1
|
Hamon L, Weinstein I, Quintin A, Safi T, Bofferding M, Daas L, Seitz B. Review for special issue: Corneal lamellar surgery: Present outcomes and future perspectives. Taiwan J Ophthalmol 2024; 14:3-14. [PMID: 38655001 PMCID: PMC11034684 DOI: 10.4103/tjo.tjo-d-23-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 04/26/2024] Open
Abstract
Since the establishment of the first eye bank in the 1940s, their role has evolved to face new challenges. With the recent development of lamellar keratoplasties, eye banks play an even bigger role in the selection and preparation of donor tissues. The increasing number of keratoplasty techniques and the high demand for "ready-to-use" tissues are challenging eye banks to improve and develop new preparation techniques. Besides necessary examinations, new approaches of tissue analysis in eye banks allow a better/optimized selection of corneal tissues. These new challenges in tissue preservation, preparation, and selection are propelling eye banks into a new era of modern eye banking.
Collapse
Affiliation(s)
- Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Isabel Weinstein
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Adrien Quintin
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Tarek Safi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Max Bofferding
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Klaus Faber Center for Corneal Diseases, Including LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
2
|
Femtosecond laser-assisted descemetorhexis for Descemet membrane endothelial keratoplasty: a cell- and tissue-based ex-vivo analysis in terms of precision and safety. J Cataract Refract Surg 2021; 48:89-94. [PMID: 34091552 DOI: 10.1097/j.jcrs.0000000000000692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze precision and safety of femtosecond laser-assisted descemetorhexis as well as postoperative corneal wound healing in human ex vivo specimens. SETTING Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany. DESIGN Experimental ex vivo study. METHODS Four donor corneas underwent femtosecond laser-assisted descemetorhexis. The descemetorhexis was performed using the LDV Z8 femtosecond laser followed by live/dead staining, phase contrast microscopy and scanning electron microscopy. The descemetorhexis parameters were set using a modified optical coherence tomography image capturing of 8 segments within a focus of 100 μm at the posterior corneal stroma (reversed capsulotomy program). RESULTS Live/dead sample staining analysis demonstrated that the femtosecond laser had minimal impact on the vitality of surrounding endothelial cells. Phase contrast microscopy and scanning electron microscopy evaluation showed that the laser produced precise, clear-cut edges leaving no stromal tissue bridges. CONCLUSIONS Femtosecond laser-assisted descemetorhexis could serve as a safe and precise technique with only minimal endothelial cell damage. To minimize stromal damage, further laser energy profile adjustments are necessary to optimize corneal treatment within different stages of corneal tissue swelling.
Collapse
|
3
|
Gadhvi KA, Romano V, Fernández-Vega Cueto L, Aiello F, Day AC, Gore DM, Allan BD. Femtosecond Laser-Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results. Am J Ophthalmol 2020; 220:191-202. [PMID: 32707206 DOI: 10.1016/j.ajo.2020.07.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the clinical outcomes in femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting. DESIGN Single-center, comparative, retrospective interventional case series. METHODS Population: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016. SETTING Moorfields Eye Hospital, London. OBSERVATIONS Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MainOutcomeMeasures: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40. RESULTS We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P = .825). CONCLUSION Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting.
Collapse
|
4
|
Titiyal JS, Aravind MJ, Kaur M, Nag TC, Sharma N, Agarwal T, Sinha R. Surface quality and endothelial cell viability after femtosecond laser-assisted donor lenticule preparation for endothelial keratoplasty - An in-vitro study. Indian J Ophthalmol 2020; 68:2404-2407. [PMID: 33120628 PMCID: PMC7774225 DOI: 10.4103/ijo.ijo_99_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare surface quality and endothelial cell viability of descemet stripping automated endothelial keratoplasty (DSAEK) donor lenticules prepared with femtosecond laser (FSL) or microkeratome (MK). Methods Experimental ex-vivo evaluation of 15 DSAEK donor lenticules prepared from optical quality donor corneas using 200 KHz FSL (9 eyes) or MK (6 eyes). Surface quality and smoothness of the cut were assessed using atomic force microscopy and endothelial cell viability was assessed using transmission electron microscopy. Results Mean lenticule thickness was 121.89 ± 17.13 μm in FSL group and 112.67 ± 5.89 μm in MK group (P = 0.33). Average roughness of stromal surface (RMSavg) [FSL- 30.51 ± 4.55 nm, MK-22.37 ± 1.83 nm; P = 0.02] and root mean square roughness (RMSrough) [FSL-31.39 ± 5.75 nm, MK-23.08 ± 0.40 nm; P = 0.012] was significantly more in FSL group. Increased granular and linear irregularities were observed in the FSL group. Endothelial cell disruption was more in FSL group (FSL- 29.49 ± 6.91% MK-13.28 ± 3.62%; P < 0.001) with decreased mean nucleus length (FSL-5.56 ± 0.17 μm, MK-7.52 ± 0.65 μm; P < 0.001). Conclusion Automated MKs are still the standard of care for donor lenticule preparation and MK-assisted donor lenticules have smoother surface with less endothelial cell disruption than FSL. Further research is mandatory before FSL platforms can be considered a viable alternative to the MK.
Collapse
Affiliation(s)
- Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - M J Aravind
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tapas C Nag
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
5
|
Chen H, Tian L, Le Q, Zhao F, Zhao Y, Chen Y, Yang Y, Hong J, Xu J. Femtosecond laser-assisted Descemet’s stripping endothelial keratoplasty: a prospective study of 6-month visual outcomes, corneal thickness and endothelial cell loss. Int Ophthalmol 2020; 40:2065-2075. [DOI: 10.1007/s10792-020-01383-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/10/2020] [Indexed: 11/28/2022]
|
6
|
Scorcia V, Giannaccare G, Logozzo L, Soda M. Keratoconus: advances in anterior lamellar keratoplasty techniques. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1728687] [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: 10/25/2022]
Affiliation(s)
- Vincenzo Scorcia
- From Department of Ophthalmology, University Magna Graecia, Catanzaro, Italy
| | | | - Laura Logozzo
- From Department of Ophthalmology, University Magna Graecia, Catanzaro, Italy
| | - Mauro Soda
- From Department of Ophthalmology, University Magna Graecia, Catanzaro, Italy
| |
Collapse
|
7
|
Femtosecond Laser-Assisted Deep Lamellar Descemet Membrane Endothelial Keratoplasty for the Treatment of Endothelial Dysfunction Associated With Posterior Stromal Scarring. Cornea 2018; 38:388-391. [DOI: 10.1097/ico.0000000000001829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Einan-Lifshitz A, Sorkin N, Boutin T, Showail M, Borovik A, Alobthani M, Chan CC, Rootman DS. Comparison of Femtosecond Laser-Enabled Descemetorhexis and Manual Descemetorhexis in Descemet Membrane Endothelial Keratoplasty. Cornea 2017; 36:767-770. [PMID: 28594697 DOI: 10.1097/ico.0000000000001217] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To introduce a novel method to perform descemetorhexis in Descemet membrane endothelial keratoplasty (DMEK) using the femtosecond laser and to compare it with Descemet membrane endothelial keratoplasty performed with manual descemetorhexis (M-DMEK). METHODS A retrospective medical chart review of 2 groups of patients who underwent DMEK surgery combined with cataract surgery secondary to Fuchs corneal endothelial dystrophy and cataract: 17 patients underwent femtosecond laser-enabled descemetorhexis Descemet membrane endothelial keratoplasty (FE-DMEK) and 89 patients underwent DMEK surgery with M-DMEK. Best spectacle-corrected visual acuity, endothelial cell density (ECD), graft detachment rate, and complications were compared. RESULTS Average age of the 106 patients (64 women and 42 men) was 68 ± 11 years. Postoperative best spectacle-corrected visual acuity was 0.19 ± 0.13 logarithm of the minimum angle of resolution in the FE-DMEK group and 0.35 ± 0.48 logarithm of the minimum angle of resolution in the M-DMEK group (P = 0.218). One day after surgery, there were no significant graft detachments in the FE-DMEK group, compared with 20% graft detachment rate in the M-DMEK group (P = 0.041). Rebubbling was performed in 17% of eyes in the M-DMEK group compared with none in the FE-DMEK group (P = 0.066). The mean endothelial cell count in the FE-DMEK and M-DMEK groups at 6 months after surgery were 2105 ± 285 cells per square millimeter (24% cells loss) and 1990 ± 600 cells per square millimeter (29% cells loss), respectively (P = 0.579). CONCLUSIONS FE-DMEK shows efficacy similar to that of M-DMEK with apparently less graft detachment and reduced need for rebubbling.
Collapse
Affiliation(s)
- Adi Einan-Lifshitz
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Utility of Anterior Segment Optical Coherence Tomography in the Management of Corneal Transplantation. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
|
11
|
Varga Z, Bergin C, Roy S, Nicolas M, Tschuor P, Majo F. Scanning Electronic Microscopy Evaluation of the Roughness of the Stromal Bed After Deep Corneal Cut with the LDV Femtosecond Laser (Z6) (Ziemer) and the ONE Microkeratome (Moria). Curr Eye Res 2016; 41:1302-1309. [PMID: 26881295 DOI: 10.3109/02713683.2015.1119281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the stromal bed surface quality and the accuracy of dissection depth after deep lamellar cuts using the Leonardo Da Vinci (LDV) femtosecond laser (Z6) and the ONE Microkeratome. METHODS Deep lamellar cuts were performed on nine human donor corneoscleral buttons: five with the LDV femtosecond (FS) laser (Z6) (Ziemer) and four with the ONE Microkeratome (MK) (Moria). Corneal thickness was measured with ultrasound pachymetry before and after the dissection. The Stromal bed quality was evaluated using light microscopy (n = 4) and scanning electron microscopy (SEM) (n = 9). The surface roughness on SEM images was graded on the scale of 1 (smoothest) to 5 (roughest) by four observers, blinded to the method used. Particle analysis on the SEM images was performed in order to have an objective measure of smoothness. RESULTS The achieved dissection depth using the FS laser was 496.4 ± 46.4 µm when attempting 500 µm and 474 ± 60 µm with the microkeratome when attempting 350 µm. Histological evaluation of the corneoscleral buttons by both light and electron microscopy showed significantly smoother surface using the FS laser compared to the microkeratome. There were fewer and smaller particles observed in the SEM images of FS laser cut buttons (p < 0.001).The average observer based score of anterior surface roughness (50×) was 2.2 for the FS laser and 3.9 for the microkeratome dissections (p < 0.001). CONCLUSIONS The LDV femtosecond laser (Z6) platform is capable of creating deep corneal lamellar dissection with smoother surface quality and with more predictable cut depth as compared to the One Microkeratome.
Collapse
Affiliation(s)
- Zsolt Varga
- a Department of Ophthalmology , University of Lausanne, Fondation Asile des Aveugles , Lausanne , Switzerland.,b Department of Clinical Neuroscience , University Hospital of Geneva , Geneva , Switzerland
| | - Ciara Bergin
- a Department of Ophthalmology , University of Lausanne, Fondation Asile des Aveugles , Lausanne , Switzerland
| | | | - Michael Nicolas
- a Department of Ophthalmology , University of Lausanne, Fondation Asile des Aveugles , Lausanne , Switzerland
| | - Patrizia Tschuor
- a Department of Ophthalmology , University of Lausanne, Fondation Asile des Aveugles , Lausanne , Switzerland
| | - François Majo
- a Department of Ophthalmology , University of Lausanne, Fondation Asile des Aveugles , Lausanne , Switzerland
| |
Collapse
|
12
|
Ocular Complications of Diabetes and Therapeutic Approaches. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3801570. [PMID: 27119078 PMCID: PMC4826913 DOI: 10.1155/2016/3801570] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/02/2016] [Indexed: 12/15/2022]
Abstract
Diabetes mellitus (DM) is a metabolic disease defined by elevated blood glucose (BG). DM is a global epidemic and the prevalence is anticipated to continue to increase. The ocular complications of DM negatively impact the quality of life and carry an extremely high economic burden. While systemic control of BG can slow the ocular complications they cannot stop them, especially if clinical symptoms are already present. With the advances in biodegradable polymers, implantable ocular devices can slowly release medication to stop, and in some cases reverse, diabetic complications in the eye. In this review we discuss the ocular complications associated with DM, the treatments available with a focus on localized treatments, and what promising treatments are on the horizon.
Collapse
|
13
|
Visual Function and Higher-Order Aberrations in Eyes After Corneal Transplantation. Cornea 2015; 34 Suppl 11:S128-35. [DOI: 10.1097/ico.0000000000000589] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
|
15
|
Aristeidou A, Taniguchi EV, Tsatsos M, Muller R, McAlinden C, Pineda R, Paschalis EI. The evolution of corneal and refractive surgery with the femtosecond laser. EYE AND VISION 2015; 2:12. [PMID: 26605365 PMCID: PMC4655461 DOI: 10.1186/s40662-015-0022-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/20/2015] [Indexed: 01/12/2023]
Abstract
The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery. With accuracy, safety, and repeatability, eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures; laser in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), penetrating keratoplasty (PKP), insertion of intracorneal ring segments, anterior and posterior lamellar keratoplasty (Deep anterior lamellar keratoplasty (DALK) and Descemet's stripping endothelial keratoplasty (DSEK)), insertion of corneal inlays and cataract surgery. As the technology matures, it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored. As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay. This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.
Collapse
Affiliation(s)
| | - Elise V Taniguchi
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, 02114 MA USA
| | | | - Rodrigo Muller
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
| | - Colm McAlinden
- Flinders University, Adelaide, South Australia Australia ; Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Roberto Pineda
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
| | - Eleftherios I Paschalis
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, 02114 MA USA
| |
Collapse
|
16
|
Tomida D, Yamaguchi T, Ogawa A, Hirayama Y, Shimazaki-Den S, Satake Y, Shimazaki J. Effects of corneal irregular astigmatism on visual acuity after conventional and femtosecond laser-assisted Descemet's stripping automated endothelial keratoplasty. Jpn J Ophthalmol 2015; 59:216-22. [PMID: 26028117 DOI: 10.1007/s10384-015-0388-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/10/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare short-term outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) using a graft prepared with either a femtosecond laser or a microkeratome. METHODS Thirty-eight patients underwent DSAEK with grafts prepared with either a femtosecond laser (f-DSAEK; 21 eyes) or a microkeratome (m-DSAEK; 17 eyes). Visual acuity, endothelial cell density, regular astigmatism and irregular astigmatism were compared between the two groups preoperatively and at 1, 3, and 6 months post-operatively. Fourier analysis was conducted to calculate astigmatism of the anterior and posterior surfaces, and total cornea, using anterior segment optical coherence tomography (AS-OCT). RESULTS Visual acuity (logMAR) improved from 1.20 ± 0.60 to 0.43 ± 0.25 after m-DSAEK (P < 0.001) and from 1.20 ± 0.57 to 0.77 ± 0.33 after f-DSAEK (P = 0.0028) at 6 months following DSAEK. Visual acuity after m-DSAEK was significantly better than after f-DSAEK at 1, 3, and 6 months (P < 0.05). AS-OCT corneal images revealed greater irregularities on the posterior surfaces of f-DSAEK grafts compared to m-DSAEK grafts. Irregular astigmatism of the total cornea and the posterior surface was significantly larger after f-DSAEK than after m-DSAEK, although there was no significant difference in irregular astigmatism of the anterior surface at 6 months. Postoperative visual acuity was significantly correlated with the postoperative irregular astigmatism of the total cornea (r = 0.6657 and P < 0.001) and the anterior (r = 0.416, P = 0.016) and posterior surfaces (r = 0.7046, P < 0.001). CONCLUSIONS Visual outcomes after f-DSAEK were poor compared to conventional m-DSAEK due to an increase in irregular astigmatism caused by posterior surface irregularities.
Collapse
Affiliation(s)
- Daisuke Tomida
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | | | | | | | | | | | | |
Collapse
|
17
|
Liu HH, Hu Y, Cui HP. Femtosecond laser in refractive and cataract surgeries. Int J Ophthalmol 2015; 8:419-26. [PMID: 25938066 DOI: 10.3980/j.issn.2222-3959.2015.02.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/15/2014] [Indexed: 11/02/2022] Open
Abstract
In the past few years, 9 unique laser platforms have been brought to the market. As femtosecond (FS) laser-assisted ophthalmic surgery potentially improves patient safety and visual outcomes, this new technology indeed provides ophthalmologists a reliable new option. But this new technology also poses a range of new clinical and financial challenges for surgeons. We provide an overview of the evolution of FS laser technology for use in refractive and cataract surgeries. This review describes the available laser platforms and mainly focuses on discussing the development of ophthalmic surgery technologies.
Collapse
Affiliation(s)
- Han-Han Liu
- Department of Ophthalmology, Shanghai East Hospital Affiliated to Tongji University, Shanghai 200120, China
| | - Ying Hu
- Department of Ophthalmology, Shanghai East Hospital Affiliated to Tongji University, Shanghai 200120, China
| | - Hong-Ping Cui
- Department of Ophthalmology, Shanghai East Hospital Affiliated to Tongji University, Shanghai 200120, China
| |
Collapse
|
18
|
|
19
|
Abstract
Corneal transplantation is one of the most common types of human transplant surgery. By removing a scarred or damaged host cornea and replacing it with a clear and healthy donor transplant, this procedure helps to restore vision in a variety of corneal diseases. The traditional technique for corneal transplantation, penetrating keratoplasty (PKP), involves transplantation of all corneal layers. Over the past decade though, there has been a trend away from PKP as surgeons have developed partial thickness transplant procedures, such as deep anterior lamellar keratoplasty and Descemet stripping automated endothelial keratoplasty. These partial thickness transplant procedures selectively replace diseased host corneal tissue, while conserving healthy and functioning tissue. This review describes current surgical techniques in the field of corneal transplantation, with special emphasis on indications for transplantation and postoperative outcomes.
Collapse
Affiliation(s)
- Grace E Boynton
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105, USA
| |
Collapse
|
20
|
Arbelaez JG, Feng MT, Pena TJ, Price MO, Price FW. A year of cornea in review: 2013. Asia Pac J Ophthalmol (Phila) 2015; 4:40-50. [PMID: 26068612 DOI: 10.1097/apo.0000000000000110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The goal of this study was to provide an update of significant corneal literature published in 2013. DESIGN This study is a systematic literature review. METHODS We conducted a systematic review of the English-language literature published from January 1, 2013, to December 31, 2013, using the following PubMed search and Medical Subject Headings terms: cornea transplantation, keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping endothelial keratoplasty, cross linking, pre-Descemet's layer, Rho-associated kinase, keratoprosthesis, infectious keratitis, corneal dystrophy, corneal astigmatism, and keratoconus. RESULTS This review summarizes relevant and innovative original articles, review articles, and novel techniques from the following journals: American Journal of Ophthalmology, British Journal of Ophthalmology, Cornea, Graefe's Archive for Clinical and Experimental Ophthalmology, Investigative Ophthalmology & Visual Science, JAMA Ophthalmology, Journal of Cataract and Refractive Surgery, Journal of Refractive Surgery, and Ophthalmology. Case reports, abstracts, letters to the Editor, and unpublished work were excluded, as well as articles e-published ahead of print in 2012 that were discussed in the previous review. One hundred twenty-seven articles met the criteria for this review. CONCLUSIONS This review summarizes significant cornea-related literature from 2013.
Collapse
Affiliation(s)
- Juan G Arbelaez
- From the *Price Vision Group; and †Cornea Research Foundation of America, Indianapolis, IN
| | | | | | | | | |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Eye-bank preparation of endothelial tissue for keratoplasty continues to evolve. Although eye-bank personnel have become comfortable and competent at Descemet's stripping automated endothelial keratoplasty (DSAEK), tissue preparation and tissue transport, optimization of preparation methods continues. Surgeons and eye-bank personnel should be up to date on the research in the field. As surgeons transit to Descemet's membrane endothelial keratoplasty (DMEK), eye banks have risen to the challenge of preparing tissue. Eye banks are refining their DMEK preparation and transport techniques. RECENT FINDINGS This article covers refinements to DSAEK tissue preparation, innovations to prepare DMEK tissue, and nuances to improve donor cornea tissue quality. SUMMARY As eye bank-supplied corneal tissue is the main source of tissue for many corneal surgeons, it is critical to stay informed about tissue handling and preparation. Ultimately, the surgeon is responsible for the transplantation, so involvement of clinicians in eye-banking practices and advocacy for pursuing meaningful research in this area will benefit clinical patient outcomes.
Collapse
|
22
|
Comparative study of corneal endothelial cell damage after femtosecond laser assisted deep stromal dissection. BIOMED RESEARCH INTERNATIONAL 2014; 2014:731565. [PMID: 25114918 PMCID: PMC4119749 DOI: 10.1155/2014/731565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
Purpose. To find a relatively safe designed stromal bed thickness to avoid endothelial damage for lamellar keratoplasty with an Allegretto Wavelight FS200 femtosecond laser. Methods. Twelve rabbits were randomly divided into 50 μm and 150 μm groups according to the anticipated residue stromal bed thickness preparation with a femtosecond laser. Six rabbits without laser cutting were used as a control group. Central endothelial images were analyzed with in vivo confocal microscopy and scanning electron microscopy. The apoptosis of endothelium was evaluated with Hoechst 33342 staining and a TUNEL assay. Results. The endothelium of the 50 μm group had extensive injuries upon in vivo confocal and scanning electron microscopic observation, and minor injuries were observed in the 150 μm group. Moreover, more apoptotic cells were observed in the 50 μm group. Conclusions. When using a FS200 femtosecond laser assisted anterior lamellar keratoplasty, there was minor endothelium damage with a 150 μm stromal bed, and a more than 150 μm thickness stromal bed design may prevent the damage of corneal endothelium.
Collapse
|
23
|
|
24
|
Nanavaty MA, Wang X, Shortt AJ. Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy. Cochrane Database Syst Rev 2014; 2:CD008420. [PMID: 24526345 PMCID: PMC4260402 DOI: 10.1002/14651858.cd008420.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fuchs endothelial dystrophy (FED) is a condition in which there is premature degeneration of corneal endothelial cells. When the number of endothelial cells is reduced to a significant degree, fluid begins to accumulate within the cornea. As a result, the cornea loses its transparency and the individual suffers a reduction in vision. The only successful surgical treatment for this condition is replacement of part or all of the cornea with healthy tissue from a donor. The established procedure, penetrating keratoplasty (PKP), has been used for many years and its safety and efficacy are well known. Endothelial keratoplasty (EK) techniques are relatively new surgical procedures and their safety and efficacy relative to PKP are uncertain. OBJECTIVES The objective of this review was to compare the benefits and complications related to two surgical methods (EK and PKP) of replacing the diseased endothelial layer of the cornea with a healthy layer in people with FED. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2014, Issue 1), MEDLINE (January 1950 to January 2014), EMBASE (January 1980 to January 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 27 January 2014. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing EK versus PKP for people (of any age and gender) who had been clinically diagnosed with FED. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results, assessed trial quality and extracted data using the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included three RCTs that enrolled a total of 139 eyes of 136 participants and analysed 123 (88%) eyes. Two RCTs randomised eyes into either the endothelial keratoplasty (EK) group or penetrating keratoplasty (PKP) group and one RCT randomised eyes into either the femtosecond laser-assisted endothelial keratoplasty (FLEK) group or PKP group. The RCTs comparing EK with PKP did not show any significant differences between procedures with respect to best corrected visual acuity (BCVA) at two years (mean difference (MD) 0.14 logMAR; 95% confidence interval (CI) -0.08 to 0.36; P = 0.23) or at one year (MD 0.09 logMAR; 95% CI -0.05 to 0.23; P = 0.22), whereas the trial comparing FLEK with PKP showed significantly better BCVA after PKP (MD 0.20 logMAR; 95% CI 0.10 to 0.30; P = 0.0001). Only one RCT reported on irregular astigmatism (higher-order aberration), which was less with EK than PKP (MD -1.20 µm; 95% CI -1.53 to -0.87; P < 0.001). Only one RCT reported on endothelial cell counts (lower after FLEK than PKP: MD -969 cells/mm²; 95% CI -1161 to -777; P < 0.001), primary graft failure (higher after FLEK than PKP: RR 7.76; 95% CI 0.41 to 145.22; P = 0.10), and graft rejection (more after FLEK than PKP: RR 1.11; 95% CI 0.07 to 17.12; P = 0.94). Only one RCT reported that 27.8% of participants had graft dislocation, 2.8% had epithelial ingrowth and postoperative pupillary block, and 13.9% had intraocular pressure (IOP)-related problems in the FLEK group compared with the PKP group, in whom 10% had suture-related problems, 5% had wound dehiscence and 10% had suture revision to correct astigmatism. Overall, the adverse events in the FLEK group appeared to be more frequent than in the PKP group. No trials reported information about quality of life or economic data. The overall methodological quality of the three trials was not satisfactory as most did not perform allocation concealment or masking of participants and outcome assessors, and all trials had a small sample size. AUTHORS' CONCLUSIONS The rapid growth of endothelial keratoplasty as the treatment of choice for FED is based upon the belief that visual recovery is more rapid, surgically induced astigmatism (regular and irregular) is less and rates of transplant rejection are lower with EK. This change in practice also assumes that the rates of long term transplant survival are equal for the two procedures. The practical differences between the surgical procedures mean that visual recovery is inherently more rapid following EK, but this review found no strong evidence from RCTs of any difference in the final visual outcome between EK and PKP for people with FED. This review also found that higher order aberrations are fewer following EK but endothelial cell loss is greater following EK. The RCTs that we included employed different EK techniques, which may have a bearing on these findings. EK procedures have evolved over the years and can be performed using different techniques, for example deep lamellar endothelial keratoplasty, Descemets stripping endothelial keratoplasty (DSEK), Descemets stripping automated endothelial keratoplasty (DSAEK), femtosecond laser-assisted endothelial keratoplasty and Descemet membrane endothelial keratoplasty (DMEK). More RCTs are needed to compare PKP with commonly performed EK procedures such as DSEK, DSAEK and DMEK in order to determine the answers to two key questions, whether there is any difference in the final visual outcome between these techniques and whether there are differences in the rates of graft survival in the long term?
Collapse
Affiliation(s)
- Mayank A Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University
Hospitals NHS Trust, Brighton, UK
| | - Xue Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
| | - Alex J Shortt
- The Moorfields Eye Hospital/UCL Institute of Ophthalmology
National Institute for Health Research Biomedical Research Centre, London, UK
| |
Collapse
|
25
|
Heichel J, Wilhelm F, Kunert KS, Schlueter R, Stuhltraeger U, Hammer T. Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis. Clin Ophthalmol 2013; 8:61-9. [PMID: 24368878 PMCID: PMC3869919 DOI: 10.2147/opth.s51200] [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: 11/23/2022] Open
Abstract
Purpose Femtosecond lasers have become the standard for laser-assisted in situ keratomileusis (LASIK) flap creation, but advanced mechanical microkeratomes are still an alternative, more cost-effective way to create the flap. The SCHWIND Carriazo-Pendular microkeratome is one of the most commonly used microkeratomes. The influence of different cutting parameters (head-advance speeds, cutting heads) on morphology of LASIK cuts was investigated. Setting Experimental study performed at the University Eye Hospital of the Martin Luther University Halle/Wittenberg, Halle (Saale), Germany. Methods The Carriazo-Pendular microkeratome was used on freshly enucleated porcine eyes for lamellar keratotomy. After flap removal, the cutting edge and stromal bed were evaluated from scanning electron micrographs using an individualized scoring system. Four different settings of microkeratome parameters were compared. For each setting, eight cuts were evaluated (n=32). Results Different oscillation frequencies and head-advance speeds did not influence the cutting qualities. A higher oscillation/feed rate ratio seemed to be advantageous for a smoother interface. Concerning different cuttings heads, a deeper keratotomy led to sharper cutting edges. The thinner the flap, the more irregularities in the stromal bed appeared. Complications did not occur. Conclusion The Carriazo-Pendular microkeratome is a safe tool with which to create a LASIK flap and is a good alternative to a costly femtosecond laser. Deeper keratotomies, as well as the use of a higher oscillation/feed rate quotient, improve the cutting quality.
Collapse
Affiliation(s)
- Jens Heichel
- Department of Ophthalmology, University Hospital of Martin Luther University Halle/Wittenberg, Halle (Saale), Germany
| | | | - Kathleen S Kunert
- Department of Ophthalmology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Rabea Schlueter
- Institute of Microbiology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Ute Stuhltraeger
- Department of Ophthalmology, University Hospital of Martin Luther University Halle/Wittenberg, Halle (Saale), Germany
| | | |
Collapse
|
26
|
|
27
|
Visual outcome and histological findings following femtosecond laser-assisted versus microkeratome-assisted DSAEK. Graefes Arch Clin Exp Ophthalmol 2013; 251:1979-85. [PMID: 23661098 DOI: 10.1007/s00417-013-2359-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/20/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the visual outcome of femtosecond laser-assisted Descemet stripping automated endothelial keratoplasty (DSAEK) to microkeratome-assisted DSAEK as well as to contrast precut versus surgeon-cut grafts. Histologic characterization of failed DSAEK grafts was performed in order to correlate ultrastructural changes with graft failures. METHODS In this case control study, 47 cases of DSAEK were investigated in terms of visual acuity, keratometric astigmatism, spherical equivalent, endothelial cell count, and postoperative complications. We formed three groups: the femtosecondlaser-assisted DSAEK with precut grafts, the microkeratome-assisted DSAEK with precut and with surgeon-cut grafts. Mean follow-up was 6 months. In the case of graft failure, penetrating keratoplasty was performed, and the excised corneal buttons were investigated by light and electron microscopy. RESULTS Microkeratome-assisted DSAEK lead to better visual outcome than femtosecond laser-assisted DSAEK. Keratometric astigmatism, spherical equivalent and endothelial cell count did not differ significantly between both methods. Precut and surgeon-cut grafts in microkeratome-assisted DSAEK did not show any significant difference regarding all upraised parameters. No definite histological correlate for graft failure following femtosecond laser-assisted DSAEK was found. CONCLUSIONS Femtosecond laser-assisted DSAEK is not the method of choice, and needs further technical improvement. However, failed femtosecondlaser-assisted DSAEK grafts did not show significant histological changes related to the technique to explain reduced visual acuity. In microkeratome-assisted DSAEK, the preparation time point of the graft does not seem to influence the visual and optical outcome.
Collapse
|