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Refractive surgery after deep anterior lamellar keratoplasty: a review of the literature. Int Ophthalmol 2022; 43:1413-1435. [PMID: 36083561 DOI: 10.1007/s10792-022-02507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The main objective of this work is to present an updated review of the different surgical procedures for the correction of residual refractive errors following deep anterior lamellar keratoplasty (DALK) surgery. METHODS A review of the literature was conducted using PubMed, Web of Science, and Scopus databases. The search was conducted in January 2022 and was limited to articles published in peer-reviewed journals. The information extracted from each publication included sample size, mean follow-up time, pre- and post-operative uncorrected (UDVA) and corrected distance visual acuity (CDVA), pre- and post-operative refraction and spherical equivalent (SE), safety and efficacy indexes and complications. RESULTS Residual ametropias, mainly high astigmatism and myopia, and the resulting anisometropia are likely to occur following DALK. They become a limiting factor and may lead to unsatisfactory visual restoration, therefore affecting patients' quality of vision and life. Alternative surgical interventions may be required to treat this residual ametropia, such as corneal refractive surgery or intraocular lens implantation. A total of 47 relevant articles were studied in detail. Different refractive surgery techniques have been shown to be effective and safe for the correction of ametropia following the DALK procedure and to improve the patient's quality of vision, although more research is needed to confirm long-term results. CONCLUSION The final refractive technique will depend on different factors, such as the amount of ametropia, the condition of the cornea or the patient's individual needs, economics, and occupational demands.
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Deshmukh R, Nair S, Vaddavalli PK, Agrawal T, Rapuano CJ, Beltz J, Vajpayee RB. Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 2021; 67:1200-1228. [PMID: 34808143 DOI: 10.1016/j.survophthal.2021.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.
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Affiliation(s)
| | - Sridevi Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Tushar Agrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
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Qin Q, Yang L, He Z, Huang Z. Clinical application of TICL implantation for ametropia following deep anterior lamellar keratoplasty for keratoconus: A CONSORT-compliant article. Medicine (Baltimore) 2017; 96:e6118. [PMID: 28225492 PMCID: PMC5348139 DOI: 10.1097/md.0000000000006118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to investigate the clinical application of phakic toric intraocular collamer lens (TICL) implantation in treating ametropia following deep anterior lamellar keratoplasty (DALK) for patients with keratoconus, especially the effectiveness and safety of high astigmatism and indications of TICL implantation after corneal transplantation. METHODS Using the self-controlled case series observation approach, 9 patients with ametropia (9 eyes) who underwent DALK surgery for keratoconus 1.5 years ago with stitches removed 3 months ago were kept under observation from May 2013 to April 2014 in Ophthalmic Center of Nanjing Drum Tower Hospital affiliated to Nanjing Medical University. TICL implantation was performed in all patients. The uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were examined before surgery and 1 week, 6 months, 1 year, and 2 years after surgery. Corneal astigmatism, corneal thickness, anterior chamber depth, corneal endothelial cell density (ECD), and preoperative and postoperative intraocular pressures at different time points were measured. Intraoperative or postoperative complications of TICL implantation were observed, and the safety of the operation was evaluated. RESULTS The UCVA and BCVA in all operated eyes were better 6 months after surgery than before surgery. The spherical diopter and cylindrical diopter decreased to different degrees after surgery. Six months after surgery, the deviation of TICL axis in all operated eyes was less than 10 degrees, tending to be stable. No severe intraoperative or postoperative complication occurred. CONCLUSION TICL implantation was an optional choice for ametropia correction after DALK surgery, especially in patients with high astigmatism.
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Affiliation(s)
- Qin Qin
- Department of Ophthalmology, Jinling Clinical Medical College of Nanjing Medical University
- Department of Ophthalmology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Jiangsu Province, People's Republic of China
| | - Liping Yang
- Department of Ophthalmology, Jinling Clinical Medical College of Nanjing Medical University
| | - Zifang He
- Department of Ophthalmology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Jiangsu Province, People's Republic of China
| | - Zhenping Huang
- Department of Ophthalmology, Jinling Clinical Medical College of Nanjing Medical University
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Additive Intraokularlinsen: Ein Überblick. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shalash RB, Elshazly MI, Salama MM. Combined intrastromal astigmatic keratotomy and laser in situ keratomileusis flap followed by photoablation to correct post-penetrating keratoplasty ametropia and high astigmatism: One-year follow-up. J Cataract Refract Surg 2015; 41:2251-7. [PMID: 26703302 DOI: 10.1016/j.jcrs.2015.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/06/2015] [Accepted: 01/10/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate a new technique combining intrastromal astigmatic keratotomy (AK) with a laser in situ keratomileusis (LASIK) flap followed by excimer laser photoablation to correct post-penetrating keratoplasty (PKP) high astigmatism and ametropia. SETTING Kasr El Aini Hospital, Cairo University, Cairo, Egypt. DESIGN Prospective interventional uncontrolled case series. METHODS Patients with post-PKP high astigmatism and ametropia had paired intrastromal AK with LASIK flap using the M2 microkeratome followed 2 to 3 months later by excimer laser photoablation. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refractive spherical equivalent (SE), and mean cylinder after each step and at the 1-year follow-up. RESULTS The study comprised 20 eyes (20 patients). All parameters were significantly improved in all patients by the last follow-up visit. The mean UDVA improved from 1.07 logMAR ± 0.2 (SD) preoperatively to 0.23 ± 0.18 logMAR (P < .001), the mean CDVA improved from 0.79 ± 0.18 logMAR to 0.12 ± 0.12 logMAR (P < .001), the mean refractive SE improved from -5.04 ± 2.62 diopters (D) to -1.47 ± 1.32 D (P = .001), and the mean cylinder reduced from -5.39 ± 0.98 D to -1.05 ± 0.71 D (P < .001). The mean correction index was 0.84 ± 0.10, and the mean flattening index was 0.83 ± 0.10. Thirty-five percent of cases developed microperforations, and 15% developed epithelial ingrowth. CONCLUSION This combined approach allowed for the correction of high astigmatism and ametropia following PKP; however, epithelial ingrowth requiring intervention is a complication to be considered. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Riad B Shalash
- From Kasr El Aini Hospital, Cairo University, Cairo, Egypt
| | | | - Marwa M Salama
- From Kasr El Aini Hospital, Cairo University, Cairo, Egypt
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Valdez-Garcia JE, Cueto-Gómez JJ, Lozano-Ramírez JF, Tamez-Peña AE. Management of extreme ametropia after penetrating keratoplasty: a series of surgical procedures for high myopia and astigmatism. Case Rep Ophthalmol 2014; 5:255-61. [PMID: 25232339 PMCID: PMC4163692 DOI: 10.1159/000365246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A series of surgical interventions – relaxing corneal incisions, intraocular lens, and intrastromal rings – were used to correct a case of extreme ametropia in a thin cornea after a penetrating keratoplasty in an 18-year-old patient who presented with a −10.25 −8.50 × 120 preoperative refraction and 20/200 best-corrected visual acuity (BCVA). After a series of surgical procedures, the patient's BCVA in his left eye improved to 20/30 with +0.50 −1.00 × 170, the slit lamp examination showed no significant findings, and the patient's visual complaints disappeared. At the 1-year follow-up, the BCVA was 20/25, without visual complaints. The process of individualizing the surgical procedure in the present case was employed in an outcome-based approach, that is, the next surgical procedure was defined after the surgery and postoperative evaluation. The patient did not present complications during the follow-up period of 2.5 years.
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Affiliation(s)
- Jorge E Valdez-Garcia
- Ophthalmology Research Chair, School of Medicine and Health Sciences, Monterrey, Mexico ; Instituto de Oftalmología y Ciencias Visuales - TECSalud, Tecnológico de Monterrey, Monterrey, Mexico
| | - Juan J Cueto-Gómez
- Ophthalmology Research Chair, School of Medicine and Health Sciences, Monterrey, Mexico
| | - Juan F Lozano-Ramírez
- Ophthalmology Research Chair, School of Medicine and Health Sciences, Monterrey, Mexico
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Coscarelli S, Ferrara G, Alfonso JF, Ferrara P, Merayo-Lloves J, Araújo LP, Machado AP, Lyra JM, Torquetti L. Intrastromal corneal ring segment implantation to correct astigmatism after penetrating keratoplasty. J Cataract Refract Surg 2012; 38:1006-13. [DOI: 10.1016/j.jcrs.2011.12.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 11/18/2011] [Accepted: 12/05/2011] [Indexed: 11/16/2022]
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Scorcia V, Lucisano A, Beltz J, Busin M. Combined Descemet-stripping automated endothelial keratoplasty and phacoemulsification with toric intraocular lens implantation for treatment of failed penetrating keratoplasty with high regular astigmatism. J Cataract Refract Surg 2012; 38:716-9. [DOI: 10.1016/j.jcrs.2012.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/22/2011] [Accepted: 09/22/2011] [Indexed: 11/29/2022]
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Additive sulcusfixierte Intraokularlinsen nach perforierender Keratoplastik in pseudophaken Augen. SPEKTRUM DER AUGENHEILKUNDE 2012. [DOI: 10.1007/s00717-012-0070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Current approaches for management of postpenetrating keratoplasty astigmatism. J Ophthalmol 2011; 2011:708736. [PMID: 21811668 PMCID: PMC3147001 DOI: 10.1155/2011/708736] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/06/2011] [Indexed: 12/02/2022] Open
Abstract
A successful corneal graft requires both clarity and an acceptable refraction. A clear corneal graft may be an optical failure if high astigmatism limits visual acuity. Intraoperative measures to reduce postkeratoplasty astigmatism include round and central trephination of cornea with an adequate size, appropriate sutures with evenly distributed tension, and perfect graft-host apposition. Suture manipulation has been described for minimising early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures containing relaxing incisions, compression sutures, laser refractive surgery, insertion of intrastromal corneal ring segments, wedge resection, and toric intraocular lens implantation can be performed. When astigmatism cannot be reduced using one or more abovementioned approaches, repeat penetrating keratoplasty should inevitably be considered. However, none of these techniques has emerged as an ideal one, and corneal surgeons may require combining two or more approaches to exploit the maximum advantages.
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de Sanctis U, Eandi C, Grignolo F. Phacoemulsification and customized toric intraocular lens implantation in eyes with cataract and high astigmatism after penetrating keratoplasty. J Cataract Refract Surg 2011; 37:781-5. [PMID: 21420606 DOI: 10.1016/j.jcrs.2011.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 12/16/2010] [Accepted: 12/16/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED Phacoemulsification and implantation of a hydrophilic acrylic toric intraocular lens (IOL) (T-flex 623T) with customized cylindrical power was performed in 1 eye in 3 consecutive patients with cataract and high postkeratoplasty astigmatism (range 6.75 to 8.75 diopters [D]). Twelve months postoperatively, the uncorrected distance visual acuity improved from 20/200 to 20/30 in Case 1, from 20/400 to 20/40 in Case 2, and from 20/200 to 20/25 in Case 3 and the corrected distance visual acuity was 20/25 or better in all 3 eyes. The spheroequivalent was within ± 0.50 D of the intended value and the refractive astigmatism was less than 1.00 D. The corneal grafts were transparent, and the endothelial cell loss range was 6% to 12%. Rotation of the toric IOL was less than 5 degrees. The toric IOL with customized cylindrical power provided good postoperative rotational stability and very satisfactory postoperative visual recovery. This type of toric IOL is appropriate to correct high postkeratoplasty astigmatism in eyes operated on for cataract. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Ugo de Sanctis
- Department of Clinical Physiopathology, Ophthalmology Institute, University of Turin, Italy.
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Song HB, Choi HJ, Kim MK, Wee WR. The Short-Term Effect of Limbal Relaxing Incision and Compression Suture on Post-Penetrating Keratoplasty Astigmatism. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.10.1142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Beom Song
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Wong Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Mehta JS, Yuen LH, Mengher LS, Papathanassiou M, Allan BDS. Correcting post-keratoplasty anisometropia with the implantable collamer phakic intraocular lens. Clin Exp Ophthalmol 2010; 38:764-767. [DOI: 10.1111/j.1442-9071.2010.02348.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Intrastromal corneal ring segment implantation for high astigmatism after penetrating keratoplasty. J Cataract Refract Surg 2009; 35:1878-84. [DOI: 10.1016/j.jcrs.2009.05.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 05/07/2009] [Accepted: 05/11/2009] [Indexed: 11/20/2022]
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Nubile M, Carpineto P, Lanzini M, Calienno R, Agnifili L, Ciancaglini M, Mastropasqua L. Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty. Ophthalmology 2009; 116:1083-92. [PMID: 19395035 DOI: 10.1016/j.ophtha.2009.01.013] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 01/08/2009] [Accepted: 01/13/2009] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the feasibility and initial outcomes of using a femtosecond laser to perform arcuate keratotomies to correct high post-keratoplasty astigmatism. DESIGN Prospective noncomparative interventional case series. PARTICIPANTS Twelve eyes of 12 consecutive patients (mean age 44.9+/-9.5 years) who presented with a high degree of astigmatism, noncorrectable with spectacles or contact lenses (10 post-penetrating keratoplasty, 2 post-deep lamellar keratoplasty), and were candidates for relaxing incisional corneal surgery. METHODS The Femtec (20/10 Perfect Vision, GmbH, Heidelberg, Germany) femtosecond laser performed paired 90-degree angled arcuate incisions on the graft button. The incision sites and depths were programmed at 1.00 mm inside the graft edge and at 90% of the corresponding local graft thickness, whereas the angular lengths of the cuts were determined by analyzing the locations and extents of the steepest meridians in the topographic map. MAIN OUTCOME MEASURES Changes in uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), mean subjective and topographically determined astigmatism; imaging of incisions by anterior segment optical coherence tomography (AS-OCT); and wound healing by in vivo confocal microscopy (IVCM). RESULTS Postoperative follow-up extended to 6 months. Mean uncorrected logarithm of the minimum angle of resolution (logMAR) BSCVA and UCVA improved from preoperative values of 0.25+/-0.16 and 1.05+/-0.18 to 6-month values of 0.11+/-0.12 (standard deviation) and 0.55+/-0.34, respectively (P<0.05). Mean subjective astigmatism was 7.16+/-3.07 diopters (D) preoperatively and 2.23+/-1.55 D at 1 month after surgery (P = 0.002) and remained stable to the end of follow-up. Anterior segment optical coherence tomography image analysis showed that the depth and location of the incisions were consistent with the preoperative surgical plan. In vivo confocal microscopy showed mild edema and keratocyte activation along the incision edges, together with initial epithelial ingrowth inside the wound, followed by subsequent moderate fibrotic scarring. CONCLUSIONS Arcuate keratotomies performed with the femtosecond laser were effective in reducing post-keratoplasty astigmatism. Laser-generated incisions within the graft button presented precise geometry and reliable depth of incision, with a wound healing pattern characterized by epithelial ingrowth and mild fibrosis. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mario Nubile
- Department of Medicine and Ageing Science, Ophthalmic Clinic, University G. D'Annunzio of Chieti and Pescara, Italy.
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Sierra Wilkinson P, Davis EA, Hardten DR. LASIK. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Bigou MA, Cochener B. [LASIK treatment for graft astigmatism]. J Fr Ophtalmol 2007; 30:511-8. [PMID: 17568345 DOI: 10.1016/s0181-5512(07)89632-x] [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: 11/20/2022]
Abstract
OBJECTIVE To analyze the advantages of LASIK as a treatment for postkeratoplasty residual astigmatism. PATIENTS and METHOD Retrospective, noncomparative, monocentric study on 14 patients with penetrative keratoplasty. Visual acuity, objective refraction, intraocular pressure, slit lamp biomicroscopy, videotopography, pachymetry, and patient satisfaction were studied before and after surgery. RESULTS Refraction was stable 6 months after treatment in 93% (13/14) of the patients. The mean uncorrected visual acuity increased from 0.16 to 0.4. Two out of four patients (14.3%) were retreated because visual acuity did not improve after the first treatment; 35% did not need any optical correction after the intervention. The measured astigmatism showed a significant decrease, from 65% greater than 5 D before treatment to 82% under 2 D after treatment. Only two out of 14 patients (14.3%) were not satisfied. No intraocular or postoperative complications were reported in this study. CONCLUSION LASIK seems to be an interesting option in the treatment of postkeratoplasty residual astigmatism. This study has shown its efficacy and safety in this indication. Its originality lies in the one-step procedure, with the flap and photoablation done in a single step. However, it is still dependent on the operator and most particularly the equipment (laser, microkeratome, aberrometry).
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Affiliation(s)
- M-A Bigou
- Service d'Ophtalmologie, CHU Morvan, Brest.
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Abstract
PURPOSE OF REVIEW Bioptics treats complex refractive errors by combining refractive techniques with different mechanisms of action, usually using an intraocular implant (a phakic or pseudophakic intraocular lens) followed by a corneal procedure (laser ablation, intrastromal implant). RECENT FINDINGS In myopia and hyperopia, bioptics with phakic intraocular lenses or refractive lens exchange and subsequent excimer laser yields improved predictability and unchanged safety, compared with sole intraocular lens surgery. Complications are related mainly to intraocular lenses. In keratoconus and pellucid marginal degeneration, intracorneal rings have been successfully combined with phacoemulsification or with phakic intraocular lenses in a limited number of eyes. In the author's series, angle-supported phakic intraocular lenses were implanted in 12 eyes to correct a mean regression of -8 D after excimer laser (reverse bioptics), achieving a mean spherical equivalent of -0.3 D, mean best spectacle-corrected visual acuity of 0.7, and mean uncorrected visual acuity of 0.5, with 83% of eyes within 0.5 D of spherical equivalent. SUMMARY Bioptics improves vision and halos and adds no particular risks to phakic or pseudophakic intraocular lens implantation in either myopia or hyperopia. Reverse bioptics, with phakic intraocular lenses or refractive lens exchange, can be used to correct regressed corneal surgery.
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Tahzib NG, Cheng YYY, Nuijts RMMA. Three-Year Follow-up Analysis of Artisan Toric Lens Implantation for Correction of Postkeratoplasty Ametropia in Phakic and Pseudophakic Eyes. Ophthalmology 2006; 113:976-84. [PMID: 16647131 DOI: 10.1016/j.ophtha.2006.02.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 02/17/2006] [Accepted: 02/17/2006] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the 3-year follow-up of efficacy and safety of Artisan toric iris-fixated lens implantation after penetrating keratoplasty (PK) to correct high ametropia and astigmatism. DESIGN Prospective noncomparative case series with a minimum follow-up of 1 year. PARTICIPANTS Artisan toric lens implantation was performed in 36 eyes of 35 patients who were contact lens intolerant or unable to wear glasses due to anisometropia and/or high astigmatism. INTERVENTION Thirty-six eyes of 35 consecutive patients received Artisan toric lens implantation for postkeratoplasty astigmatism and/or anisometropia. MAIN OUTCOME MEASURES Manifest refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and corneal topography were determined or performed before surgery and at 3, 6, and 12 months and yearly intervals up to 4 years after surgery. Efficacy, safety, percent reduction of refractive astigmatism, anisometropia of defocus, and the astigmatism correction index were determined. A patient satisfaction questionnaire and specular microscopy were assessed. RESULTS The mean +/- standard deviation of preoperative refractive cylinder was -7.06+/-2.01 diopters (D) (range, -3.0 to -11.0), which was reduced to -1.73+/-1.25 D, -1.69+/-1.15 D, -1.94+/-1.68 D, -2.02+/-1.93 D, and -2.00+/-1.53 D at 6 months (n = 36), 1 year (n = 36), 2 years (n = 29), 3 years (n = 15), and the last follow-up examination (28.5+/-12.5 months, n = 36), respectively (P<0.001 for all time points, paired t test). The spherical equivalent was reduced from -3.19+/-4.31 D (range, +5.5 to -14.25 D) preoperatively to -1.03+/-1.20 D (range, +1.0 to -5.25 D) at the last follow-up. The UCVA and BSCVA were > or =20/40 in 31.6% and 80.6%, respectively. There was a loss of BSCVA of >2 lines in 8.3% of eyes and a gain of at least 2 lines in 8.3% of eyes. Percent reductions in refractive astigmatism and anisometropia of defocus were 88.8%+/-29.5% and 77.8%+/-19.3%, respectively. The astigmatism correction index was 96.0%+/-24.2%. Satisfaction increased from 3.6 to 8.0 (scale, 0-10) after implantation. The endothelial cell loss as compared with preoperatively was 13.8%+/-18.7% (n = 34), 21.2%+/-21.8% (n = 33), 29.6%+/-27.3% (n = 26), 30.4%+/-32.0% (n = 18), and 34.8%+/-26.3% (n = 6) at 6 months (P = 0.001), 1 year (P<0.001), 2 years (P<0.001), 3 years (P = 0.001), and 4 years postoperatively (P = 0.1), respectively. In 2 patients, irreversible graft rejections occurred, and in 1 patient, gradual endothelial decompensation occurred. CONCLUSION Artisan toric lens implantation after PK was effective for reduction of refractive astigmatism and ametropia. All patients were suitable for spectacle correction after implantation. There was continuing endothelial cell loss from 6 months to 3 years postoperatively. In 3 cases, corneal graft failure developed.
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Affiliation(s)
- Nayyirih G Tahzib
- Department of Ophthalmology, Academic Hospital Maastricht, Maastricht, The Netherlands
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