incidence and management of early postoperative complications in lamellar corneal transplantation. Graefes Arch Clin Exp Ophthalmol 2023; 261:3097-3111. [PMID: 37103622 PMCID: PMC10134734 DOI: 10.1007/s00417-023-06073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK). METHODS A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review. RESULTS Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome. CONCLUSION It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes.
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Affiliation(s)
- Davide Romano
- Ophthalmology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kunal A Gadhvi
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pietro Viola
- Department of Ophthalmology, San Bartolo Hospital, Vicenza, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Semeraro
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Vito Romano
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy.
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Lucisano A, Scorcia V, Taloni A, Rossi C, Gioia R, Giannaccare G. Impact of topographic localization of corneal ectasia on the outcomes of deep anterior lamellar keratoplasty employing large (9 mm) versus conventional diameter (8 mm) grafts. Eye (Lond) 2023; 37:3477-3483. [PMID: 37081075 PMCID: PMC10630389 DOI: 10.1038/s41433-023-02536-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES Visual and topographic outcomes of large (9.0 mm) versus conventional (8.0 mm) deep anterior lamellar keratoplasty (DALK) for the treatment of keratoconus (KC) were compared in relation to the different localization of the corneal ectasia (within or beyond the central 8.0 mm). METHODS This is a retrospective, comparative case series. Preoperatively, the topographic extension of the conus was calculated by measuring the distance from the geometric center of the cornea and the outermost point of the corneal ectasia (ectasia <8.0 mm, group A; ectasia ≥8.0 mm, group B). DALK was performed using both small grafts (8.0 mm, group 1) and large grafts (9.0 mm, group 2). Best-corrected visual acuity and topographic astigmatism were evaluated preoperatively (T0) and postoperatively after complete suture removal (1 year, T1). RESULTS Data from 224 eyes of 196 patients (mean age 37.6 ± 15.1 years) were evaluated. Topographic astigmatism improved from T0 to T1 (4.94 ± 2.92 diopters (D) [95% CI, 4.56-5.33] vs 4.19 ± 2.45 D [95% CI, 3.87-4.51], p = 0.001). There was no significant difference in postoperative topographic cylinder between group 1 and group 2 when considering eyes with corneal ectasia <8.0 mm (group 1 A, 4.15 ± 2.19 D [95% CI, 3.64-4.66] vs group 2 A, 3.65 ± 2.13 D [95% CI, 2.92-4.38], p = 0.14); conversely, the difference was significant considering eyes with corneal ectasia ≥8.0 mm (group 1B, 4.74 ± 2.90 D [95% CI, 4.09-5.38] vs group 2B, 3.68 ± 1.94 D [95% CI, 3.10-4.26], p = 0.02). CONCLUSIONS Large 9.0-mm DALK provided better anatomical outcomes compared to conventional 8.0-mm DALK, particularly in eyes with corneal ectasia extending beyond the central 8.0 mm.
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Affiliation(s)
- Andrea Lucisano
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy.
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Raffaella Gioia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
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Pedrotti E, Bonacci E, Fasolo A, Fraccaroli S, Anastasi M, Vinciguerra R, Vinciguerra P, Giorgio M. Meniscus-Shaped Stromal Lenticule Addition Keratoplasty for Corneal Regularization and Thickening in Advanced Keratoconus. Cornea 2023; 42:1221-1228. [PMID: 36156527 DOI: 10.1097/ico.0000000000003144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to investigate the outcome of the meniscus-shaped stromal lenticule addition keratoplasty (MS-SLAK) in corneal regularization and thickness. METHODS Patients waiting for deep anterior lamellar keratoplasty for advanced keratoconus with an intolerance to contact lenses (CLs) underwent the MS-SLAK procedure by FSL 80 kHz ablation (VICTUS, Technolas Perfect Vision, DE). Customized positive meniscus-shaped stromal lenticules were obtained and implanted. Examination was performed at baseline and at 3-, 6-, and 12-month follow-up and included corrected distance visual acuity both with spectacles and CLs (spectacle CDVA and CL-CDVA), manifest refraction spherical equivalent, slit-lamp examination, anterior segment optical coherence tomography, corneal topography, and in vivo confocal microscopy. RESULTS Fifteen patients completed the study. Statistical increases in corneal thickness values were found from the first follow-up ( P < 0.001). Improvement in the Surface Asymmetry Index ( P = 0.04), Symmetry Index ( P = 0.02), spherical aberration ( P < 0.001), coma ( P = 0.18), high-order aberration ( P = 0.37), and anterior asphericity index (Q) ( P = 0.31) were found at 12 months. At the 12-month follow-up, no improvement were found in spectacle CDVA ( P = 0.23); however, all patients reported CL wearing tolerance recovery, and significant improvement in CL-CDVA ( P = 0.002) was found. The confocal microscopy at 12 months showed a significant increase in keratocyte density within the lenticule and absence of fibrotic reactions in both anterior and posterior interfaces. CONCLUSIONS MS-SLAK seems to be effective in regularizing the corneal surface as showed by the significant improvement in topographic symmetry indices, coma, and high-order aberration. The corneal regularization is also confirmed by the results in anterior Q and the recovery of the CL wearing tolerance.
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Affiliation(s)
- Emilio Pedrotti
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Erika Bonacci
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Adriano Fasolo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sebastiano Fraccaroli
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Anastasi
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Paolo Vinciguerra
- IRCCS Humanitas Research Hospital, Milan, Italy; and
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Marchini Giorgio
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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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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Sorkin N, Hatch W, Mimouni M, Chew HF, Rootman DS, Slomovic AR, Bujak MC, Chan CC, Thorpe KE, Perez M, Stiuso V, Singal N. A randomized controlled trial comparing femtosecond-enabled deep anterior lamellar keratoplasty and standard deep anterior lamellar keratoplasty (FEDS Study). Eye (Lond) 2023; 37:2693-2699. [PMID: 36693916 PMCID: PMC10482827 DOI: 10.1038/s41433-023-02387-1] [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: 10/01/2022] [Revised: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To compare outcomes of femtosecond-enabled deep anterior lamellar keratoplasty (FE-DALK) and standard deep anterior lamellar keratoplasty (S-DALK). METHODS An open label, randomized controlled trial (Kensington Eye Institute, Toronto, ON, Canada) including 100 eyes of 97 participants with either keratoconus or corneal scarring, randomized to either FE-DALK (n = 48) or S-DALK (n = 49). PRIMARY OUTCOMES postoperative astigmatism and surgically induced corneal astigmatism (SIA) - both at 15 months. SECONDARY OUTCOMES 6-, 12- and 15-month postoperative uncorrected- and best spectacle-corrected visual acuity, steep and flat keratometry, manifest sphere and astigmatism, rate of conversion to penetrating keratoplasty (PK), big-bubble success, central corneal thickness, endothelial cell count and complications. RESULTS In intention-to-treat analysis, mean postoperative astigmatism in the FE-DALK (n = 30) and S-DALK (n = 30) groups at 15 months was 7.8 ± 4.4 D and 6.3 ± 5.0 D, respectively (p = 0.282) with an adjusted mean difference of 1.3 D (95% CI -1.08, +3.65). Mean SIA (arithmetic) was 9.2 ± 7.8 and 8.8 ± 5.4 D, respectively (p = 0.838) with a mean difference of 0.4 D (95% CI -3.13, +3.85). In an analysis of successful DALK cases only, mean postoperative astigmatism in the FE-DALK (n = 24) and S-DALK (n = 20) groups at 15 months (after excluding 4 eyes with AEs) was 7.3 ± 4.4 and 6.2 ± 4.9 D, respectively (p = 0.531) with an adjusted mean difference of 0.9 D (95% CI -1.94, +3.71). Mean SIA (arithmetic) was 9.1 ± 7.8 and 7.9 ± 4.6 D, respectively (p = 0.547) with a mean difference of 1.2 D (95% CI -2.70,+5.02). Comparison of secondary outcomes showed only weak statistical evidence. CONCLUSIONS In this randomized controlled trial, FE-DALK and S-DALK showed comparable functional and anatomical outcomes.
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Affiliation(s)
- Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Wendy Hatch
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, Rambam Health Care Campus affiliated with the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Matthew C Bujak
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre (AHRC), Toronto, ON, Canada
| | - Mauricio Perez
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Vera Stiuso
- Kensington Eye Institute, Toronto, ON, Canada
| | - Neera Singal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
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Zheng N, He W, Zhu S. Incidence of wound dehiscence after keratoplasty: a meta-analysis of observational studies. Front Med (Lausanne) 2023; 10:1187555. [PMID: 37711746 PMCID: PMC10498922 DOI: 10.3389/fmed.2023.1187555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023] Open
Abstract
Background The comprehensive investigation of the association between keratoplasty and wound dehiscence remains limited, despite corneal disease being a leading cause of visual impairment. Methods A meticulous search strategy was executed across prominent databases such as Web of Science, PubMed, Cochrane Library, and Embase. Data relevant to our research objective were extracted from eligible studies. The methodological quality of each study was assessed using the ROBINS-I tool, while statistical analysis was conducted utilizing STATA 17.0. To evaluate potential publication bias, the Funnel plot and Egger's test were employed. Results A total of 11 articles were deemed suitable for inclusion in our analysis. Our findings indicate that the overall incidence of wound dehiscence following keratoplasty was estimated to be 1.9% (95% CI: 0.013, 0.026), although substantial heterogeneity was observed (I2 = 72.798%). Notably, developed countries exhibited a higher incidence of wound dehiscence compared to their developing counterparts. Furthermore, the occurrence of wound dehiscence was found to be lower in deep anterior lamellar keratoplasty (DALK) procedures when compared to penetrating keratoplasty (PK). Analysis utilizing Egger's linear regression method yielded no evidence of publication bias (p = 0.91). Moreover, within the first year post-keratoplasty, approximately 31.4% of patients experienced wound dehiscence (95% CI: 0.149, 0.503), and 43.1% exhibited a decline in best-corrected visual acuity (BCVA) (95% CI, 0.341, 0.522). Conclusion The results of our study unveiled the occurrence rate of wound dehiscence following keratoplasty, exhibiting variations based on economic level and the specific surgical procedure employed. Furthermore, onset time of wound dehiscence and visual acuity warrant consideration.
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Affiliation(s)
- Na Zheng
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenjing He
- Big Data Research Center, University of Electronic Science and Technology, Chengdu, China
| | - Siquan Zhu
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Panthagani J, Law EM, Chipeta C, Roberts H, Myerscough J. High Astigmatism After Conventional Diameter Deep Anterior Lamellar Keratoplasty in Keratoconus Can Be Successfully Managed With Repeat Wide Diameter Deep Anterior Lamellar Keratoplasty. Cornea 2023; 42:1057-1061. [PMID: 37126842 DOI: 10.1097/ico.0000000000003298] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to describe a new surgical technique to replace a conventional diameter (≤8 mm) deep anterior lamellar keratoplasty (DALK) graft with associated high astigmatism refractory to corneal-based astigmatic procedure/intolerance to contact lenses with a larger diameter (≥9 mm) DALK graft to improve best spectacle-corrected visual acuity (BSCVA). METHODS Two eyes from 2 keratoconic patients at Southend University Hospital between December 2019 and June 2021 with a minimum follow-up of 17 months were evaluated. The primary outcome of interest was Snellen BSCVA with a secondary outcome of topographic cylinder. RESULTS Patient 1 had undergone initial 8 mm diameter DALK, with residual keratometric astigmatism of nearly 12 diopters (D) postoperatively despite numerous astigmatic interventions, with a BSCVA of 6/60, before undergoing 9 mm diameter repeat modified DALK. After suture removal and subsequent in-the-wound blunt manual relaxing incisions, the patient had a final keratometric astigmatism of 3.5 D, manifest refraction of plano/-3.50 × 175, and a BSCVA of 6/9. Patient 2 had undergone initial 7.75 mm diameter DALK, with residual keratometric astigmatism of 10.5 D with a BSCVA of counting fingers. The patient underwent 9 mm repeat modified DALK with final residual keratometric astigmatism of 3.1 D after suture removal, manifest refraction of -1.00/-2.75 × 25, and BSCVA of 6/9. CONCLUSIONS Wide diameter DALK (>9 mm) is effective in the management of conventional diameter DALK (≤8 mm) associated high astigmatism in keratoconus. Creation of a peripheral posterior stromal shoulder also allows safe further titration of residual astigmatism if needed.
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Affiliation(s)
- Jesse Panthagani
- Department of Ophthalmology, Southend NHS University Hospital, Southend-on-Sea, United Kingdom
| | - Elizabeth M Law
- Department of Ophthalmology, Southend NHS University Hospital, Southend-on-Sea, United Kingdom
| | - Chimwemwe Chipeta
- Department of Ophthalmology, Southend NHS University Hospital, Southend-on-Sea, United Kingdom
| | - Harry Roberts
- West of England Eye Unit, Royal Devon University Healthcare, NHS Foundation Trust, Exeter, United Kingdom; and
| | - James Myerscough
- Department of Ophthalmology, Southend NHS University Hospital, Southend-on-Sea, United Kingdom
- University of Plymouth, Faculty of Medicine and Dentistry, United Kingdom
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Montolío-Marzo E, Díaz-Valle D, Burgos-Blasco B, Etxabe H, Gegúndez-Fernández JA. Spontaneous Descemet Layer Dissection Without Pneumodissection in Femtosecond Laser-Assisted Mushroom-Type Deep Anterior Lamellar Keratoplasty. Cornea 2023; 42:1045-1048. [PMID: 36707916 DOI: 10.1097/ico.0000000000003232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this study was to describe a case of spontaneous Descemet layer dissection without pneumodissection in femtosecond laser-assisted mushroom-type deep anterior lamellar keratoplasty. METHODS This study is a case report. RESULTS A 46-year-old woman diagnosed with reticular dystrophy underwent, in her left eye, mushroom configuration femtosecond laser-assisted DALK (F-DALK). After laser trephination and removal of the superficial stroma using manual dissection, a type 2 BB formation was observed intraoperatively in the AS-OCT without signs of an associated microperforation. A deeper stromal removal was accomplished by layer-by-layer manual dissection, while the BB persisted. After stromal dissection, the donor cornea was secured with 8 interrupted 10-0 nylon sutures. The next day AS-OCT showed a detachment of DM. After 1 week, a spontaneous resolution of the DM detachment was observed. CONCLUSIONS This unknown F-DALK intraoperative complication has been detected through intraoperative AS-OCT images which may improve our understanding of F-DALK surgery and possible complications associated with femtolaser-assisted procedures.
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Affiliation(s)
- Elena Montolío-Marzo
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
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Deshmukh R, Ong ZZ, Rampat R, Alió del Barrio JL, Barua A, Ang M, Mehta JS, Said DG, Dua HS, Ambrósio R, Ting DSJ. Management of keratoconus: an updated review. Front Med (Lausanne) 2023; 10:1212314. [PMID: 37409272 PMCID: PMC10318194 DOI: 10.3389/fmed.2023.1212314] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Keratoconus is the most common corneal ectatic disorder. It is characterized by progressive corneal thinning with resultant irregular astigmatism and myopia. Its prevalence has been estimated at 1:375 to 1:2,000 people globally, with a considerably higher rate in the younger populations. Over the past two decades, there was a paradigm shift in the management of keratoconus. The treatment has expanded significantly from conservative management (e.g., spectacles and contact lenses wear) and penetrating keratoplasty to many other therapeutic and refractive modalities, including corneal cross-linking (with various protocols/techniques), combined CXL-keratorefractive surgeries, intracorneal ring segments, anterior lamellar keratoplasty, and more recently, Bowman's layer transplantation, stromal keratophakia, and stromal regeneration. Several recent large genome-wide association studies (GWAS) have identified important genetic mutations relevant to keratoconus, facilitating the development of potential gene therapy targeting keratoconus and halting the disease progression. In addition, attempts have been made to leverage the power of artificial intelligence-assisted algorithms in enabling earlier detection and progression prediction in keratoconus. In this review, we provide a comprehensive overview of the current and emerging treatment of keratoconus and propose a treatment algorithm for systematically guiding the management of this common clinical entity.
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Affiliation(s)
- Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Zun Zheng Ong
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Radhika Rampat
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jorge L. Alió del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Dalia G. Said
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Harminder S. Dua
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Renato Ambrósio
- Department of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Darren Shu Jeng Ting
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Yasu-Mimura R, Hirayama M, Kasamatsu H, Yamaguchi T, Shimazaki J. Etiology-Specific Comparison of the Long-Term Clinical Outcome of Repeat Deep Anterior Lamellar Keratoplasty for Optical Indications. Cornea 2023; 42:598-606. [PMID: 36727893 DOI: 10.1097/ico.0000000000003189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/24/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to evaluate the etiology-specific clinical outcomes and complications of repeat deep anterior lamellar keratoplasty (DALK) after failed DALK. METHODS This retrospective case study included 32 eyes of 27 patients who underwent repeat DALK of 450 cases of DALK performed for optical indications between 1997 and 2013. The patients were divided into 4 etiology-specific subgroups (the corneal dystrophy, ocular surface disease, stromal scar, and others) or those with or without limbal stem cell deficiency (LSCD). The clinical outcomes evaluated were graft survival, best-corrected visual acuity, endothelial cell density, and complications. RESULTS The mean postoperative follow-up duration was 69.6 ± 54.8 months. The 1-, 3-, and 5-year overall graft survival rate were 76.7%, 57.5%, and 38.8% respectively. The graft survival rate was the highest in the corneal dystrophy group ( P = 0.0014) and was significantly ( P = 0.0010) higher in eyes without LSCD than in eyes with LSCD. There were no significant differences in the graft survival rates between the previous and current DALK groups. The postoperative best-corrected visual acuity of all subjects improved significantly. The postoperative endothelial cell density did not decrease after repeat DALK. There were no significant differences in the incidence of complications between patients with and without LSCD, except the incidence of persistent epithelial defects. CONCLUSIONS Repeat DALK had favorable outcomes in all etiology-specific groups, whereas eyes with LSCD required careful assessment of the ocular surface to avoid graft failure due to persistent epithelial defects.
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Affiliation(s)
- Ririko Yasu-Mimura
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masatoshi Hirayama
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan ; and
| | - Hirotsugu Kasamatsu
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
- Department of Ophthalmology, School of Medicine, Shinsyu University, Nagano, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Shin JD, Mahesh S. Deep anterior lamellar keratoplasty (DALK) interface neovascularization: An unusual complication. J Fr Ophtalmol 2023:S0181-5512(23)00117-1. [PMID: 37076390 DOI: 10.1016/j.jfo.2022.11.018] [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: 08/17/2022] [Revised: 10/16/2022] [Accepted: 11/11/2022] [Indexed: 04/21/2023]
Abstract
We present a case of a 31-year-old male with a past ocular history significant for keratoconus in both eyes, who underwent Deep Anterior Lamellar Keratoplasty (DALK) for his left eye and experienced graft-host interface neovascularization and interface hemorrhage as a complication. He was treated initially with removal of sutures and optimization of the ocular surface followed by subconjunctival bevacizumab, which subsequently improved his hemorrhage and neovascularization.
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Affiliation(s)
- J D Shin
- School of Medicine, New York Medical College, 40, Sunshine Cottage road, Valhalla, NY 10595, United States
| | - S Mahesh
- School of Medicine, New York Medical College, 40, Sunshine Cottage road, Valhalla, NY 10595, United States; Department of Ophthalmology, Westchester Medical Center, 100, Woods road, Valhalla, NY 10595, United States.
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Ashena Z, Niestrata M, Tavassoli S. Management of Stromal Corneal Dystrophies; Review of the Literature with a Focus on Phototherapeutic Keratectomy and Keratoplasty. Vision (Basel) 2023; 7:vision7010022. [PMID: 36977302 PMCID: PMC10059954 DOI: 10.3390/vision7010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Corneal dystrophies are a group of non-inflammatory inherited disorders of the cornea. This review considers treatment options for epithelial-stromal and stromal corneal dystrophies: namely Reis–Bücklers, Thiel–Behnke, lattice, Avellino, granular, macular and Schnyder corneal dystrophies. Where there is visual reduction, treatment options may include either phototherapeutic keratectomy (PTK) or corneal transplantation. Due to the anterior location of the deposits in Reis-Bücklers and Thiel–Behnke dystrophies, PTK is considered the treatment of choice. For lattice, Avellino, granular and macular corneal dystrophies, PTK provides temporary visual improvement; however, with recurrences, repeat PTK or a corneal transplant would be needed. For Schnyder dystrophy, should treatment be required, PTK may be the preferred option due to the potential for recurrence of the disease in corneal transplantation. This review discusses the literature and evidence base for the treatment of corneal dystrophies in terms of visual outcomes and recurrence rate.
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Affiliation(s)
- Zahra Ashena
- Ophthalmology Department, Queen’s Hospital, Barking, Havering and Redbridge University NHS Hospitals Trust, Romford RM7 0AG, UK
- Correspondence: ; Tel.: +01708-435000
| | - Magdalena Niestrata
- Moorfields Reading Centre and Clinical AI Hub, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
- NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London EC1V 2PD, UK
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Acute Sterile Keratolysis After Deep Anterior Lamellar Keratoplasty in a Patient With Keratoconus: A Case Report. Cornea 2023:00003226-990000000-00255. [PMID: 36881012 PMCID: PMC10392883 DOI: 10.1097/ico.0000000000003271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/04/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The purpose of this study was to report the outcomes of using gamma-irradiated sterile cornea (GISC) as a deep lamellar keratoplasty (DALK) graft in a patient with keratoconus. METHODS This is a case report. RESULTS A 33-year-old male patient diagnosed with keratoconus underwent DALK using a GISC and developed a persistent epithelial defect which eventually led to sterile keratolysis necessitating further surgical interventions. Management and slitlamp photography, anterior segment optical coherence tomography (AS-OCT), and histopathological examination of the explanted graft are described in detail. CONCLUSIONS This is the first reported case of sterile keratolysis after the use of GISC lenticule in DALK in a healthy patient with keratoconus. The underlying pathophysiology is not clearly understood, and some theories have been proposed in this report. Surgeons need to be aware of this rare complication and are encouraged to have a low threshold for graft replacement to ensure good clinical and visual outcomes. Developing a prospective complication registry to document complications after the use of GISC lenticules in ophthalmic surgery is recommended.
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Jamali H, Saluoti R, Maalhagh M, Hosseini S, Shirvani M. Comparison of visual outcomes, keratometric parameters and biomechanical profiles between deep anterior lamellar keratoplasty with big-bubble technique vs. Melles technique for keratoconus: a retrospective study. BMC Ophthalmol 2023; 23:69. [PMID: 36793020 PMCID: PMC9930343 DOI: 10.1186/s12886-023-02816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Comparing results of two different DALK surgery techniques (big bubble vs. Melles) in patients with advanced keratoconus. DESIGN a retrospective comparative clinical study. PARTICIPANTS This study conducted on 72 eyes of 72 participants. INTRODUCTION This study designed to compare the results of two different DALK surgery techniques (big bubble vs. Melles) in patients with advanced keratoconus. METHOD Thirty-seven eyes were treated using the big bubble DALK method, while 35 eyes were treated using the Melles approach. Uncorrected visual acuity (UCVA), best corrected spectacle visual acuity (BCSVA), manifest refraction, keratometric characteristics, contrast sensitivity, corneal aberrations, corneal biomechanical characteristics, and endothelial cell profile are the outcome measurements. RESULTS Mean UCVA in big bubble group was 0.61 ± 25 LogMAR and in Melles group was 0.89 ± 0.41 LogMAR (p-value 0.043). Mean BCSVA in big bubble group (0.18 ± 0.12 Log MAR) was significantly better than Melles group (0.35 ± 0.16 Log MAR). Mean of sphere and cylinder refraction showed no significant difference between two groups. Comparing the endothelial cell profile, corneal aberrations, corneal biomechanical properties and keratometry had no significantdifferences. Contrast sensitivity reported as modulation transfer function (MTF) showed higher values in big bubble group and differences with Melles group weresignificant. Results of point spread function (PSF) in big bubble group had superiority to Melles group with considerable statistical P value of 0.023. CONCLUSION When opposed to the Melles approach, the big bubble technique generates a smooth interface with less stromal residue, which results in higher visual quality and contrast sensitivity.
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Affiliation(s)
- Hossein Jamali
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Saluoti
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Maalhagh
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahla Hosseini
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Shirvani
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. .,Geriatric Ophthalmology Research Center, Shahid sadoughi University of Medical Science, Yazd, Iran.
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