Update on nonexcimer laser refractive surgery technique: conductive keratoplasty

Ex vivo multiphoton analysis of rabbit corneal wound healing following conductive keratoplasty

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.

Surgical Correction of Hyperopia

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.

Orbscan Global Pachymetry: Analysis of Repeated Measures

PURPOSE

The Orbscan II is a hybrid slit-scanning and Placido disc corneal topographer capable mapping global pachymetry over a 10-mm corneal diameter. In this study, the repeatability of the Orbscan global pachymetry was determined.

METHODS

Five consecutive Orbscan examinations were performed on one eye of 20 healthy volunteers by one examiner in one session. Mean, standard deviation, range of readings, and coefficient of variance were calculated for the central, thinnest point and global pachymetry.

RESULTS

Orbscan repeatability for the central pachymetry was 3.62 microm (95% confidence interval [CI], 0.57-6.66) with a coefficient of variance of 0.67% (95% CI, 0.09-1.25) and intraclass correlation coefficient (ICC) of 0.978 (95% CI, 0.959-0.990). Thinnest point pachymetry had a repeatability of 4.25 microm (95% CI, 1.19-7.31) with a coefficient of variance of 0.80% (95% CI, 0.19-1.42) and ICC of 0.973 (95% CI, 0.950-0.988). Global pachymetry had a coefficient of variance <1.5% in the central 4 mm and <<2.5% across the entire cornea. Global pachymetry showed an area of greatest repeatability (<< +/- 5 microm) within a central 3.0-mm horizontal and 4.0-mm vertical diameter.

DISCUSSION

Orbscan is capable of giving repeatable pachymetry readings that are comparable to the ultrasound pachymeter within the central and thinnest point of the cornea. There is a gradual loss of repeatability toward the peripheral cornea possibly as a result of a lack of overlapping data points.

Conductive keratoplasty: histological study of human corneas

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.

Surgical treatment of presbyopia: scleral, corneal, and lenticular

PURPOSE OF REVIEW

Having solved most of the problems concerning myopia, hyperopia, and astigmatism, it is perfectly understandable that the surgical treatment of presbyopia should be next on the agenda. It is a new challenge where every possible aspect is explored.

RECENT FINDINGS

The past five years have been troubled by the debate over von Helmholtz theory on accommodation. Numerous investigations have been carried out on the primate and humans using various procedures. The more we learn about this mechanism, the nearer we will be to finding a solution to presbyopia. It appears essential to refer to recent works confirming von Helmholtz theory. Therefore, understanding presbyopia requires a great deal of optical ingenuity such as monovision, scleral modifications, which still remain controversial, or clear lens exchange or refilling.

SUMMARY

In 2003, with all the different techniques available, the surgeon has a wide choice to offer patients that are satisfactory from a practical, theoretical, and ethical point of view. However, these techniques must only be proposed once the patients have been carefully informed.