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Gour A, Garg A, Tibrewal S, Pegu J, Gupta S, Mathur U, Sangwan V. Corneal transplantation in children - when and how? EXPERT REVIEW OF OPHTHALMOLOGY 2023. [DOI: 10.1080/17469899.2023.2177153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Abha Gour
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Aastha Garg
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Shailja Tibrewal
- Department of Pediatric Ophthalmology, Strabismus and Neurophthamology, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Julie Pegu
- Department of Glaucoma and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Sonal Gupta
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Umang Mathur
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Virender Sangwan
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
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Vanathi M, Raj N, Kusumesh R, Aron N, Gupta N, Tandon R. Update on Pediatric Corneal Diseases and Keratoplasty. Surv Ophthalmol 2022; 67:1647-1684. [PMID: 35918016 DOI: 10.1016/j.survophthal.2022.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 10/31/2022]
Abstract
Managing pediatric corneal disorders is challenging as the prognosis of pediatric keratoplasty depends on several factors. Advancements in the genetic basis of congenital corneal diseases and investigations in congenital corneal conditions provide a better understanding of pediatric corneal conditions. Surgeons performing keratoplasty in children now have a choice of various techniques. Evolving surgical techniques of anterior lamellar and endothelial keratoplasties has expanded the management interventions in these pediatric corneal morbidity conditions; however, considerable concerns still exist in association with corneal transplantation in infants and children. Outcomes in pediatric keratoplasty depend upon the preoperative indications, the timing of surgical intervention, intraoperative and postoperative factors including the patient/care givers' compliance. Factors such as low scleral rigidity, higher rate of graft failure, need for frequent examinations under anesthesia, and difficulty in optimal visual acuity assessment still remain a considerable challenge in pediatric scenarios. In children, deprivation amblyopia as a result of the corneal opacification can adversely affect visual development, causing dense amblyopia. Outcomes to surgical interventions for management of corneal opacification in children is further compromised by the pre-existing amblyopia apart from the concerns of refractive outcome of the graft. Graft rejection, graft infection, amblyopia, and glaucoma continue to be serious concerns. In recent years both anterior and posterior lamellar keratoplasty techniques are being increasingly performed in pediatric eyes, which offer advantages in the form of lower risk of graft rejection. The timing of surgery, careful case selection, cautious intraoperative approach, and optimal postoperative management can improve the anatomical and functional outcome in difficult cases.
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Affiliation(s)
- Murugesan Vanathi
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India.
| | - Nimmy Raj
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Rakhi Kusumesh
- Cornea & Ocular Surface Services, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Neelima Aron
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Noopur Gupta
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Radhika Tandon
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
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Sharma N, Agarwal R, Jhanji V, Bhaskar S, Kamalakkannan P, Nischal KK. Lamellar keratoplasty in children. Surv Ophthalmol 2020; 65:675-690. [DOI: 10.1016/j.survophthal.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023]
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Sahay P, Stevenson LJ, Agarwal T, Sharma B, Sharma N, Vajpayee RB. Shaped corneal transplantation surgery. Br J Ophthalmol 2020; 105:9-16. [PMID: 32217546 DOI: 10.1136/bjophthalmol-2019-315754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/22/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022]
Abstract
Since its inception in 1905, keratoplasty techniques have continuously evolved. Shaped keratoplasty procedures have allowed corneal surgeons to use complex graft-host junctions and non-circular graft designs to optimise wound strength and healing, facilitate early suture removal and expedite visual rehabilitation. While this was initially limited to penetrating procedures, shaped lamellar keratoplasty techniques have since emerged. Furthermore, the arrival of femtosecond laser has dramatically increased the range of graft designs available to surgeons, due to the technology's ability to precisely cut complex wound edges. This review describes the broad range of shaped keratoplasty grafts currently available and elaborates on their respective advantages and disadvantages in relation to conventional keratoplasty.
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Affiliation(s)
- Pranita Sahay
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Tushar Agarwal
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Namrata Sharma
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia .,University of Melbourne, Parkville, Victoria, Australia.,Vision Eye Institute, Melbourne, Victoria, Australia
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Feizi S, Javadi MA, Najafi M, Abolhosseini M, Moshtaghion SM. Outcomes of big-bubble deep anterior lamellar keratoplasty for pediatric keratoconus. Int Ophthalmol 2020; 40:1253-1259. [PMID: 31974823 DOI: 10.1007/s10792-020-01291-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed for pediatric keratoconus. METHODS This retrospective study enrolled 44 consecutive eyes of 39 keratoconus-affected children (≤ 18 years of age). All patients underwent big-bubble DALK from March 2004 to June 2016. The outcome measures included postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry readings, and complications. RESULTS The mean participant age was 16.8 ± 1.4 years, and the mean follow-up period was 68.5 ± 39.9 months. Successful big bubble was achieved in 33 eyes (75.0%), while the surgical technique was predescemetic DALK in 11 (25.0%). The mean BSCVA changed from 1.34 ± 0.49 LogMAR preoperatively to 0.24 ± 0.10 LogMAR postoperatively (P < 0.001). The mean keratometry decreased from 59.54 ± 5.17 D preoperatively to 46.23 ± 2.17 D postoperatively (P < 0.001). The complications encountered during the study period were intraoperative Descemet's membrane perforation (n = 5, 11.4%), the Urrets Zavalia syndrome (n = 1, 2.3%), graft epithelial problems (n = 3, 6.8%), subepithelial graft rejection (n = 5, 11.4%), high intraocular pressure (n = 8, 18.2%), and traumatic wound dehiscence (n = 2, 4.6%). Suture-related complications included premature loosening (n = 13, 29.6%), broken sutures (n = 12, 27.3%), suture-tract vascularization (n = 6, 13.6%), suture-associated abscesses (n = 5, 11.4%), and suture cheese wiring (n = 2, 4.6%). A clear graft was found in 40 eyes (90.9%) at the last follow-up examination. CONCLUSION This study showed promising results with big-bubble DALK in keratoconus-affected children. A frequent and close follow-up with dedicated parental involvement is essential for the early recognition and management of postoperative complications.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran, 16666, Iran.
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran, 16666, Iran
| | - Maryam Najafi
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran, 16666, Iran
| | - Mohammad Abolhosseini
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran, 16666, Iran
| | - Seyed-Mohamadmehdi Moshtaghion
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St, Pasdaran Avenue, Tehran, 16666, Iran
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Elkamshoushy A, Gonnah R, Madi S, Beltz J. Single-piece femtosecond-assisted mushroom keratoplasty in children. J AAPOS 2019; 23:28.e1-28.e5. [PMID: 30500436 DOI: 10.1016/j.jaapos.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/13/2018] [Accepted: 08/19/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To report outcomes of femtosecond-assisted single-piece mushroom keratoplasty for the treatment of full-thickness corneal disease in pediatric patients with healthy endothelium. METHODS Femtosecond-assisted mushroom keratoplasty was performed in 8 eyes of 8 patients (age range, 8-17 years) with central full-thickness corneal opacity. The single-piece mushroom-shaped graft consisted of a large anterior portion (9 mm in diameter; 250 μm in thickness) and a small posterior portion (6-6.5 mm). Donor and recipient corneas were prepared using the WaveLight FS200 laser (Alcon Laboratories, Fort Worth, TX). The donor cornea was oversized by 0.2 mm. Outcome measures were best spectacle-corrected visual acuity, spectacle refraction, topographic astigmatism, endothelial cell density, graft rejection, and graft failure at 1, 3, 6, and 12 months. RESULTS Mean best spectacle-corrected visual acuity at 1, 3, 6, and 12 months was 0.28, 0.16, 0.13, and 0.10 logMAR; all patients achieved logMAR of at least 0.4 at 1, 3, 6, and 12 months. The mean refractive cylinder was 2.6 D, and mean endothelial cell loss was 13.3% at 12 months postoperatively. Two eyes had immunologic rejection episodes that were reversed with topical steroids. All corneas remained clear at final follow-up. CONCLUSIONS Femtosecond-assisted mushroom keratoplasty is a viable surgical option for eyes of older pediatric patients with full-thickness corneal stromal disease and healthy endothelium. Mushroom keratoplasty combines the refractive advantage of a large keratoplasty with the immunologic advantage of a small keratoplasty. Single-piece femtosecond-assisted mushroom keratoplasty may have a mechanical advantage over regular penetrating keratoplasty.
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Affiliation(s)
- Amr Elkamshoushy
- Ophthalmology Department, Alexandria University, Alexandria, Egypt
| | - Reem Gonnah
- Ophthalmology Department, Alexandria University, Alexandria, Egypt
| | - Silvana Madi
- Ophthalmology Department, Alexandria University, Alexandria, Egypt.
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Buzzonetti L, Petrocelli G, Valente P, Petroni S, Parrilla R, Iarossi G. Refractive outcome of keratoconus treated by big-bubble deep anterior lamellar keratoplasty in pediatric patients: two-year follow-up comparison between mechanical trephine and femtosecond laser assisted techniques. EYE AND VISION 2019; 6:1. [PMID: 30656177 PMCID: PMC6330749 DOI: 10.1186/s40662-018-0127-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/22/2018] [Indexed: 11/24/2022]
Abstract
Background To evaluate refractive outcome 24 months after Deep Anterior Lamellar Keratoplasty (DALK) in pediatric patients by comparing results achieved using mechanical trephine and femtosecond laser. Methods Twenty eyes of 20 patients affected by keratoconus were evaluated. To perform big-bubble DALK, 10 eyes (Group 1; mean age 11.2 ± 2.2 years) were subjected to the Hessburg-Barron mechanical trephine and the remaining 10 eyes (Group 2; mean age 11.3 ± 3.1 years) to a 150 kHz femtosecond laser that performed mushroom incisions. Preoperative thinnest point in the corneal thickness map and K readings were measured by the Sirius Scheimpflug camera. We also evaluated corrected distance visual acuity (CDVA) as logMAR value using spectacles, spherical equivalent and refractive astigmatism. Results Mean preoperative thinnest point and pre- and post-operative K readings did not show significant difference (P > 0.05) between the two groups. CDVA, spherical equivalent and refractive astigmatism were respectively, 0.14 ± 0.08 logMAR and 0.13 ± 0.10 logMAR (P = 0.8), − 4.2 ± 1.1 D and − 2.8 ± 1.2 D (P = 0.03), 4.4 ± 2.0 D and 3.6 ± 1.2 D (P = 0.4) in Groups 1 and 2. All DALK procedures were uneventful. Conclusion Our findings suggest that femtosecond laser compared to mechanical trephine could significantly reduce the spherical equivalent amount in pediatric big-bubble DALK.
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Affiliation(s)
- Luca Buzzonetti
- Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc - 00050 Passoscuro, Rome, Italy
| | - Gianni Petrocelli
- Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc - 00050 Passoscuro, Rome, Italy
| | - Paola Valente
- Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc - 00050 Passoscuro, Rome, Italy
| | - Sergio Petroni
- Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc - 00050 Passoscuro, Rome, Italy
| | - Rosa Parrilla
- Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc - 00050 Passoscuro, Rome, Italy
| | - Giancarlo Iarossi
- Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc - 00050 Passoscuro, Rome, Italy
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Lu Y, Chen X, Yang L, Xue C, Huang Z. Femtosecond laser-assisted deep anterior lamellar keratoplasty with big-bubble technique for keratoconus. Indian J Ophthalmol 2017; 64:639-642. [PMID: 27853010 PMCID: PMC5151152 DOI: 10.4103/0301-4738.194326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the clinical results after deep anterior lamellar keratoplasty (DALK) assisted by the femtosecond laser with big-bubble technique for keratoconus. Methods: A case series of 22 eyes in 19 patients with keratoconus was enrolled in the study. The 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec AG, Jena, Germany) was used to create a vertical side cut on donor and recipient corneas. Intraoperative and postoperative complications, uncorrected visual acuity, best-corrected visual acuity, corneal curvature, and central corneal thickness were evaluated in all patients. Results: Big-bubble and naked Descemet's membrane (DM) were successfully achieved in twenty eyes (90.9%). Intraoperative macroperforation of DM occurred in two cases and converted to full-thickness keratoplasty. The mean follow-up time was 18.8 ± 5.3 months. The best-corrected visual acuity was increased from 0.3 to 1.0, mean corneal curvature was 43.0 ± 2.3D, and mean central corneal thickness was 508.9 ± 60.1 μm (range, from 430 to 600 μm) postoperatively. Conclusion: Our results indicate that femtosecond laser-assisted DALK with big-bubble technique is an accurate, safe, and effective method to treat the patients with keratoconus.
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Affiliation(s)
- Yan Lu
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Xiangfei Chen
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University; Department of Endocrinology, Geriatric Research Center, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Liping Yang
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Chunyan Xue
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Zhenping Huang
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
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Di Zazzo A, Bonini S, Crugliano S, Fortunato M. The challenging management of pediatric corneal transplantation: an overview of surgical and clinical experiences. Jpn J Ophthalmol 2017; 61:207-217. [PMID: 28374268 DOI: 10.1007/s10384-017-0510-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 02/27/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Pediatric keratoplasty is an immense challenge because of the technical complexity of the procedure and the high risk of rejection in young graft recipients. Our aim is to describe the major indications and appropriate timing of corneal transplantation intervention, including a report of our experience and surgical tips, in conjunction with the current literature. METHODS Review of the literature on indications for keratoplasty in pediatric patients classified as: congenital, traumatic and acquired non-traumatic opacities. We additionally explored the challenges corneal surgeons face in performing this type of surgery and review the most pressing transplant-related problems and their management. RESULTS Outcomes after pediatric keratoplasty, in terms of visual development, restoration and clarity of the graft, are influenced by peri-operative local and systemic conditions and factors, and by intraoperative management of the transplantation procedure itself. CONCLUSION Pediatric corneal transplantation is a critical tool for visual restoration and development in young patients with corneal opacities, particularly during the critical period of visual development. Successful management of the significant challenges associated with pediatric keratoplasty requires customized clinical and surgical management of each patient with particular attention paid to proper post-operative rehabilitation.
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Affiliation(s)
- Antonio Di Zazzo
- IRCCS G.B. Bietti Foundation ONLUS, via Livenza n.3, 00198, Rome, Italy.
| | - Stefano Bonini
- Department of Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy
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Four years of corneal keratoplasty in Italian paediatric patients: indications and clinical outcomes. Graefes Arch Clin Exp Ophthalmol 2016; 254:2239-2245. [PMID: 27488912 DOI: 10.1007/s00417-016-3447-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose was to evaluate indications and clinical outcomes in paediatric corneal keratoplasty. METHODS Fifty-four eyes of 43 patients who underwent corneal keratoplasty from the 1st of January 2010 through the 31st of December 2013 at the Bambino Gesù Children's Hospital in Rome, Italy, were retrospectively evaluated. To assess the effect of age on graft failure rate, the recipient age was considered as a dichotomous variable (≤5 or >5 years) and a 2X2 table was developed, using the chi-square test for testing the statistical significance. Furthermore, two separate subgroup analyses were conducted on patients of ≤5 years and those of >5 years, to evaluate the effect of penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) on the graft failure rate. The level of statistical significance was set at p < 0.05 RESULTS: Mean recipient age was 8.9 ± 5.7 [SD] years. Mean follow-up time was 22.8 months. Main preoperative diagnoses were keratoconus (37 %) and congenital glaucoma (20 %). Patients ≤5 years showed a higher percentage of graft failure (p = 0.0008). PK and DALK did not show statistically significant differences regarding the graft failure in both subgroups (p = 0.15 for ≤5 years group and p = 0.27 for >5 years group, respectively). However, across groups DALK provided a lower rate of graft failure. CONCLUSIONS Our findings suggest that children older than 5 years show a significantly better graft outcome and that DALK seems to offer greatest benefits in terms of failure risk in paediatric patients.
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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Lu Y, Shi YH, Yang LP, Ge YR, Chen XF, Wu Y, Huang ZP. Femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus and keratectasia. Int J Ophthalmol 2014; 7:638-43. [PMID: 25161934 DOI: 10.3980/j.issn.2222-3959.2014.04.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/04/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK) for keratoconus and post-LASIK keratectasia. METHODS In this non-comparative case series, 10 eyes of 9 patients underwent DALK procedures with a femtosecond laser (Carl Zeiss Meditec AG, Jena, Germany). Of the 9 patients, 7 had keratoconus and 2 had post-LASIK keratectasia. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal thickness, astigmatism, endothelial density count (EDC), and corneal power. RESULTS All eyes were successfully treated. Early postoperative evaluation showed a clear graft in all cases. Intraoperative complications included one case of a small Descemet's membrane perforation. Postoperatively, there was one case of stromal rejection, one of loosened sutures, and one of wound dehiscence. A normal corneal pattern topography and transparency were restored, UCVA and BCVA improved significantly, and astigmatism improved slightly. There was no statistically significant decrease in EDC. CONCLUSION Our early results indicate that femtosecond laser-assisted deep anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology. This approach shows promise as a safe and effective surgical choice in the treatment of keratoconus and post-LASIK keratectasia.
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Affiliation(s)
- Yan Lu
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Yu-Hua Shi
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Li-Ping Yang
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Yi-Rui Ge
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Xiang-Fei Chen
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Yan Wu
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Zhen-Ping Huang
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
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Sati A, Ramappa M, Chaurasia S, Prasad SM. Deep anterior lamellar keratoplasty in case of Hurler-Scheie syndrome. BMJ Case Rep 2014; 2014:bcr-2013-202730. [PMID: 24706723 DOI: 10.1136/bcr-2013-202730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-year-old boy with Hurler-Scheie syndrome (H/S syndrome) reported with reduced vision in both the eyes for past few years. Deep anterior lamellar keratoplasty (DALK) was performed for visual rehabilitation in his left eye. During surgery, the predescemet's plane was reached by meticulously dissecting the lamellar fibres using a manual technique. Histopathology of the dissected cornea showed the presence of numerous alcian blue positive deposits corroborating with the diagnosis of mucopolysaccharidosis (MPS). Postoperative course was uneventful. One year following surgery, the graft was clear and had a visual acuity of 20/50 with +1.00 170° - 0.75 refractive correction. Endothelial cell count, as measured by non-contact specular microscopy, was 2473.4 cells/mm(2). This case report highlights the application of DALK in a case of MPS-related corneal stromal opacification.
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Affiliation(s)
- Alok Sati
- Department of Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
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Chew ACY, Mehta JS, Tan DTH. One Year of Cornea Research in Review-2012. Asia Pac J Ophthalmol (Phila) 2013; 2:401-13. [PMID: 26107152 DOI: 10.1097/apo.0000000000000022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to provide an update of significant cornea literature published in the past 1 year. DESIGN This was a literature review. METHODS The authors conducted a 1-year English-language literature search on PubMed, from January 1, 2012, to December 31, 2012, using the following terms: corneal transplantation, anterior lamellar keratoplasty, penetrating keratoplasty, endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, Descemet membrane endothelial transfer, ocular surface epithelial transplantation, limbal epithelial transplantation, cultivated oral mucosal epithelial transplantation, keratoprosthesis, infectious keratitis, cross-linking, keratoconus, corneal neovascularization, corneal imaging, optical coherence tomography, Pentacam Scheimpflug imaging, and in vivo confocal microscopy. RESULTS This review includes original articles and review articles that contain significant updates and novel aspects in the field of cornea from the following journals: American Journal of Ophthalmology, British Journal of Ophthalmology, Ophthalmology, Investigative Ophthalmology and Visual Science, and Cornea. Letters to the editor, unpublished work, manuscripts not in English, and abstracts were not included. CONCLUSIONS This review highlights significant literature that is applicable to the practicing ophthalmologist.
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Affiliation(s)
- Annabel C Y Chew
- From the *Singapore National Eye Centre, †Singapore Eye Research Institute, ‡Duke-NUS Graduate Medical School, and §Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Femtosecond laser and big-bubble deep anterior lamellar keratoplasty: a new chance. J Ophthalmol 2012; 2012:264590. [PMID: 22496960 PMCID: PMC3306993 DOI: 10.1155/2012/264590] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/30/2011] [Accepted: 11/08/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. To report the 12-month follow-up after big-bubble deep anterior lamellar keratoplasty (DALK) assisted by femtosecond laser that we have called IntraBubble. Methods. A 60 kHz IntraLase femtosecond laser (Abbott Medical Optics) firstly created a 30° angled intrastromal channel to insert the air injection cannula, 50 μ above the thinnest corneal site measured by Sirius Scheimpflug camera (CSO, Firenze, Italy), then performed a full lamellar cut 100 μ above the thinnest corneal point, and from the same corneal depth, created a mushroom incision. The lamella was removed, and the smooth cannula of Fogla was inserted into the stromal channel and air was injected to achieve a big bubble. The follow up is 12 months, and sutures were removed by the 10th postoperative month in all patients. Best Corrected Visual Acuity (BCVA), spherical equivalent and, by Sirius Scheimpflug camera (CSO, Firenze, Italy) keratometric astigmatism were evaluated. Results. All procedures were completed as DALK except 2 converted to PK because an inadvertent intraoperative macroperforation occurred. Mean postoperative BCVA was 0.8, mean spherical equivalent was -3.5 ± 1.7 D, and mean keratometric astigmatism was 4.8 ± 3.1 D. Conclusion. The femtosecond laser could standardize the big-bubble technique in DALK, reducing the risk of intraoperative complications and allowing good refractive outcomes.
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