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Gururani H, Chittajallu SNSH, Doulatramani M, Chinthapenta V, Basu S, M. R. Collagen imaging reveals synergistic effects of sutures and host-donor misalignment on topographical irregularities in penetrating keratoplasty. PLoS One 2024; 19:e0308204. [PMID: 39116076 PMCID: PMC11309498 DOI: 10.1371/journal.pone.0308204] [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: 03/11/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE Mitigating unwanted refractive errors is crucial for surgeons to ensure quality vision after penetrating keratoplasty (PK). The primary objective of the present study is to highlight the importance of microstructural matching of the host and the donor cornea during PK on the distribution of the corneal tissue while suturing. METHODS For this purpose, the present study undertakes an in-vitro PK model to analyse the effect of suturing and host-donor misalignment on corneal birefringence. Five groups of experiments were performed using five corneoscleral buttons. In each group, N = 16 data points (corresponding to 16 simple interrupted sutures) were assessed before and after PK with five degrees of misalignments, 0°, 30°, 45°, 60° and 90° to detect the variations in corneal birefringence post-PK. The technique of digital photoelasticity is utilized to capture the corneal birefringence experimentally. RESULTS The local and global features of corneal birefringence provided interesting insights into the nuances of corneal birefringence in PK. Statistical analysis was performed to study the effects of suturing on the birefringence around the suture bites. It was observed that the interaction of the suture tension and structural misalignment between the host and the donor cornea influences the corneal birefringence in PK. Conclusions The zero-degree structural misalignment of the host and the donor tissue is preferable to minimize the topographical irregularities and related astigmatism post-PK. The findings of the present study envisage an additional step of structurally aligning the donor tissue with the host before suturing to minimize topographical irregularities in PK.
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Affiliation(s)
- Himanshu Gururani
- Department of Mechanical and Aerospace Engineering, Micro-Mechanics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Sai Naga Sri Harsha Chittajallu
- Department of Mechanical and Aerospace Engineering, Micro-Mechanics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Minal Doulatramani
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Viswanath Chinthapenta
- Department of Mechanical and Aerospace Engineering, Micro-Mechanics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Sayan Basu
- Professor Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramji M.
- Department of Mechanical and Aerospace Engineering, Engineering Optics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
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Bhayani R, Walkden A. Managing Post Keratoplasty Astigmatism. Clin Ophthalmol 2024; 18:1727-1734. [PMID: 38887510 PMCID: PMC11182034 DOI: 10.2147/opth.s393975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
Corneal transplantation, when used in the correct setting, can significantly improve visual acuity and therefore quality of life. One of the barriers to good vision following keratoplasty is residual post operative surgical astigmatism. Following a thorough literature search, we present the different options available to readers, with regards to how post-operative astigmatism can be approached and managed in order to improve vision. We present available data from the literature, which in some areas are scarce, with a view to collating all of this information in one place, allowing comparison between different modalities of treatment.
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Affiliation(s)
- Raj Bhayani
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Papadopoulos K, Elalfy MS, Hamada S, Matsou A. Rotational stability of two different piggyback toric intraocular lenses for correction of high post-keratoplasty pseudophakic ametropia. Digit J Ophthalmol 2024; 30:27-32. [PMID: 38962666 PMCID: PMC11218835 DOI: 10.5693/djo.02.2024.02.002] [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: 07/05/2024]
Abstract
We present the case of a 65-year-old man with bilateral keratoconus and history of bilateral penetrating keratoplasty (PK) who developed gradual visual decline in the left eye due to cataract formation. Following successful left eye cataract surgery and monofocal, non-toric intraocular lens (IOL) in-the-bag implantation, the patient experienced persistently low uncorrected distance visual acuity (UDVA) due to high residual refractive error and intolerance to contact lenses. A supplementary toric IOL was placed in the ciliary sulcus, but subsequent rotational instability of the lens required repeated realignment. Despite two attempts at IOL repositioning, the rotational instability persisted, necessitating the replacement of the original Sulcoflex IOL with a toric, implantable Collamer lens. Following the implantation of the toric ICL, the patient achieved excellent UDVA with no adverse events over a 4-year follow-up period. This case highlights the potential rotational instability associated with toric piggyback IOLs in keratoconic, post-PK, pseudophakic eyes and the special considerations on choosing the type of piggyback lens in these eyes.
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Affiliation(s)
- Konstantinos Papadopoulos
- Ophthalmology Department, General Hospital of Imathia (Unit of Veroia), Veroia, Greece
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Mohamed S. Elalfy
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
- The Research Institute of Ophthalmology, Cairo, Egypt
| | - Samer Hamada
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Artemis Matsou
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
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Ting DSJ, Tatham AJ, Donachie PHJ, Buchan JC. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 16, influence of remuneration model on choice of intraocular lens in the UK. Eye (Lond) 2023; 37:3854-3860. [PMID: 37563427 PMCID: PMC10698051 DOI: 10.1038/s41433-023-02665-y] [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: 04/05/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND/OBJECTIVES Cataract surgery with intraocular lens (IOL) implantation is one of the most commonly performed surgeries worldwide. Within the UK, publicly funded cataract surgery is remunerated by two models: (1) "block contract" (BC), which commissions organisations to deliver whole service pathways without considering specific activity items; or (2) "payment by results" (PbR), which pays a tariff price for each procedure. This study aimed to examine the association between remuneration model and the cost and types of IOL used. SUBJECTS/METHODS Cataract operations recorded on the Royal College of Ophthalmologists' National Ophthalmology Database were included, with additional data collected for remuneration model from NHS England and cost of IOL from the NHS Spend Comparison Service. RESULTS We included 907,052 cataract operations from 87 centres. The majority of operations were performed in PbR centres (456 198, 50.3%), followed by BC centres (240 641, 26.5%) and mixed models centres (210 213, 23.2%). The mean price of hydrophobic (n = 7) and hydrophilic IOLs (n = 5) were £45.72 and £42.86, respectively. Hydrophobic IOLs were predominantly used (650 633, 71.7%) and were significantly more commonly used in centres remunerated by BC (96.5% vs. 3.5%) than those by PbR (65.7% vs. 34.3%) when compared to hydrophilic IOLs (p < 0.001). CONCLUSIONS This study demonstrated that the IOL choice may be perversely incentivised by the IOL cost and remuneration model. Although hydrophobic IOLs are more expensive at the point of surgery, their potential longer-term cost-effectiveness due to reduced requirement for YAG capsulotomy should be considered.
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Affiliation(s)
- Darren S J Ting
- Birmingham and Midland Eye Centre, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK
| | - John C Buchan
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK.
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Moshirfar M, Herron MS, Cha DS, Santos J, Payne CJ, Hoopes PC. Comparing Effective Optical Zones After Myopic Ablation Between LASIK, PRK, and SMILE With Correlation to Higher Order Aberrations. J Refract Surg 2023; 39:741-750. [PMID: 37937754 DOI: 10.3928/1081597x-20231016-02] [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: 11/09/2023]
Abstract
PURPOSE To explore size, decentration, and eccentricity of effective optical zones (EOZs) in laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE) and correlate them to higher order aberrations (HOAs). METHODS This was a retrospective chart review of 188 eyes that underwent refractive surgery for compound myopia (61 LASIK, 84 PRK, 43 SMILE). EOZ measurements were determined using 1-year postoperative Pentacam (Oculus Optikgeräte GmbH) tangential difference maps. HOA data were measured using Pentacam wavefront aberration Zernike polynomials. Correlations between EOZs and HOAs were analyzed. RESULTS The EOZs of LASIK and PRK are smaller than SMILE at 19.54 ± 1.44, 19.39 ± 1.66, and 22.18 ± 2.61 mm2, respectively (P < .001). No difference existed in absolute decentration from corneal vertex (P = .078) or pupil center (P = .131), but horizontal and vertical components differed significantly (P < .001). Smaller EOZ areas were correlated with greater spherical aberration induction (rLASIK = -0.378, rPRK = -0.555, rSMILE = -0.501) and total HOA induction in all groups. Absolute decentration from corneal vertex positively correlated with total HOA (rLASIK = 0.396, rPRK = 0.463, rSMILE = 0.399) and directional vertical coma induction negatively correlated with vertical decentration from the corneal vertex (rLASIK = -0.776, rPRK = -0.665, rSMILE = -0.576) in all groups. CONCLUSIONS SMILE results in a larger EOZ than LASIK and PRK, and absolute decentration remains comparable regardless of surgical reference center, despite horizontal/vertical differences. Surgical planning to ensure adequate EOZ size and centration may reduce induction of HOAs, including spherical aberrations and vertical coma. [J Refract Surg. 2023;39(11):741-750.].
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Rangu N, Seiler TG, Riaz KM, Cooke DL, Langenbucher A, Fischinger IR, Kohnen T, Wendelstein J. Considerations on the Calculation of Multifocal Duet Implantation in a Monovision Scenario for the Correction of Presbyopia - A Case Example. Klin Monbl Augenheilkd 2023; 240:1284-1291. [PMID: 37647937 DOI: 10.1055/a-2162-7758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Neal Rangu
- The University of Oklahoma College of Medicine, Oklahoma City, United States
| | - Theo G Seiler
- Institute for refractive and ophthalmic surgery (IROC), Zürich, Switzerland
- Department of Ophthalmology, Inselspital, Bern, Switzerland
- Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Kamran M Riaz
- Department of Ophthalmology, University of Oklahoma, Dean McGee Eye Institute, Oklahoma City, Oklahoma, United States
| | - David L Cooke
- Great Lakes Eye Care, St. Joseph, Michigan, United States
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, United States
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Isaak Raphael Fischinger
- Eye Day Clinic at the Spreebogen, Berlin, Germany
- Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Frankfurt, Germany
| | - Jascha Wendelstein
- Institute for refractive and ophthalmic surgery (IROC), Zürich, Switzerland
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
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Devebacak A, Degirmenci C, Barut Selver O, Palamar M, Egrilmez S. Correction of high astigmatism with toric intraocular lens in eyes with corneal transplant. Eur J Ophthalmol 2022; 33:11206721221123885. [PMID: 36046940 DOI: 10.1177/11206721221123885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the results of toric intraocular lens (IOL) implantation during cataract surgery in eyes with high regular astigmatism associated with prior penetrating keratoplasty (PK). METHODS A retrospective data analysis of patients with prior PK, who underwent uncomplicated cataract surgery with hydrophobic toric single piece IOL (EyeCryl Toric®, Biotech Vision Care, Luzern, Switzerland). RESULTS A total of 18 eyes of 18 patients were included in the study. The mean age was 53.4 ± 12.4 (25-70) years. The mean follow-up period was 15.5 (4-24) months. The mean best corrected visual acuity (BCVA) significantly increased from 1.36 ± 1.0 logMAR to 0.31 ± 0.17 logMAR (p < .001) pre- and post-operative 4 weeks, respectively. There was no significant change in mean BCVA during follow-up; mean BCVA was 0.32 ± 0.17 logMAR at the last visit. The mean pre-operative topographic astigmatism was 6.52 ± 1.80 diopters (D). The mean manifest refraction astigmatism was decreased from 6.55 ± 1.62 D to 2.80 ± 1.43 D (p˂0.001). The mean Surgically induced astigmatism (SIA) was 3.74 ± 0.77 D according to vector analysis. There was no patient with graft rejection or failure, the mean endothelial cell loss rate was 12.75 ± 3.76% (7-17%). There was no patient requiring IOL reposition. CONCLUSIONS Toric IOL implantation during cataract surgery provides an option to correct astigmatism in post-PK eyes with high regular astigmatism. When appropriate patients are selected it is a safe method to achieve significant improvements in visual acuity and astigmatism.
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Affiliation(s)
- Ali Devebacak
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
| | | | | | - Melis Palamar
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
| | - Sait Egrilmez
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
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Hashemi H, Aghamirsalim M, Shahhoseini S, Moghaddasi A, Asgari S. SMILE after DALK to reduce residual refraction: two-year results. Int Ophthalmol 2022; 42:3803-3812. [PMID: 35776392 DOI: 10.1007/s10792-022-02400-8] [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: 09/12/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the two-year results of small incision lenticule extraction (SMILE) for correcting post-keratoplasty myopia and myopic astigmatism. METHODS In this case-series study, 10 eyes of 10 patients with a 6- to 10-year history of successful deep lamellar keratoplasty (DALK) underwent SMILE using the VisuMax laser platform. Ophthalmologic examinations and visual acuity and refraction measurement were taken pre- and 1, 3, 6, 12, and 24 months postoperatively. The Pentacam and Sirius imaging were done in the first and last follow-up sessions. RESULTS The mean age of the patients was 39.60 ± 7.86 years. Six subjects were male. Two years after SMILE, the mean improvement in UDVA and CDVA was 3.60 ± 1.84 (P < 0.001) and 1.60 ± 2.91 (P = 0.231) LogMAR, respectively. The mean decrease in spherical equivalent, spherical error, and cylinder power was 1.92 ± 1.96 diopter (D) (P = 0.013), 0.70 ± 3.05D (P = 0.213), and 2.42 ± 2.91D (P = 0.024), respectively. The vector mean target-induced astigmatism, surgical-induced astigmatism, and difference vector were 1.30D@44˚, 1.11D@24˚, and 0.86D@73˚, respectively. Two years after SMILE, vertical coma, horizontal coma, and spherical aberration increased by 0.44 ± 0.51, 0.23 ± 0.32, and 0.02 ± 0.16 µm, respectively, (all P > 0.05) while trefoil reduced by 0.29 ± 0.75 µm (P = 0.428). CONCLUSION SMILE can be an effective procedure for reducing refraction and astigmatism after DALK in patients with moderate myopia and moderate to severe astigmatism and improves the visual acuity in these patients. Axis rotation during surgery may result in under-correction of astigmatism. Refinement of SMILE treatment nomogram for post-DALK cases seems necessary.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran.
| | | | - Saied Shahhoseini
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| | - Alireza Moghaddasi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
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Toric intraocular lens for astigmatism correction following keratoplasty in phakic and pseudophakic eyes. J Cataract Refract Surg 2022; 48:1078-1087. [PMID: 35137695 DOI: 10.1097/j.jcrs.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022]
Abstract
ABSTRACT Residual astigmatism and anisometropia significantly impact patients' vision and quality of life even in clear grafts after corneal transplant. We reviewed and summarized the role of toric intraocular lens (IOL) in phakic and pseudophakic eyes after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) in correcting residual astigmatism. We included 342 eyes from 20 studies with iris-clipped toric IOL, ciliary sulcus toric implantable collamer lens, piggyback sulcus toric IOL, or posterior chamber toric IOL implantations for phakic, pseudophakic, or eyes undergoing cataract surgery after keratoplasty. Visual, refractive, and predictability outcomes were encouraging. Secondary re-alignment rate and complications were low. Endothelial cell loss secondary to phakic toric IOL might be a concern over the long-term, particularly in iris-clipped IOL in PKP eyes. Toric IOL represent a viable option in the treatment of residual astigmatism in post-keratoplasty eyes, resulting in improved visual acuity and reduced anisometropia.
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Singh VM, Ramappa M, Murthy SI, Rostov AT. Toric intraocular lenses: Expanding indications and preoperative and surgical considerations to improve outcomes. Indian J Ophthalmol 2021; 70:10-23. [PMID: 34937203 PMCID: PMC8917572 DOI: 10.4103/ijo.ijo_1785_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since the introduction of the first toric intraocular lens (IOLs) in the early 1990s, these lenses have become the preferred choice for surgeons across the globe to correct corneal astigmatism during cataract surgery. These lenses allow patients to enjoy distortion-free distance vision with excellent outcomes. They also have their own set of challenges. Inappropriate keratometry measurement, underestimating the posterior corneal astigmatism, intraoperative IOL misalignment, postoperative rotation of these lenses, and IOL decentration after YAG-laser capsulotomy may result in residual cylindrical errors and poor uncorrected visual acuity resulting in patient dissatisfaction. This review provides a broad overview of a few important considerations, which include appropriate patient selection, precise biometry, understanding the design and science behind these lenses, knowledge of intraoperative surgical technique with emphasis on how to achieve proper alignment manually and with image-recognition devices, and successful management of postoperative complications.
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Affiliation(s)
| | - Muralidhar Ramappa
- Cataract and Refractive Services; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Cataract and Refractive Services; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Alió Del Barrio JL, Bhogal M, Ang M, Ziaei M, Robbie S, Montesel A, Gore DM, Mehta JS, Alió JL. Corneal transplantation after failed grafts: Options and outcomes. Surv Ophthalmol 2020; 66:20-40. [PMID: 33065176 DOI: 10.1016/j.survophthal.2020.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/27/2022]
Abstract
Corneal transplantation is the most commonly performed human tissue transplantation procedure worldwide. Because of the large number of transplants, corneal graft failure has become one of the most common indications for corneal transplantation. The relatively recently developed lamellar transplant techniques have brought about specific potential complications leading to graft failure that may require different approaches to repeat transplantation other than penetrating keratoplasty. On the other hand, these new lamellar techniques also provide novel ways of rescuing failed penetrating grafts, with potential advantages over successive penetrating keratoplasties, such as reduced intraoperative risks and faster visual rehabilitation. We summarize the incidence and risk factors of graft failure for penetrating and lamellar (stromal and endothelial) corneal transplants and discuss the various surgical alternatives currently available to rescue such failed grafts, with a focus on the reported outcomes and limitations.
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Affiliation(s)
- Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
| | | | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore
| | - Mohammed Ziaei
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Scott Robbie
- Cornea Unit, Guy's & St Thomas' Hospital, London, UK
| | - Andrea Montesel
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Daniel M Gore
- External Disease Service, Moorfields Eye Hospital, London, UK
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore
| | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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12
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Gundersen KG, Potvin R. Refractive and Visual Outcomes After Implantation of a Secondary Toric Sulcus Intraocular Lenses. Clin Ophthalmol 2020; 14:1337-1342. [PMID: 32546940 PMCID: PMC7244900 DOI: 10.2147/opth.s255725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the rotational stability, visual acuity and refractive error after sulcus implantation of a secondary toric IOL. Setting One clinical practice in Haugesund, Norway. Design Non-interventional single-arm diagnostic study. Methods Eligible subjects who had previous successful primary cataract or refractive lens exchange surgery in one or both eyes and the AddOn® secondary toric IOL implanted in the sulcus were evaluated at a single postoperative diagnostic visit to measure visual outcomes. Subjects with surgical complications (either primary or secondary) or pathology that would affect best-corrected visual acuity (eg, amblyopia) were excluded. Clinical evaluations at the diagnostic visit included measurement of visual acuity, manifest refraction and IOL orientation. Results Eighteen eyes were evaluated. After secondary IOL implantation, mean residual refractive astigmatism was significantly reduced (1.66 ± 0.92 to 0.32 ± 0.25 D). There was no appreciable change in the spherical equivalent refraction. Sixteen of 18 eyes (89%) had residual refractive astigmatism ≤0.50D, and no eye had more than 0.75D after secondary IOL implantation. Mean UCVA was 0.00 ± 0.03 logMAR, with no eyes worse than 0.10. Mean BCVA was −0.05 ± 0.03 logMAR (20/20+2), with all eyes having BCVA of 0.00 logMAR. The mean change in orientation was near zero, with a mean absolute change of 4.9 ± 3.7 degrees. Sixteen of 18 eyes (89%) had a lens orientation ≤10 degrees from intended, with no eye oriented more than 13 degrees from intended. Conclusion The AddOn® toric sulcus IOL significantly reduced postoperative refractive astigmatism in patients with high astigmatism after their primary cataract or RLE surgery, providing very good uncorrected distance vision.
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Management of Cataract in Patients with Irregular Astigmatism with Regular Central Component by Phacoemulsification Combined with Toric Intraocular Lens Implantation. J Ophthalmol 2020; 2020:3520856. [PMID: 32411427 PMCID: PMC7210554 DOI: 10.1155/2020/3520856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/23/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate visual acuity (VA) and refractive status in patients with cataract and irregular astigmatism with a regular central component after phacoemulsification with implantation of a toric intraocular lens (IOL). Methods Patients with cataract associated with irregular astigmatism with a regular central component were enrolled. All patients underwent phacoemulsification and toric IOL implantation. Postoperative visual acuity, residual astigmatism, toric IOL rotation, higher-order aberration, and objective and subjective visual quality were measured 3 months after surgery. Results Twenty-three eyes were included in the study. The logMAR corrected and uncorrected distance visual acuity values were decreased at 3 months postoperatively (p < 0.005). The preoperative average corneal astigmatism and postoperative residual astigmatism were 1.15–6.97 D (1.99 ± 1.26 D) and 0–2.75 D (0.65 ± 0.57 D), respectively. The average IOL rotation was 3.17 ± 2.01°. Some objective indicators of visual quality, including the modulation transfer function (p < 0.05), Strehl ratio (p < 0.005), 100% VA (p < 0.005), 20% VA (p < 0.005), and 9% VA (p < 0.005), were significantly higher than the corresponding preoperative values. The objective scatter index (p < 0.005) was significantly lower than that before surgery. The postoperative VF-14 scale score was 83.99 ± 14.58. Conclusion Toric IOL implantation has a good corrective effect on certain specific types of corneal irregular astigmatism with cataract. This effect can be attributed to its ability to correct the regular component of irregular astigmatism. The indications for toric IOL implantation could be expanded to some extent, thereby bringing benefit to more patients.
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Kwitko S, Marafon SB, Stolz AP. Toric intraocular lens in asymmetric astigmatism. Int Ophthalmol 2020; 40:1291-1298. [DOI: 10.1007/s10792-020-01296-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
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Stepwise Combination of Femtosecond Astigmatic Keratotomy With Phacoemulsification and Toric Intraocular Lens Implantation in Treatment of Very High Postkeratoplasty Astigmatism. Cornea 2019; 39:71-76. [PMID: 31490273 DOI: 10.1097/ico.0000000000002131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the outcomes of stepwise combined femtosecond astigmatic keratotomy (FSAK) and phacoemulsification with toric intraocular lens (IOL) implantation in the treatment of very high astigmatism after either penetrating keratoplasty or deep anterior lamellar keratoplasty. METHODS This is a retrospective, interventional case series including 8 eyes of 6 patients with very high astigmatism [≥8.00 diopter (D)] after either penetrating keratoplasty or deep anterior lamellar keratoplasty who underwent FSAK, followed by phacoemulsification and toric IOL implantation. Outcome measures were corneal and manifest astigmatism and uncorrected and best spectacle-corrected visual acuity (UCVA, BSCVA). RESULTS The average age was 58.9 ± 5.1 years. The average follow-up time was 40.9 ± 43.8 months. Outcome measure changes after both FSAK and toric IOL implantation were: corneal astigmatism improved from 13.56 ± 4.81 D to 4.48 ± 2.83 D (P < 0.001), manifest astigmatism improved from 9.15 ± 3.86 to 1.46 ± 0.88 D (P = 0.011), UCVA improved from 1.69 ± 0.45 LogMAR (Snellen equivalent ∼20/980) to 0.23 ± 0.11 LogMAR (Snellen equivalent ∼20/33, P < 0.001), and BSCVA improved from 1.01 ± 0.71 LogMAR (Snellen equivalent ∼20/200) to 0.19 ± 0.11 LogMAR (Snellen equivalent ∼20/30, P = 0.015). BSCVA and UCVA at the last follow-up were 20/40 or better in all patients. All procedures were uneventful. Two eyes underwent photorefractive keratectomy after FSAK to regularize and further reduce astigmatism before toric IOL implantation. One patient underwent temporary compression suturing because of FSAK overcorrection. CONCLUSIONS Combined stepwise use of FSAK and phacoemulsification with toric IOL implantation was an effective and apparently safe approach in patients with very high postkeratoplasty astigmatism. Additional treatment using photorefractive keratectomy may be beneficial in some cases.
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Customized Toric Intraocular Lens Implantation in Eyes with Cataract and Corneal Astigmatism after Deep Anterior Lamellar Keratoplasty: A Prospective Study. J Ophthalmol 2018; 2018:1649576. [PMID: 30057802 PMCID: PMC6051070 DOI: 10.1155/2018/1649576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/19/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the effectiveness of toric intraocular lenses (IOLs) for treating corneal astigmatism in patients with cataract and previous deep anterior lamellar keratoplasty (DALK). Setting San Giovanni-Addolorata Hospital, Rome, Italy. Design Prospective interventional case series. Methods Patients undergoing cataract surgery after DALK for keratoconus were enrolled. Total corneal astigmatism (TCA) was assessed by a rotating Scheimpflug camera combined with Placido-disk corneal topography (Sirius; CSO, Firenze, Italy). A customized toric IOL (FIL 611 T, Soleko, Rome, Italy) was implanted in all eyes. One year postoperatively, refraction was measured, the IOL position was recorded, and vectorial and nonvectorial analyses were performed to evaluate the correction of astigmatism. Results Ten eyes of 10 patients were analyzed. The mean preoperative TCA magnitude was 4.92 ± 1.99 diopters (D), and the mean cylinder of the IOL was 6.18 ± 2.44. After surgery, the difference between the planned axis of orientation of the IOL and the observed axis was ≤10° in all eyes. The mean surgically induced corneal astigmatism was 0.35 D at 20°. The mean postoperative refractive astigmatism power was 1.13 ± 0.94 D; with respect to preoperative TCA, the reduction was statistically significant (p < 0.0001). The mean change in astigmatism power was 3.80 ± 1.60 D, corresponding to a correction of 77% of preoperative TCA power. Nine eyes out of 10 had a postoperative refractive astigmatism power ≤ 2D. Conclusions Toric IOLs can effectively correct corneal astigmatism in eyes with previous DALK. The predictability of cylinder correction is partially lowered by the variability of the surgically induced changes of TCA. This trial is registered with NCT03398109.
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Nanavaty MA, Vijjan KS, Yvon C. Deep anterior lamellar keratoplasty: A surgeon's guide. J Curr Ophthalmol 2018; 30:297-310. [PMID: 30555961 PMCID: PMC6276733 DOI: 10.1016/j.joco.2018.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/27/2018] [Accepted: 06/09/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose To review and highlight important practical aspects of deep anterior lamellar keratoplasty (DALK) surgery and provide some useful tips for surgeons wishing to convert to this procedure from the conventional penetrating keratoplasty (PK) technique. Methods In this narrative review, the procedure of DALK is described in detail. Important pre, intra, and postoperative considerations are discussed with illustrative examples for better understanding. A comprehensive literature review was conducted in PubMed/Medline from January 1995 to July 2017 to identify original studies in English language regarding DALK. The primary endpoint of this review was the narrative description of surgical steps for DALK, its pitfalls, and management of common intraoperative complications. Results A standard DALK procedure can be successfully performed taking into consideration factors such as age, ophthalmic co-morbidities, status of the crystalline lens, retina, and intraocular pressure. Careful trephination and dissection of the host cornea employing appropriate technique (such as big bubble technique, manual dissection, visco-dissection, etc.) suitable for the specific case is important to achieve good postoperative outcomes. Prompt identification of intraoperative complications such as double bubble, micro and macroperforations, etc. are vital to change the management strategies. Conclusion Although there is a steep learning curve for DALK procedure, considering details and having insight into the management of intraoperative issues facilitates learning and reduces complication rates.
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Affiliation(s)
- Mayank A Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Kanwaldeep Singh Vijjan
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Camille Yvon
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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Kaur M, Shaikh F, Falera R, Titiyal JS. Optimizing outcomes with toric intraocular lenses. Indian J Ophthalmol 2017; 65:1301-1313. [PMID: 29208810 PMCID: PMC5742958 DOI: 10.4103/ijo.ijo_810_17] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Toric intraocular lenses (IOLs) are the procedure of choice to correct corneal astigmatism of 1 D or more in cases undergoing cataract surgery. Comprehensive literature search was performed in MEDLINE using “toric intraocular lenses,” “astigmatism,” and “cataract surgery” as keywords. The outcomes after toric IOL implantation are influenced by numerous factors, right from the preoperative case selection and investigations to accurate intraoperative alignment and postoperative care. Enhanced accuracy of keratometry estimation may be achieved by taking multiple measurements and employing at least two separate devices based on different principles. The importance of posterior corneal curvature is increasingly being recognized in various studies, and newer investigative modalities that account for both the anterior and posterior corneal power are becoming the standard of care. An ideal IOL power calculation formula should take into account the surgically induced astigmatism, the posterior corneal curvature as well as the effective lens position. Conventional manual marking has given way to image-guided systems and intraoperative aberrometry, which provide a mark-less IOL alignment and also aid in planning the incisions, capsulorhexis size, and optimal IOL centration. Postoperative toric IOL misalignment is the major factor responsible for suboptimal visual outcomes after toric IOL implantation. Realignment of the toric IOL is needed in 0.65%–3.3% cases, with more than 10° of rotation from the target axis. Newer toric IOLs have enhanced rotational stability and provide precise visual outcomes with minimal higher order aberrations.
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Affiliation(s)
- Manpreet Kaur
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Farin Shaikh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchita Falera
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Nuzzi R, Monteu F. Correction of High Astigmatism after Penetrating Keratoplasty with Toric Multifocal Intraocular Lens Implantation. Case Rep Ophthalmol 2017; 8:385-388. [PMID: 28868034 PMCID: PMC5567111 DOI: 10.1159/000478518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/09/2017] [Indexed: 11/25/2022] Open
Abstract
After penetrating keratoplasty (PK), high astigmatism is often induced, being frequently about 4–6 dpt. According to the entity and typology of astigmatism, different methods of correction can be used. Selective suture removal, relaxing incisions, wedge resections, compression sutures, photorefractive keratectomy, and laser-assisted in situ keratomileusis can reduce corneal astigmatism and ametropia, but meanwhile they can cause a reduction in the corneal integrity and cause an over- or undercorrection. In case of moderate-to-high regular astigmatisms, the authors propose a toric multifocal intraocular lens (IOL) implantation to preserve the corneal integrity (especially in PK after herpetic corneal leukoma keratitis). We evaluated a 45-year-old patient who at the age of 30 was subjected to PK in his left eye due to corneal leukoma herpetic keratitis, which led to high astigmatism (7.50 dpt cyl. 5°). The patient was subjected to phacoemulsification and customized toric multifocal IOL implantation in his left eye. The correction of PK-induced residual astigmatism with a toric IOL implantation is an excellent choice but has to be evaluated in relation to patient age, corneal integrity, longevity graft, and surgical risk. It seems to be a well-tolerated therapeutic choice and with good results.
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Affiliation(s)
- Raffaele Nuzzi
- M.D. Eye Clinic Section, University of Turin, Ophthalmic Hospital, Turin, Italy
| | - Francesca Monteu
- M.D. Eye Clinic Section, University of Turin, Ophthalmic Hospital, Turin, Italy
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Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism. J Ophthalmol 2016; 2016:3686380. [PMID: 27446606 PMCID: PMC4944078 DOI: 10.1155/2016/3686380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose. To evaluate the visual and refractive outcomes after small incision lenticule extraction (SMILE) for treating myopia and myopic astigmatism after penetrating keratoplasty (PKP). Design. Case-series. Methods. Ten eyes of 10 patients with previous PKP and residual myopic astigmatism for whom pentacam imaging and thickness measurements were acceptable for laser vision correction. Manifest refraction (MR), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained preoperatively and one day, one week, and one, 3, and 6 months postoperatively. Cases were operated on the VisuMax® femtosecond laser platform with 500 kHz repetition rate. Results. The mean correction ratio for spherical errors was 0.84 ± 0.19 D and for the mean refractive spherical equivalent (MRSE) was 0.79 ± 0.13 D. Vector analysis showed a mean astigmatism reduction at the intended axis of 67 ± 25.25%, a correction index of 0.81 ± 0.21, and an overall mean percentage of success of astigmatism surgery of 53 ± 37.9%. The postoperative MRSE was stable throughout the 6-month follow-up period. The efficacy index was 0.93 and the safety index was 1.12. Conclusion. SMILE for correction of post-PKP myopia and astigmatism is effective, safe, and stable with moderate accuracy and predictability. Centration of the treatment within the grafts was easily performed.
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Supplementary, Sulcus-Fixated Intraocular Lens in the Treatment of Spherical and Astigmatic Refractive Errors in Pseudophakic Eyes After Keratoplasty. Cornea 2016; 34:1052-6. [PMID: 26114825 DOI: 10.1097/ico.0000000000000506] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy, refractive outcomes, and complications of supplementary intraocular lens (IOL) implantation in pseudophakic eyes after keratoplasty. METHODS This is a retrospective review of pseudophakic postkeratoplasty eyes after implantation of a custom-designed, sulcus-fixated, supplementary "piggyback" IOL to correct refractive errors. The outcome measures included preoperative and postoperative uncorrected distance visual acuity (UDVA), spectacle-corrected distance visual acuity (CDVA), refractive correction, and complications. RESULTS This study evaluated 10 eyes (10 patients) with previous penetrating or deep anterior lamellar keratoplasty with a mean follow-up period of 12.2 ± 10.7 months (range, 2-33 months). All eyes showed improved UDVA postoperatively with 70% achieving ≥20/40. Median UDVA (logarithm of the minimum angle of resolution) improved from 1.2 (20/280, range 20/70-20/2000) preoperatively to 0.3 (20/40, range 20/20-20/60) postoperatively at the latest follow-up visit (P < 0.01). Five eyes (50%) had improvement in CDVA by at least 1 line of Snellen acuity with all eyes achieving ≥20/40 and 70% achieving ≥20/25. Median CDVA (logarithm of the minimum angle of resolution) was 0.2 (20/30, range 20/20-20/50) preoperatively compared with 0.1 (20/25, range 20/20-20/40) postoperatively (P = 0.03). In 8 eyes that received toric secondary IOLs, the mean refractive astigmatism decreased by 84% from 5.7 diopters (D) (range, 4-9 D) to 0.9 D (range, 0.2-3.0 D) (P = 0.01). Postoperative refractive astigmatism was ±1 D of predicted astigmatism for 7 of 8 eyes. No eyes lost any lines of UDVA or CDVA, and there were no keratoplasty rejection/failure events. CONCLUSIONS Implantation of a supplementary, sulcus-based IOL is an effective approach to reduce spherical and astigmatic refractive errors in pseudophakic eyes after keratoplasty.
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The Results of Toric Intraocular Lens Implantation in Patients With Cataract and High Astigmatism After Penetrating Keratoplasty. Eye Contact Lens 2015; 42:e8-e11. [PMID: 25955827 DOI: 10.1097/icl.0000000000000147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the results of toric intraocular lens (IOL) implantation in patients with cataract and postpenetrating keratoplasty astigmatism. METHODS Seven eyes of 7 patients with cataract and more than 3.5 diopters (D) astigmatism following penetrating keratoplasty were included in this retrospective case series study. All of the eyes underwent phacoemulsification and Acrysof toric IOL (t5-t9) implantation at least 6 months later than the complete suture removal. Corrected visual acuity (CVA), manifest astigmatism, the keratometry measurements, and complications were assessed. RESULTS The mean preoperative CVA significantly increased (0.7±0.3 [range: 0.3-1.3] logMAR to 0.1±0.04 [range: 0.05-0.15] logMAR; P<0.05) at mean 8.71±4.11 months after the surgery. The mean preoperative corneal astigmatism and the average manifest refractive astigmatism at the last visit were 5.4±0.9 D (range: 4.25-7 D) and 1.6±0.6 D (range: 0.5-2.5 D), respectively. The mean attempted cylinder correction at spectacle plane was 4.3±0.9 D (range: 2.4-4.7 D) whereas the mean cylinder correction was 4.6±0.5 D (range: 3.9-5.9 D), showing a slightly tendency for overcorrection. All eyes (100%) were within 1 D of predicted residual astigmatism. No complication occurred during the follow-up. CONCLUSION Toric IOL implantation seems to be an effective, predictable, and safe procedure in patients with cataract formation and high astigmatism after penetrating keratoplasty.
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Clinical results with a supplementary toric intraocular lens for the correction of astigmatism in pseudophakic patients. Eur J Ophthalmol 2015; 25:302-8. [PMID: 25633616 DOI: 10.5301/ejo.5000564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual outcomes of pseudophakic patients who underwent supplementary toric intraocular lens (IOL) implantation to correct astigmatic refractive errors. METHODS Pseudophakic patients referred for the implantation of a supplementary toric IOL (Sulcoflex Toric 653T) were evaluated. Uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), spherical equivalent (SE) refraction, rotational stability, higher order aberrations (HOA), and photopic glare and no-glare contrast sensitivity (CSV-1000, VectorVision) were evaluated. RESULTS A total of 10 eyes of 10 patients were included. The mean age was 56.42 ± 5.9 years (range 45-65 years). Mean follow-up was 6.99 ± 5.1 months (6-18 months). Postoperatively, UDVA improved to 0.10 ± 0.12 (0.3 to -0.1) (p = 0.004) and CDVA to 0.07 ± 0.12 (0.3 to -0.1) (p = 0.021). Mean SE was -0.30 ± 0.56 D (-1.00 to +0.75) (p = 0.001). Mean toric IOL axis rotation at 6-month follow-up was 3.0° ± 2.45° (0-6). Ocular aberrometry values decreased after surgery (for average HOA root mean square, p = 0.008). Photopic contrast sensitivity (for all spatial frequencies) showed a trend for improvement after surgery; however, this was not borne out from the analysis (p>0.05). CONCLUSIONS The implantation of the Sulcoflex Toric IOL to correct astigmatism in pseudophakic patients provided excellent visual outcomes, predictability of refractive results, rotational stability, and optical performance. The implantation of this IOL is a safe and effective technique to correct pseudophakic cylindrical refractive errors and reduce spectacle dependence in these patients.
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New combined technique of deep intrastromal arcuate keratotomy overlayed by LASIK flap for treatment of high astigmatism. Cornea 2014; 33:1123-8. [PMID: 25127189 DOI: 10.1097/ico.0000000000000236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to describe a novel technique combining deep intrastromal arcuate keratotomy and superficial lamellar keratotomy followed by excimer photoablation for the management of high naturally occurring or postkeratoplasty astigmatism. METHODS In this retrospective case series, the first step was deep intrastromal arcuate keratotomy and superficial lamellar keratotomy performed at 100-μm depth by femtosecond laser. Manual incisions were made for flap elevation. The second step, after 1 month, consisted of reopening the flap and using an excimer laser to correct residual ametropia. RESULTS Nine eyes series were studied. The mean preoperative refractive cylinder correction was 6.11 ± 2.54 diopters (D). The mean postoperative refractive cylinder correction was 2.85 ± 1.31 D. The mean correction index was 1.07 ± 0.28 D. The mean best-corrected visual acuity improved from 20/40 to 20/22 after the 2 steps. The median follow-up was 11 (range, 9-17) months. No complications were observed and postoperative outcome was satisfactory. CONCLUSIONS Permitting correction of a broader range of high astigmatism with good accuracy, this combined approach minimizes excision of corneal stromal tissue and postoperative complications.
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Feuerstacke J, Hellwinkel O, Naydis I, Linke S, Klemm M. [Astigmatism after keratoplasty: influence of orthotopic transplantation]. Ophthalmologe 2014; 111:846-52. [PMID: 24728287 DOI: 10.1007/s00347-013-2977-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients undergoing corneal transplantation often suffer from postoperative reduced vision due to high astigmatism. This retrospective study analyzed the influence of heterotopic or orthotopic transplantation on astigmatism and visual outcome. PATIENTS AND METHODS In this study 373 eyes of 334 patients were analyzed. Group 1 (OT) contained 186 eyes, which underwent orthotopic transplantation (side of recipient and donor corresponded), whereas group 2 (HT) included 187 heterotopic keratoplasties (donor cornea placed in the recipient's contralateral side). After 1, 3, 6, 12 and 24 months the median of keratometric astigmatism, objective astigmatism, topographic astigmatism and best corrected visual acuity (BCVA) were assessed and compared between groups. RESULTS The long-term results showed no statistically significant differences regarding keratometric and objective astigmatism, whereas topographic astigmatism differed significantly (p = 0.04) after 3 months. We observed a lower astigmatism of 5.7 dpt (range 3.08-7.78 dpt) in group OT than in the group HT with 7.1 dpt (range 3.9-10.7 dpt). No differences were found at the other time points. The BCVA showed a significantly better effect after 1 month (p = 0.01) in the OT group of 0.2 (0.1-0.3) than in HT group of 0.1 (0.05/0.25). In the postoperative course no additional significant dissimilarities were documented. CONCLUSIONS Heterotopic and orthotopic keratoplasty show no significant long-term differences in astigmatism and visual outcom.
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Affiliation(s)
- J Feuerstacke
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, Gebäude W40, 20246, Hamburg, Deutschland,
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Ferreira TB, Marques EF, Filipe HP. Combined corneal collagen crosslinking and secondary intraocular lens implantation for keratectasia after radial keratotomy. J Cataract Refract Surg 2014; 40:143-7. [DOI: 10.1016/j.jcrs.2013.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 12/01/2022]
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Wade M, Steinert RF, Garg S, Farid M, Gaster R. Results of toric intraocular lenses for post-penetrating keratoplasty astigmatism. Ophthalmology 2013; 121:771-7. [PMID: 24321143 DOI: 10.1016/j.ophtha.2013.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 10/08/2013] [Accepted: 10/08/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Evaluate the usefulness of toric intraocular lens (IOL) implantation during cataract surgery in patients after penetrating keratoplasty (PKP). DESIGN Retrospective case review. PARTICIPANTS A total of 21 eyes of 16 patients with prior PKP and moderate to high regular astigmatism after full suture removal underwent phacoemulsification and implantation of a single-piece acrylic toric IOL (SN6AT series; Alcon, Fort Worth, TX). METHODS Patients underwent comprehensive examinations at standard intervals, including visual acuity, manifest refraction, and corneal topography. MAIN OUTCOME MEASURES Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR) and manifest refraction astigmatism. RESULTS From preoperatively to the last visit (mean, 14.7 ± standard deviation 12.8 months), the 21 eyes had significant improvement in UDVA (logMAR, 0.90 ± 0.48 to 0.23 ± 0.25; P = 0.0001) and CDVA (logMAR, 0.31 ± 0.14 to 0.08 ± 0.13; P = 0.0001). A total of 14 of 21 eyes (67%) and 17 of 21 eyes (81%) had UDVA and CDVA of ≥ 20/30, respectively. Preoperative topographic astigmatism was 4.57 ± 2.05 diopters (D). Postoperative manifest refraction astigmatism was 1.58 ± 1.25 D overall, but lower (0.75 ± 0.54 D) in the T7-T9 subgroup (excluding 1 outlier whose corneal astigmatism doubled after surgery) than in the T4-T6 subgroup (1.88 ± 1.28 D; P = 0.013). A total of 16 of all 21 eyes (76.2%) and 8 of 9 eyes (89%) in the T7-T9 subgroup were within 1 D of postoperative manifest astigmatism as predicted or better. CONCLUSIONS Toric IOLs placed during cataract surgery after PKP and full suture removal can reduce manifest refraction cylinder to predictably low levels with corresponding improvement in UDVA and CDVA in patients with moderate to high regular preoperative topographic astigmatism.
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Affiliation(s)
- Matthew Wade
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California.
| | - Roger F Steinert
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California
| | - Sumit Garg
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California
| | - Marjan Farid
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California
| | - Ronald Gaster
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California
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