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Sarnicola E, Sarnicola C, De Bernardo M, Rosa N, Sarnicola V. Cataract surgery in setting of ocular surface disease. Curr Opin Ophthalmol 2024; 35:155-162. [PMID: 38018802 DOI: 10.1097/icu.0000000000001024] [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: 11/30/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the available strategies to successfully identify and manage ocular surface disease (OSD) pre, intra and post-cataract surgery. RECENT FINDINGS Cataract surgery and OSD have an intricate relationship: the surgical procedure can induce or exaggerate OSD symptoms, while OSD can negatively impact surgical refractive outcomes and increase the rate of postoperative complications. SUMMARY Improving the health and stability ocular surface is the key to enhance post cataract surgery refractive outcomes and avoid complications. This is pivotal for patients affected by severe OSD, but is also important for patients with minimal signs or symptoms. A correct diagnosis and a stepwise approach are the keys to improve the quality of life of such patients.
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Affiliation(s)
- Enrica Sarnicola
- Ambulatorio di Chirurgia Oculare Santa Lucia
- Clinica degli Occhi Sarnicola, Grosseto
- Università degli Studi di Salerno, Salerno
| | - Caterina Sarnicola
- Clinica degli Occhi Sarnicola, Grosseto
- Ophthalmology department, Ospedale San Donato AUSL Toscana Sud-Est, Arezzo, Italy
| | | | | | - Vincenzo Sarnicola
- Ambulatorio di Chirurgia Oculare Santa Lucia
- Clinica degli Occhi Sarnicola, Grosseto
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Bineshfar N, Tahvildari A, Feizi S. Management of post-keratoplasty ametropia. Ther Adv Ophthalmol 2023; 15:25158414231204717. [PMID: 37854948 PMCID: PMC10580728 DOI: 10.1177/25158414231204717] [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: 04/15/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
Even after a successful corneal transplant, patients experience severe refractive errors, impeding their rehabilitation and satisfaction. Refractive errors can be caused by recipient pathology and corneal thickness, as well as intraoperative factors such as donor-host discrepancy, recipient's eccentric trephination, vitreous length, wound apposition, technique of suturing, and suture material. Also, wound healing and the interim between keratoplasty and suture removal contribute to astigmatism. Lamellar keratoplasty outperforms penetrating keratoplasty in terms of endothelial cell loss and endothelial graft rejection, yet the risk of developing refractive errors is comparable. Nonsurgical interventions such as spectacles and lenses fail to provide desirable vision in cases with high astigmatism and corneal irregularity. When these limitations are encountered, surgical interventions including incisional keratotomy, wedge resection, laser refractive surgeries, intracorneal segments, and intraocular lens implantation are employed. However, occasionally, none of these approaches deliver the desired effects, leading to the need for a repeat keratoplasty.
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Affiliation(s)
- Niloufar Bineshfar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136, USA
| | - Azin Tahvildari
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chou WY, Kuo YS, Lin PY. Cataract surgery in patients with Fuchs' dystrophy and corneal decompensation indicated for Descemet's membrane endothelial keratoplasty. Sci Rep 2022; 12:8500. [PMID: 35589882 PMCID: PMC9120518 DOI: 10.1038/s41598-022-12434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
The availability of corneal donor tissue is limited in most developing countries. This study evaluated whether patients with coexisting cataract and Fuchs’ dystrophy with corneal decompensation awaiting Descemet’s membrane endothelial keratoplasty (DMEK) benefited from phacoemulsification. This is a retrospective case–control study which included patients with Fuchs’ dystrophy and evidence of corneal decompensation awaiting DMEK. Best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were documented at baseline (pre-cataract surgery in the case group, or at the time of transplantation registry in the control group), 1-month and pre-DMEK. A total of 16 phakic patients with visually significant cataracts had cataract surgery during the study period, and 15 pseudophakic patients were included as controls. There was no significant difference with regard to BCVA at baseline, 1-month or pre-DMEK between the case and control groups. Similarly, no significant difference in CCT was found at baseline, 1-month or pre-DMEK. In the case group, 4 patients with improved visual acuity post-cataract surgery chose to defer DMEK. After stratification, statistical analysis showed significantly better BCVA in the deferred group (n = 4) at 1-month post-cataract surgery, compared to the DMEK group (n = 12) (0.21 ± 0.21 vs. 0.86 ± 0.29 LogMAR, P = 0.004). The other parameters, including baseline BCVA and CCT at any time point documented, were not statistically different. In conclusion, in patients with Fuchs’ dystrophy and decompensated corneas awaiting transplantation, phacoemulsification did not lead to significant increase of corneal thickness nor deterioration of visual acuity. A few patients achieved satisfactory vision after cataract surgery and deferred endothelial keratoplasty.
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Affiliation(s)
- Wei-Yi Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, ShihPai Rd., Taipei, Taiwan, 11217.,Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Yih-Shiuan Kuo
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, ShihPai Rd., Taipei, Taiwan, 11217
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, ShihPai Rd., Taipei, Taiwan, 11217. .,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Grzybowski A, Zemaitiene R, Markeviciute A, Tuuminen R. Should We Abandon Hydrophilic Intraocular Lenses? Am J Ophthalmol 2022; 237:139-145. [PMID: 34843687 DOI: 10.1016/j.ajo.2021.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize the features of hydrophilic intraocular lenses (IOLs) important in the clinical context of expected prolonged duration time of the IOL within the eye. DESIGN Perspective. METHODS Discussion includes possible factors and mechanisms associated with hydrophilic IOLs' susceptibility to calcification and posterior capsule opacification (PCO) formation. RESULTS Results of recently reported studies show that particular surgeries, such as pars plana vitrectomy, Descemet stripping (automated) endothelial keratoplasty, and Descemet membrane endothelial keratoplasty with intraocular gas or air injection, might predispose the calcification process of hydrophilic IOLs, leading to a significant decrease in visual quality and possibly explantation of the IOL. Hydrophilic IOLs are more susceptible than hydrophobic IOLs to PCO formation, which is the most common of late postoperative complications that are associated with significant side effects. CONCLUSIONS We believe that all patients should be informed about the higher risk of calcification and PCO associated with hydrophilic IOLs. We also recommend limiting the use of hydrophilic acrylic IOLs during cataract surgery, especially when it is combined with pars plana vitrectomy or endothelial keratoplasty, and in patients with endothelial diseases who will probably require operation on it in the future.
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Affiliation(s)
- Andrzej Grzybowski
- From the Department of Ophthalmology, University of Warmia and Mazury, (A.G.), Olsztyn; Institute for Research in Ophthalmology (A.G.), Poznan, Poland.
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences (R.Z., A.M.), Kaunas, Lithuania
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences (R.Z., A.M.), Kaunas, Lithuania
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki (R.T.), Helsinki; Department of Ophthalmology, Kymenlaakso Central Hospital (R.T.), Kotka, Finland
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Editorial: advancing cataract surgery through innovation and methodology. Curr Opin Ophthalmol 2022; 33:1-2. [PMID: 34854825 DOI: 10.1097/icu.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sarnicola E, Sarnicola C, Cheung AY, Sarnicola V. Deep anterior lamellar keratoplasty for corneal penetrating wounds. Eur J Ophthalmol 2021; 32:11206721211014385. [PMID: 33938313 DOI: 10.1177/11206721211014385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report our surgical experience of deep anterior lamellar keratoplasty (DALK) performed in eyes with scarring resulting from a corneal penetrating wound without tissue loss. METHODS Case series of three eyes of three patients that underwent DALK for poor vision due to a scar resulting from a previous corneal penetrating wound. Surgery was performed at least 1 year after the initial injury. Manual dissection technique was used in all cases. Preoperative and postoperative best correct visual acuity (BCVA), postoperative residual bed thickness, and postoperative endothelial cell count (ECC) were evaluated. RESULTS Preoperative BCVA ranged from 1.3 to 1.0 LogMAR. Two eyes were pseudophakic and one eye had a traumatic cataract. Manual DALK was successfully accomplished in all three cases. The mean residual recipient bed thickness was 103 µm (range 68-130 µm). The mean endothelial cell loss at the 6th month of follow-up was 6% (range 3%-11%) with a further 1% decrease at 4 years. One of the patients underwent cataract surgery and limbal relaxing incisions 1 year after DALK having a total endothelial cell loss of 4.8% at 2 years of follow-up. BCVA at 2 years of follow-up was 0.1 LogMAR (range 0.22-0.0 LogMAR). No episode of rejection was recorded, and all grafts remained clear at last follow-up (5 years, range 4-6 years). CONCLUSIONS Manual DALK should be considered in cases of corneal scars in optical zone resulting from penetrating wound.
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Affiliation(s)
- Enrica Sarnicola
- Oftalmico di Torino, Turin, Italy
- Ospedale San Giovanni Bosco, Turin, Italy
| | - Caterina Sarnicola
- Oftalmico di Torino, Turin, Italy
- Ospedale San Giovanni Bosco, Turin, Italy
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Comparison between two devices in the detection of corneal thickness changes after cataract surgery. Sci Rep 2021; 11:6709. [PMID: 33758298 PMCID: PMC7988103 DOI: 10.1038/s41598-021-86158-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
This study compared corneal thickness (CT) changes obtained with specular microscopy (SM) and a rotating Scheimpflug camera (RSC) after conventional phacoemulsification surgery (PS). One hundred sixty six eyes of 83 patients were analyzed before and one month after PS. One eye underwent PS, while the fellow phakic one was used as control. CT was measured with SM at the center of the cornea and with RSC at the pupil center, at the corneal apex and at the thinnest point. In the operated eye, SM showed a larger CT mean increase than those one detected at the three different measurements’ points evaluated by RSC. Inversely, in the fellow phakic eye, SM showed a greater CT mean decrease than those one registered by RSC at its three measurement’s points. Thus, one month after surgery, even if cornea appears clear at the slit-lamp, a significant thickness increase is still present. This is even more evident if the slight decrease of the fellow phakic eye is considered. The differences between the two devices are probably related to the different measured areas.
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Abstract
PURPOSE OF REVIEW There are several different approaches to handling regular and irregular astigmatism during cataract surgery, but still much debate on which solutions are most effective given unique patient circumstances. In this review, we examine recent literature and studies to highlight some of the most effective ways to plan preoperatively, manage regular and irregular astigmatism during cataract surgery, as well as managing postoperative complications. RECENT FINDINGS Recent developments in technology have provided increased courses of action for astigmatism management during cataract surgery. Additional options of toric IOLs with presbyopic platforms, light adjustable lenses, intraocular pinhole lenses, online technological tools and platforms, wavefront or topographic laser technology, and phototherapeutic keratectomy are all effective solutions to managing regular and irregular astigmatism. In this review, we will explore optimal approaches for unique situations. SUMMARY With increased technology, research, and methods, correcting regular and irregular astigmatism during cataract surgery is achievable in most patients. With in-depth preoperative planning, analysis of patient-specific factors, and a tailored approach, surgeons can obtain excellent uncorrected vision for patients.
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Sarnicola E, Sarnicola C, Cheung AY, Panico E, Panico C, Sarnicola V. Manual deep anterior lamellar keratoplasty after partial unintentional full-thickness trephination. Eur J Ophthalmol 2020; 31:774-777. [PMID: 32493069 DOI: 10.1177/1120672120932108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to describe a surgical technique to perform deep anterior lamellar keratoplasty (DALK) despite inadvertent full thickness trephination in one quadrant. METHODS Case report of a 19-year-old boy who underwent DALK for visually significant post-infectious stromal scar in his left eye. An unintentional full thickness trephination occurred in the upper-nasal quadrant at the beginning of the surgery. After suturing the perforated area, manual DALK was performed, and an air bubble was left in the anterior chamber. Evaluated outcomes included best spectacle corrected visual acuity (BSCVA), residual recipient bed thickness, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double anterior chamber. RESULTS The surgery was completed without any further complications. No double anterior chamber or Urrets-Zavalia syndrome was observed on the first postoperative day. Mean residual recipient bed thickness was 72 μm and regular. ECC was 2446 cell/mm2. BSCVA at 18 months of follow-up was 0.9. There were no episodes of rejection, and the graft remained clear at the last follow-up (4 years). CONCLUSION Inadvertent partial full thickness trephination of the recipient cornea is a largely preventable but possible complication during DALK. Penetrating keratoplasty conversion can be avoided by performing a manual dissection DALK.
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Affiliation(s)
- Enrica Sarnicola
- Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy.,Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
| | - Caterina Sarnicola
- Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy.,Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
| | | | | | - Claudio Panico
- Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy.,Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
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