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Leydolt C, Schartmüller D, Schwarzenbacher L, Röggla V, Schriefl S, Menapace R. Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial. Am J Ophthalmol 2020; 217:224-231. [PMID: 32335056 DOI: 10.1016/j.ajo.2020.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years. DESIGN Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. PATIENT POPULATION Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye. OBSERVATION PROCEDURES Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA). MAIN OUTCOME MEASURE PCO score (scale, 0-10). RESULTS The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23). CONCLUSION The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.
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Çakir H, Genç S, Güler E. 360-Degree Iris Burns Following Conductive Keratoplasty. J Refract Surg 2017; 32:776-778. [PMID: 27824383 DOI: 10.3928/1081597x-20160803-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE The authors report a case with multiple iris burns after conductive keratoplasty to correct hyperopia. METHODS Case report. RESULTS A 52-year-old woman with hyperopia had a previous conductive keratoplasty procedure and underwent a conductive keratoplasty re-treatment 6 months later. Postoperatively, she presented with 360-degree iris burns in both eyes that were correlated with the corneal conductive keratoplasty scars. In addition, specular microscopy revealed decreased endothelial cell density for both eyes. CONCLUSIONS This is the first reported case of iris burns associated with conductive keratoplasty. [J Refract Surg. 2016;32(11):776-778.].
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Moussa K, Jehangir N, Mannis T, Wong WL, Moshirfar M. Corneal Refractive Procedures for the Treatment of Presbyopia. Open Ophthalmol J 2017; 11:59-75. [PMID: 28553423 PMCID: PMC5427700 DOI: 10.2174/1874364101711010059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose: Refractive surgery has been in use for a long time and is evolving at a fast pace with several new corneal procedures being used for the correction of presbyopia. The purpose of this article is to give a comprehensive review of the literature to evaluate the outcome and success of different corneal refractive surgical procedures in presbyopic patients. Methods: We performed a comprehensive search on PubMed to identify published reports of the various procedures utilized in the past and present to correct presbyopia. The outcomes of these procedures were recorded. Results and conclusion: We found that varying rates of success have been reported with these procedures. The results of our exhaustive search are presented in this report for review.
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Affiliation(s)
- Kareem Moussa
- Department of Ophthalmology, Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA 94143, USA
| | - Naz Jehangir
- Research Associate, Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA 94143, USA
| | - Tova Mannis
- Clinical fellow, Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA 94143, USA
| | - Wai L Wong
- Department of Ophthalmology, Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA 94143, USA
| | - Majid Moshirfar
- Medical Director HDR Research Center, Hoopes Vision and Professor of Ophthalmology, Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
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Impact of temporary hyperthermia on corneal endothelial cell survival during organ culture preservation. Graefes Arch Clin Exp Ophthalmol 2015; 253:753-8. [DOI: 10.1007/s00417-014-2903-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022] Open
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Moshirfar M, Anderson E, Hsu M, Armenia JM, Mifflin MD. Comparing the rate of regression after conductive keratoplasty with or without prior laser-assisted in situ keratomileusis or photorefractive keratectomy. Middle East Afr J Ophthalmol 2013; 19:377-81. [PMID: 23248539 PMCID: PMC3519124 DOI: 10.4103/0974-9233.102743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To assess the regression rate of conductive keratoplasty (CK) in patients with or without previous laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). Setting: University of Utah, Medical School, John A. Moran Eye Center, Salt Lake City, Utah. Materials and Methods: A retrospective, age-matched chart review identified records of 6 patients who underwent CK after refractive surgery and 12 patients who underwent CK without prior refractive surgery. The main outcome measures were postoperative uncorrected and corrected visual acuities and refraction changes over time. Results: Preoperatively, the mean manifest refraction spherical equivalent (MRSE) of the 15 eyes (12 patients) that underwent CK without refractive surgery was 0.83 diopters (D) and the 7 eyes (6 patients) that underwent CK after refractive surgery had an average MRSE of 0.27 D. Postoperatively, the mean MRSE of the refractive surgery patients was -0.86 D at 6 months, regressing to -0.67 D at 12 months. The postoperative MRSE in the eyes without refractive surgery was -0.58 D. at 6 months, regressing to -0.38 D at 12 months. The rate of regression was linear in both groups, calculated at 0.033 D per month in all patients. Conclusions: Patients with previous LASIK or PRK showed a greater treatment response to CK but regressed at a similar rate as those eyes without prior LASIK or PRK. Overall CK is a safe procedure that inevitably regresses.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, University of Utah, John A Moran Eye Center, Salt Lake City, UT, USA
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Habibollahi A, Hashemi H, Mehravaran S, Khabazkhoob M. Visual Outcomes of Conductive Keratoplasty to Treat Hyperopia and Astigmatism After Laser in situ Keratomileusis and Photorefractive Keratectomy. Middle East Afr J Ophthalmol 2011; 18:238-42. [PMID: 21887081 PMCID: PMC3162738 DOI: 10.4103/0974-9233.84055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: To determine the effect of conductive keratoplasty (CK) for the treatment of induced hyperopia and astigmatism after complicated myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). Materials and Methods: In this interventional case series, 11 eyes of seven subjects with a history of previous LASIK or PRK with inadequate stromal bed or flaps complications were enrolled. Inclusion criteria included residual spherical hyperopia of 1.00 to 3.00 diopters (D) and cylinder of –0.75 to –3.00 D. The modified Refractec nomogram and the LightTouch technique of CK were performed on all eyes. To treat cylinder, a pair of spots per –0.75 D of cylinder were delivered to the flat meridian. Uncorrected visual acuity at near and far (UCVAN and UCVAF respectively, logMAR), best corrected VA at near and far (BCVAN and BCVAF respectively, logMAR) were measured. Refractive outcome, contrast sensitivity, wave front aberrations were measured preoperatively and postoperatively. Statistical analysis was performed with the Wilcoxon signed rank test and the repeated measures analysis of variance with P<0.05 indicating statistically significant change from preoperatively to 1 year postoperatively. Results: The mean preoperative sphere (MS) was 2.57 ± 1.19 D and cylinder (MC) was –1.5 ± 0.49 D. Postoperatively, there was a significant decrease in MS to 0.36±0.98 D (P=0.003) and MC to –1.25 ± 0.76 D at 1 year (P<0.05, both cases). Spherical equivalent (SE) significantly decreased from +2.13 ± 1.09 D to –0.47 ± 1.29 D (P<0.001). The mean UCVAN significantly improved from 0.56 ± 0.32 preoperatively to 0.17 ±0.16 postoperatively (P=0.003). The mean UCVAF was 0.29 preoperatively and 0.22 postoperatively (P=0.353). Mean BCVAN was 0.18 and 0.02 after surgery, and mean BCVAF for far was 0.07 (P>0.05, both cases). Conclusions: CK is a predictable and reliable method to correct hyperopia after LASIK and PRK, however cylinder correction may induce irregular and unpredictable outcomes and a modified nomogram is required for further studies.
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Kato N, Toda I, Kawakita T, Sakai C, Tsubota K. Topography-guided conductive keratoplasty: treatment for advanced keratoconus. Am J Ophthalmol 2010; 150:481-489.e1. [PMID: 20692643 DOI: 10.1016/j.ajo.2010.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 05/12/2010] [Accepted: 05/13/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the use of topography-guided conductive keratoplasty in eyes with keratoconus. DESIGN Interventional case series. METHODS We examined 21 eyes in 21 patients with advanced keratoconus. Topography-guided conductive keratoplasty was performed with intraoperative monitoring of corneal astigmatism using a surgical keratometer. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal topography, manifest refraction, intraocular pressure (IOP), corneal endothelial cell counts, complications, and eventual outcomes were evaluated. RESULTS UCVA (logarithm of the minimal angle of resolution [logMAR]), which was 1.65 ± 0.49 preoperatively, improved to 1.04 ± 0.64 at 1 week (P < .001) and 1.12 ± 0.61 at 1 month after surgery (P < .001). BSCVA, which was 1.02 ± 0.56 preoperatively, improved to 0.76 ± 0.65 at 1 week (P = .026) and 0.76 ± 0.60 at 1 month after surgery (P = .003). Manifest refraction, which was -15.13 ± 6.66 diopters (D) before surgery, declined to -9.97 ± 6.71 D at 1 month after surgery (P = .002). Although corneal topography reverted to the preoperative pattern and UCVA and BSCVA also regressed toward preoperative values, 12 of 21 eyes were better able to tolerate and conduct normal daily activities using contact lenses. Five subjects have undergone or are considering corneal transplantation after unsatisfactory postoperative results. No serious perioperative complication was observed. CONCLUSIONS Topography-guided conductive keratoplasty may be effective in reshaping corneal configuration in eyes with keratoconus, without serious complications, and possibly contributed to avoiding or delaying corneal transplantation.
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Affiliation(s)
- Naoko Kato
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.
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Abstract
PURPOSE OF REVIEW Ametropia and astigmatism following successful penetrating keratoplasty can seriously impact a patient's quality of vision. Similar limitations can result following anterior lamellar keratoplasty (ALK) and Descemet's stripping endothelial keratoplasty (DSEK). These patients often suffer from aniseikonia and can be intolerant of spectacles and contact lenses. Refractive surgery can correct both ametropia and astigmatism following corneal transplantation and improve a patient's final visual outcome. The same methods used to correct naturally occurring refractive errors are being used with increasing success in patients who have undergone corneal transplants. RECENT FINDINGS Many refractive options are available to treat ametropia following penetrating keratoplasty. Incisional keratotomies have been employed to treat high amounts of astigmatism. Photorefractive keratectomy (PRK) and laser in-situ keratomileusis (LASIK) are also used to treat myopia, hyperopia and astigmatism. LASIK has been shown to have an overall better outcome compared to PRK; however, the use of mitomycin-C with PRK has improved results. Phakic and pseudophakic piggyback intraocular lenses are also being used to treat high degrees of ametropia and astigmatism; however, the long-term results are somewhat limited. SUMMARY Refractive surgery can improve the final visual outcome of patients who have undergone successful corneal transplantation. Currently available modalities provide many options for patients who are intolerant of spectacles and contact lenses. Continued advances and research will enable surgeons to optimize visual quality in postkeratoplasty patients.
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Chang JSM, Lau SYF. Conductive keratoplasty to treat hyperopic overcorrection after LASIK for myopia. J Refract Surg 2010; 27:49-55. [PMID: 20166620 DOI: 10.3928/1081597x-20100212-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 01/13/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE to investigate the refractive outcomes and stability of conductive keratoplasty (CK) for retreatment of myopic LASIK overcorrection. METHODS seven eyes (six patients) that were overcorrected after myopic LASIK by +1.00 to +2.75 diopters (D) manifest refraction spherical equivalent (MRSE) were retreated using CK. All eyes had insufficient stromal thickness for LASIK retreatment. LightTouch CK was performed at least 1 year after LASIK. Either 8 or 16 spots were applied at 7- and/or 8-mm zones on the cornea. Uncorrected distance visual acuity, manifest refraction, corrected distance visual acuity (CDVA), and postoperative complications were analyzed. RESULTS mean MRSE after CK at last follow-up was +0.38 ± 0.52 D (range: -0.38 to +1.13 D). The change in MRSE ranged from -0.63 to -2.38 D. Mean MRSE after CK changed from -0.60 ± 2.07 D (range: -3.38 to +1.50 D) at 1 week to +0.45 ± 0.69 D (range: -0.38 to +1.38 D) at 12 months. Two eyes experienced an initial overcorrection of -2.75 D and -3.38 D, respectively, at 1 week after CK. Cylinder ≤0.75 D was induced in four eyes, whereas one eye had a 0.75-D reduction in cylinder. All eyes had CDVA of logMAR 0.10 or better. Two eyes lost one line of CDVA and no eyes lost more than one line. CONCLUSIONS lighttouch CK retreatment for over-corrected myopic LASIK can reduce the hyperopia but produces minimal change in cylinder, and may be appropriate for eyes with insufficient stromal tissue for repeated excimer laser surgery. Early regression occurs commonly.
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Affiliation(s)
- John S M Chang
- Guy Hugh Chan Refractive Surgery Centre, Department of Ophthalmology, Hong Kong Sonatorium and Hospital, Happy Valley, Hong Kong.
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Wang TJ, Lo W, Hsueh CM, Hsieh MS, Dong CY, Hu FR. Ex vivo multiphoton analysis of rabbit corneal wound healing following conductive keratoplasty. JOURNAL OF BIOMEDICAL OPTICS 2008; 13:034019. [PMID: 18601564 DOI: 10.1117/1.2943156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Ex vivo multiphoton imaging is used to characterize rabbit corneal wound healing after conductive keratoplasty (CK) procedures. CK is performed on the right eyes from eight New Zealand albino rabbits while the left eyes are punctured by a keratoplast tip without energy application. Rabbits are humanely sacrificed 1 day, 1, 2, and 4 weeks after the CK procedure. Eye balls are enucleated and placed on the microscope for multiphoton imaging. Multiphoton imaging reveals damage of corneal epithelium and stroma caused by the CK procedure and the subsequent wound healing process can be followed without histological procedures. Multiphoton excited autofluorescence images demonstrate that re-epithelilialization is accomplished within 1 week in both CK and control groups. However, epithelial hyperplasia is observed in CK corneas. In addition, stromal wounds in the control group become inconspicuous within 1 week while obvious wounds still exist in CK corneas for at least 4 weeks. Postconductive keratoplasty corneal damage and wound healing can be characterized by multiphoton microscopy without histological procedures. Our results suggest that multiphoton microscopy has potential in the clinical evaluation of corneal damage due to refractive surgery, and can be used to study and reduce the unwanted side effects of these procedures.
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Affiliation(s)
- Tsung-Jen Wang
- Taipei Medical University Hospital, Department of Ophthalmology, Taipei 110, Taiwan
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Abstract
Surgical attempts to correct hyperopia have yielded varying results over the last 130 years. These techniques include the reshaping of the cornea through incisions, burns, or lamellar cuts with removal of peripheral tissue; the addition of central inlays; laser ablations; and the replacement of the crystalline lens. By examining the success of each surgical technique, the refractive surgeon may be able to make an informed decision on its indications and limitations, based on the specific patient's characteristics. Reporting the outcomes and complications of hyperopic surgery will help refine our approach to the management of an increasingly hyperopic and presbyopic population.
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Affiliation(s)
- Salomon Esquenazi
- LSU Eye Center and LSU Neuroscience Center, Louisiana State University Health Sciences Center, New Orleans, USA.
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Naoumidi TL, Pallikaris IG, Naoumidi II, Astyrakakis NI. Conductive keratoplasty: histological study of human corneas. Am J Ophthalmol 2005; 140:984-992. [PMID: 16376640 DOI: 10.1016/j.ajo.2005.06.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 06/03/2005] [Accepted: 06/11/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the morphologic changes in human corneas over time following radiofrequency-based conductive keratoplasty (CK) treatment. DESIGN Prospective, observational case series. METHODS In a single-center study six human corneas of six patients with localized peripheral keratoconus underwent CK treatment followed by penetrating keratoplasty. Three spots were applied in the periphery of each cornea (6 mm optical zone). Corneal buttons were examined with light and electron microscopy at different postoperative intervals up to 6 months post-CK. RESULTS In samples assessed on day one post-CK, small areas of detachment between the basal layer of epithelial cells and Bowman's layer were observed. At 1 week after the CK procedure, the epithelium appeared almost normal. Endothelium and Descemet's membrane had no alterations. In all samples, thermally induced misconfiguration of collagen fibers, described as "crumpled" changes of collagen layers, was observed reaching 75% to 80% of the stromal depth. The area of alterations had a cylindrical shape with a diameter of 120 mum. CONCLUSIONS The conductive keratoplasty procedure produced collagen "crumpling and splitting" changes in human corneas, which were observed during the follow-up of 6 months. Areas adjacent to treatment site were minimally damaged.
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Affiliation(s)
- Tatiana L Naoumidi
- University of Crete, School of Medicine, Vardinoyannion Eye Institute of Crete, Voutes PO 1352, 71110 Heraklion, Crete, Greece.
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Alió JL, Ramzy MI, Galal A, Claramonte PJ. Conductive Keratoplasty for the Correction of Residual Hyperopia After LASIK. J Refract Surg 2005; 21:698-704. [PMID: 16329361 DOI: 10.3928/1081-597x-20051101-07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the 6-month results concerning efficacy, safety, predictability, and stability of conductive keratoplasty for the correction of residual hyperopia after corneal refractive surgery. METHODS A total of 35 eyes (26 patients) with residual hyperopia after corneal refractive surgery ranging between +1.00 to +4.75 diopters (D) of spherical equivalent refraction were enrolled in the study and underwent conductive keratoplasty following a modified nomogram. RESULTS Variables and data were available for all eyes at 6 months postoperatively. A total of 24 (69%) eyes had uncorrected visual acuity (UCVA) of > or = 20/40, and 10 (29%) eyes had UCVA of 20/20. Manifest refractive spherical equivalent was within +/- 0.50 D in 17 (49%) eyes and within +/- 1.00 D in 25 (71%) eyes in cases of previous hyperopic LASIK; the optical zone was significantly increased. CONCLUSIONS Using a modified nomogram, conductive keratoplasty for correction of residual hyperopia was effective, but predictability was not satisfactory and safety needs to be established.
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Affiliation(s)
- Jorge L Alió
- Instituto Oftalmológico De Alicante, Refractive Surgery and Cornea Department, Miguel Hernández University, Medical School, Alicante, Spain.
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Hersh PS, Fry KL, Chandrashekhar R, Fikaris DS. Conductive keratoplasty to treat complications of LASIK and photorefractive keratectomy. Ophthalmology 2005; 112:1941-7. [PMID: 16157379 DOI: 10.1016/j.ophtha.2005.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 05/16/2005] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the outcomes of conductive keratoplasty (CK) for patients with complications related to LASIK or photorefractive keratectomy (PRK). DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Sixteen eyes of 15 patients were treated using CK after complications of initial LASIK or PRK surgeries. Five cases are described in detail. INTERVENTION Rehabilitative CK was performed. MAIN OUTCOME MEASURES Uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), refractive error, keratometry, topography analysis, and a subjective assessment of visual quality. RESULTS After CK treatment, there was a mean improvement in UCVA of 2 lines; 1 eye lost >1 line of UCVA. Best-corrected visual acuity improved or remained the same in 12 of 15 eyes; no eyes lost >1 line of BSCVA. There was a mean reduction in astigmatism of 54%. Videokeratography generally demonstrated improved quality of the corneal optical surface, and patients reported a reduction in optical symptoms such as glare and halo. CONCLUSIONS Conductive keratoplasty may give improved corneal optics and vision in patients with complications of LASIK or PRK. This application of CK offers an alternative in cases in which further flap manipulation or laser treatments are contraindicated.
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Affiliation(s)
- Peter S Hersh
- Cornea and Laser Eye Institute-Hersh Vision Group, Teaneck, New Jersey 07666, USA.
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Abstract
PURPOSE OF REVIEW Many patients who have undergone corneal transplantation are unable to achieve satisfactory visual acuity with spectacle and contact lens correction alone. For these patients, refractive surgery becomes a viable option to reduce the post-keratoplasty ametropia. With the many recent advances in refractive surgery for naturally occurring refractive error, new possibilities arise for application to this complicated set of patients. This review discusses key recent developments in refractive surgery after corneal transplantation. RECENT FINDINGS The biomechanical effects of incisional keratotomy on post-keratoplasty corneas continue to be studied, and these techniques remain a common and simple method of reducing astigmatism. Photorefractive keratectomy, previously problematic for regression and haze formation, is gaining new prominence as early experience with the adjunctive use of mitomycin C has demonstrated good results. Long-term studies with laser in-situ keratomileusis (LASIK) have continued to show good safety and efficacy. Modern developments in cataract surgery appear to have lower incidences of graft rejection and failure. Developments in lens implantation technology continue to offer expanding options for intraocular refractive surgery. SUMMARY Although visual rehabilitation after corneal transplantation remains a formidable challenge, developments in refractive surgery for naturally occurring ametropias directly translate into an improved ability to help these most challenging refractive cases. Continued research will bring about improved efficacy while maintaining a high level of safety.
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Kymionis GD, Naoumidi TL, Aslanides IM, Kumar V, Astyrakakis NI, Tsilimbaris M, Pallikaris IG. Intraocular Pressure Measurements After Conductive Keratoplasty. J Refract Surg 2005; 21:171-5. [PMID: 15796223 DOI: 10.3928/1081-597x-20050301-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the possible impact of conductive keratoplasty (CK) on intraocular pressure (IOP) measurements. METHODS A prospective, single-center, noncomparative interventional case series was performed. Baseline and postoperative IOPs were measured by Goldmann applanation tonometry in 32 eyes of 18 patients who underwent CK for hyperopia correction. Mean follow-up was 11.9 months (range: 8 to 18 months). RESULTS After CK, a statistically significant decrease in the measured IOP was observed (before CK: 14.22+/-1.64 vs after CK: 12.66+/-2.21, P<.001). The change in IOP readings postoperatively was not correlated with age, sex, keratometric readings, or attempted correction. CONCLUSIONS Despite the limitations due to the small number of patients enrolled in this study, the applanation tonometer appears to underestimate the true IOP after CK.
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Affiliation(s)
- George D Kymionis
- Department of Ophthalmology, and Vardinoyannion Eye Institute of Crete, University of Crete, Greece.
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Abstract
PURPOSE To provide 6-month results of a 1-year clinical trial evaluating conductive keratoplasty (CK) for the treatment of presbyopic symptoms in emmetropic and hyperopic eyes. METHODS A total of 143 patients with presbyopic symptoms were enrolled in this 1-year United States FDA clinical trial and treated to improve near vision in 1 eye (unilateral treatment). In addition, 33 fellow eyes were treated to improve distance vision (bilateral treatment). For near vision correction, the target refraction was up to -2.0 D in the nondominant eye, and for distance vision correction, 0.0 D. Enrolled patients had a preoperative spherical equivalent of plano to +2.00 D, no more than 0.75 D of refractive astigmatism, and were 40 years of age or older. No retreatments were performed. RESULTS Of the eyes treated for near, 77% had uncorrected near vision of J3 or better at 6 months postoperatively. A total of 85% of all patients had binocular distance UCVA of 20/25 or better along with J3 or better near, a combination that represents functional acuity for a presbyope. Sixty-six percent of eyes treated for near had a manifest refractive spherical equivalent (MRSE) within +/- 0.50 D of intended at 6 months. In 89% of eyes, the MRSE changed 0.05 D or less between 3 and 6 months postoperatively. After month 1, the incidence of variables associated with safety was 1% or lower. Seventy-six percent were very satisfied or satisfied with their procedure. CONCLUSIONS CK appears to be very safe and effective in producing functional visual acuity in presbyopic eyes up to 6 months following the procedure. Patient satisfaction with the procedure is similar to that of monovision LASIK.
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Kymionis GD, Aslanides IM, Khoury AN, Markomanolakis MM, Naoumidi T, Pallikaris LG. Laser in situ Keratomileusis for Residual Hyperopic Astigmatism After Conductive Keratoplasty. J Refract Surg 2004; 20:276-8. [PMID: 15188907 DOI: 10.3928/1081-597x-20040501-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report a case of laser in situ keratomileusis (LASIK) in a patient with previous conductive keratoplasty. METHODS A 48-year-old man underwent conductive keratoplasty for low hyperopic astigmatism (manifest refraction OD: +2.25 -0.50 x 77 degrees; OS: +2.50 -0.50 x 105 degrees). Three months postoperatively, UCVA was 20/25 and BSCVA was 20/20 in both eyes; manifest refraction OD: -0.25 -0.75 x 110 degrees; OS: +0.75 -0.75 x 50 degrees. Sixteen months after the operation, regression of refractive outcome was (manifest) OD: +1.75 -1.25 x 90 degrees; OS: +2.50 -0.50 x 85 degrees; UCVA was 20/40 in the right eye and 20/63 in the left eye and BSCVA was 20/20 in both eyes. LASIK was performed for hyperopic regression in the left eye using an automated microkeratome (Alcon SKBM, 130-microm plate; Aesculap-Meditec MEL 70 excimer laser). RESULTS LASIK was uneventful and no intraoperative or postoperative complications related to the previous conductive keratoplasty procedure or LASIK were observed. Three months after LASIK and 19 months after the initial conductive keratoplasty, the patient's left eye was emmetropic; UCVA was 20/20(-2), BSCVA was 20/20 and manifest refraction was +0.25 -0.25 x 35 degrees. There was a uniform increase in topographical steepening. Visual acuity, refraction and topographic findings remained unchanged at 6 months. CONCLUSIONS Even though our experience is limited, treatment of hyperopia with LASIK in an eye with refractive regression following previous conductive keratoplasty resulted in a predicted refractive outcome, with no complications, and improvement in visual acuity at 6 months follow-up.
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Affiliation(s)
- George D Kymionis
- University Of Crete, VEIC, Medical School Department of Ophthalmology, 71110 Heraklion, Crete, Greece.
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Pallikaris LG, Naoumidi TL, Panagopoulou SI, Alegakis AK, Astyrakakis NI. Conductive Keratoplasty for Low to Moderate Hyperopia: 1-year Results. J Refract Surg 2003; 19:496-506. [PMID: 14518738 DOI: 10.3928/1081-597x-20030901-04] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the safety, efficacy, and stability of conductive keratoplasty in the treatment of low to moderate hyperopia and evaluate the impact of the procedure on the quality of vision. METHODS Thirty-six eyes (25 patients; 13 female and 12 male) were treated for hyperopia up to +3.25 D with a Refractec ViewPoint CK system and followed for 1 year. Mean age was 50.2 +/- 8.7 years (range 31 to 71). RESULTS Before surgery, mean spherical equivalent refraction was +1.90 +/- 0.60 D (range +1.00 to +3.25 D), decreasing at 1 year after conductive keratoplasty to -0.06 +/- 0.80 D, and was within +/- 0.50 D of emmetropia in 68% (24 eyes) and within +/- 2.00 D in all eyes. Twelve months after conductive keratoplasty, uncorrected visual acuity was 20/20 or better in 19 eyes (50%) and 20/40 or better in 32 eyes (89%). No eye lost > or = 2 Snellen lines or had induced cylinder > or = 2.00 D. The mean root mean square values for higher order optical aberrations were 0.060 +/- 0.039 before and 0.174 +/- 0.170 at 3 months after surgery. No statistically significant changes in contrast sensitivity were noted. CONCLUSIONS Conductive keratoplasty for low to moderate hyperopia provided safe, effective, and stable results both in refraction and quality of vision.
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Affiliation(s)
- loannis G Pallikaris
- University of Crete, Medical School, Vardinoyannion Eye Institute of Crete, Heraklion, Greece
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Kymionis GD, Naoumidi TL, Aslanides IM, Pallikaris IG. Corneal iron ring after conductive keratoplasty. Am J Ophthalmol 2003; 136:378-9. [PMID: 12888074 DOI: 10.1016/s0002-9394(03)00224-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report formation of corneal iron ring deposits after conductive keratoplasty. DESIGN Observational case report. METHODS Case report. RESULTS A 54-year-old woman underwent conductive keratoplasty for hyperopia. One year after conductive keratoplasty, iron ring pattern pigmentation was detected at the corneal epithelium of both eyes. CONCLUSIONS This is the first report of the appearance of corneal iron ring deposits following conductive keratoplasty treatment in a patient. It is suggested that alterations in tear film stability, resulting from conductive keratoplasty-induced changes in corneal curvature, constitute the contributory factor for these deposits.
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Affiliation(s)
- George D Kymionis
- Department of Ophthalmology and the Vardinoyannion Eye Institute of Crete, University of Crete, Heraklion, Crete, Greece.
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Abstract
Excimer laser-based refractive surgery techniques have been the most popular forms to correct myopia, hyperopia, and astigmatism. However, development of non-excimer based refractive surgery such as thermal techniques provides a viable alternative to laser vision correction. Earlier forms of thermal techniques showed a lack of predictability and stability, resulting in the abandonment of the further development of these techniques. Recently, conductive keratoplasty, a laserless, radiofrequency-based technique, has been approved by the FDA for the correction of low to moderate hyperopia. Preliminary data showed that conductive keratoplasty seems to be safe, effective, and showed good refractive stability. This review will discuss recent studies on conductive keratoplasty technique in terms of its efficacy, safety, refractive predictability, and stability.
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Affiliation(s)
- Bo Huang
- Pepose Vision Institute, Chesterfield, MO 63017, USA.
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Pallikaris IG, Naoumidi TL, Astyrakakis NI. Conductive Keratoplasty to Correct Hyperopic Astigmatism. J Refract Surg 2003; 19:425-32. [PMID: 12899473 DOI: 10.3928/1081-597x-20030701-08] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of conductive keratoplasty in the treatment of pre-existing and surgically induced hyperopic astigmatism. METHODS In this prospective, noncomparative case series, four eyes of four subjects, two female and two male (age 25 to 47 yr) were treated for hyperopia (up to +5.50 D) and hyperopic astigmatism (up to +5.75 D) with the Refractec ViewPoint conductive keratoplasty system. The follow-up period was 6 months. Uncorrected and spectacle-corrected visual acuity, manifest and cycloplegic refraction, and videokeratographs were obtained before and after surgery. We treated two patients who had already had LASIK, one of them with a decentered ablation and the other with flap striae, one patient after PRK, and one patient with keratoconus. RESULTS No complications were observed. No eye lost lines of spectacle-corrected visual acuity. All eyes showed improvement of uncorrected visual acuity of 3 or more lines. Videokeratographs demonstrated improved centration and reduction in keratometric power readings. Each eye was analyzed separately, including a comparative analysis of the proposed nomograms and quality of vision after surgery. CONCLUSIONS Conductive keratoplasty may be a minimally invasive solution for patients with irregular hyperopic astigmatism, offering improved quality of vision in instances of flap striae by tightening the central cornea.
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Affiliation(s)
- Ioannis G Pallikaris
- University of Crete, Medical School, Vardinoyannion Eye Institute of Crete, Heraklion, Greece
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Rojas MC, Manche EE. Comparison of Videokeratographic Functional Optical Zones in Conductive Keratoplasty and Laser in situ Keratomileusis for Hyperopia. J Refract Surg 2003; 19:333-7. [PMID: 12777029 DOI: 10.3928/1081-597x-20030501-10] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the videokeratographic functional optical zone of eyes treated with conductive keratoplasty to eyes treated with laser in situ keratomileusis (LASIK) for hyperopia. METHODS Sixteen eyes treated with conductive keratoplasty for hyperopia were retrospectively evaluated to determine the size of the videokeratographic functional optical zone. The functional optical zone of these eyes was compared to the functional optical zone of 16 eyes that underwent LASIK for hyperopia with the VISX S2 excimer laser, for comparable amounts of hyperopia. The functional optical zone was measured at the edge of central corneal steepening and paracentral flattening on videokeratography 3 to 6 months after surgery. RESULTS The functional optical zone after surgery measured an average of 5.6 mm horizontally and 5.6 mm vertically in the conductive keratoplasty eyes, and 4.7 mm horizontally and 5.1 mm vertically in the hyperopic LASIK eyes (P<.001 and P<.005). The mean functional optical zone area was 31.1 mm2 in the conductive keratoplasty eyes and 24.6 mm2 in the hyperopic LASIK eyes (P<.001). The functional optical zone created by conductive keratoplasty had more uniform central steepening and less peripheral blending than the functional optical zone created by hyperopic LASIK. CONCLUSION Conductive keratoplasty was effective at creating central steepening in the cornea. The functional optical zone resulting from conductive keratoplasty was significantly larger than that obtained with hyperopic LASIK using the VISX S2 excimer laser.
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Affiliation(s)
- Maria C Rojas
- Stanford University School of Medicine, Department of Ophthalmology, Stanford, CA 94305, USA
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Abstract
As the number and types of keratorefractive procedures increase and as the baby boomer population moves into the "cataractous decades," the number of patients requiring cataract surgery following refractive surgery grows larger each year. While technological advances in surgical instrumentation and intraocular lens (IOL) design allow us to perform cleaner, faster, and more reliable cataract extractions, the ultimate postoperative refraction depends primarily on calculations performed before surgery. Third-generation IOL formulas ( Haigis, Hoffer Q, Holladay 2, or SRK/T) provide outstanding accuracy when used for eyes with physiologic, prolate corneas. In addition, most instruments used today for measuring corneal curvature and power were designed before the era of refractive surgery. These formulas and instruments make assumptions about the anatomy and refractive properties of the cornea that are no longer valid following most keratorefractive procedures. These breakdowns in IOL calculation often result in a "refractive surprise" after cataract surgery, which may require subsequent surgical correction. This article examines recent publications of modeling studies of various methods for estimating effective K values for IOL calculation, cataract surgery case series following refractive surgery, new corneal topography technologies and methods for correcting "refractive surprises" postoperatively.
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Affiliation(s)
- D Rex Hamilton
- Minnesota Eye Consultants, P.A., Minneapolis, Minnesota 55404, USA
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Comaish IF, Lawless MA. Conductive keratoplasty to correct residual hyperopia after corneal surgery. J Cataract Refract Surg 2003; 29:202-6. [PMID: 12551689 DOI: 10.1016/s0886-3350(02)01498-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Conductive keratoplasty (CK) is an electrical-current-based technique for steepening the central cornea to reduce low to moderate hyperopia. We report 4 patients who had CK to correct hyperopia after laser in situ keratomileusis (LASIK) and were followed for at least 6 months. An overcorrection was noted after the CK procedure in all patients, but no sight-threatening complications arose. Conductive keratoplasty appears to be safe and well tolerated after LASIK. However, the algorithms should be modified to increase the predictability of the CK procedure in previously treated eyes.
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