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Moreno-Martínez A, Martín-Melero O, Andrés-Pretel F, Gómez-Cortés A, Granados-Centeno JM. Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism. Cornea 2024; 43:76-82. [PMID: 37099688 DOI: 10.1097/ico.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/13/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE The aim of this study was to assess the short-term and long-term effectiveness of toric intraocular lenses (IOLs) as a treatment for significant postkeratoplasty astigmatism. METHODS This was a retrospective case review study that analyzes postkeratoplasty eyes after phacoemulsification with toric IOL implantation. RESULTS Seventy-five eyes were included. Previous surgery was penetrating keratoplasty (50.6%), deep anterior lamellar keratoplasty (34.6%), or automated anterior lamellar therapeutic keratoplasty (14.6%). The mean age at phacoemulsification with toric IOL implantation was 55.0 years (SD: ±14.4). The mean follow-up time was 48.2 ± 26.6 months. Preoperative mean topographic astigmatism was 6.34 ± 2.70 D (range 2-13.2 D). The mean IOL cylinder power was 6.00 ± 4.75 D (range 2-12 D). Both mean refractive astigmatism and mean refractive spherical equivalent decreased significantly from -5.30 ± 1.86 D to -1.62 ± 1.94 D ( P < 0.001) and from -4.00 ± 4.46 D to -0.25 ± 1.25 D ( P < 0.001), respectively. From preoperative to the last visit, there was a significant improvement in mean uncorrected distance visual acuity (UCVA) (from 1.3 ± 1.0 logMAR to 0.4 ± 0.3 logMAR, P < 0.001) and mean corrected distance visual acuity (CDVA) (from 0.7 ± 0.6 logMAR to 0.2 ± 0.3 logMAR, P < 0.001). Postoperative UDVA was 20/40 and 20/30 or better in 34% and 21% of eyes, respectively. Postoperative CDVA was 20/40 and 20/30 or better in 70% and 58% of eyes, respectively. CONCLUSIONS Phacoemulsification and toric IOL implantation can effectively reduce moderate to high postkeratoplasty astigmatism, with a corresponding significant visual improvement.
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Affiliation(s)
- Almudena Moreno-Martínez
- Department of Ophthalmology (Cornea Unit), Albacete University Hospital Complex, Albacete, Castilla-La Mancha, Spain
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Qureshi S, Dohlman TH. Penetrating Keratoplasty: Indications and Graft Survival by Geographic Region. Semin Ophthalmol 2023; 38:31-43. [PMID: 36527378 PMCID: PMC10084850 DOI: 10.1080/08820538.2022.2152710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/23/2022]
Abstract
Corneal transplantation, or penetrating keratoplasty (PK), is the most common form of solid-organ transplantation performed worldwide. Here, we evaluated the indications for PK and rates of transplant survival around the world by geographic region. We conducted a literature search of PubMed, MEDLINE, and Google Scholar databases and identified 155 relevant studies from 41 countries published between 1987 and 2021. The most common indications for PK were keratoconus in Europe, Africa, the Middle East, Australia, New Zealand, and Central and South America, bullous keratopathy in North America, and corneal scarring in Asia. The overall global mean graft survival rates at 1-, 2-, 3-, 5-, and 10-years were 88.6%, 81.2%, 78.9%, 72.8%, and 61.2%, respectively. Through this systematic analysis of PK by region, we hope to bring a new perspective to the corneal transplantation literature and to potentially highlight global differences and unmet needs in patient care.
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Affiliation(s)
- Sana Qureshi
- Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Statham M, Apel A, Stephensen D. Correction of astigmatism after penetrating keratoplasty using the Acri.Comfort toric intraocular lens. Clin Exp Optom 2021; 93:42-4. [DOI: 10.1111/j.1444-0938.2009.00436.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Andrew Apel
- The Eye Health Centre, Brisbane, Australia E‐mail:
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Bamdad S, Khalili MR, Khosravi A, Attarzade A, Movahedan H, Nejabat M. Corneal Cross-linking as an Adjunct for The Management of Refractory Fungal Keratitis. Middle East Afr J Ophthalmol 2021; 27:204-209. [PMID: 33814816 PMCID: PMC7993049 DOI: 10.4103/meajo.meajo_130_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 04/15/2020] [Accepted: 09/19/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE: To evaluate the effectiveness of ultraviolet (UV)-A/Riboflavin corneal cross-linking (CXL) for the treatment of the refractory cases of fungal keratitis. METHODS: In this prospective interventional study, 9 patients with the diagnosis of fungal keratitis that were referred to our emergency eye center were included. These patients were resistant to conventional treatment and underwent therapeutic UV-A/Riboflavin CXL. Response to the treatment was considered as good if rapid epithelialization and rapid decrease in stromal infiltration was occurred after PACK-CXL, and poor when the emergency transplantation was necessary to eradicate the infection. RESULTS: Nine patients treated with CXL due to recalcitrant fungal keratitis. Culture of the corneal scrapings showed Aspergillus species in 4 patients, Candida albicans in 1 patient and Fusarium species in the remainder of them. CXL was performed from 1 to 20 days after the presentation of corneal ulcers (Mean: 9.12 ± 4.02; range: 5–20 days). Postoperatively, the mean time to epithelialization was 14.25 ± 2.38 days, and mean time to resolution of stromal infiltration was 22.5 ± 7.29 days, in responsive cases. Four out of 9 eyes showed good response, and five patients showed no response, and corneal transplantation was performed to eradicate the infection. There was no statistically significant difference in mean depth of infiltration and mean size of ulcer between responsive and unresponsive patients (P = 0.86 and 0.08, respectively). CONCLUSION: Although UV-A/Riboflavin CXL is not a definite treatment for all of the fungal keratitis, it seems promising in the management of some refractory cases.
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Affiliation(s)
- Shahram Bamdad
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad R Khalili
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Khosravi
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Adel Attarzade
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Movahedan
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Nejabat
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Özbek Uzman S, Yalnız Akkaya Z, Düzova E, Şingar E, Burcu A. Corneal Pathology and Cataract: Combined Surgery or Sequential Surgery? Turk J Ophthalmol 2021; 51:1-6. [PMID: 33631878 PMCID: PMC7931653 DOI: 10.4274/tjo.galenos.2020.04382] [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: 12/01/2022] Open
Abstract
Objectives To compare our combined surgery (CS) and sequential surgery (SS) results. Materials and Methods The files of 44 patients who underwent CS (penetrating keratoplasty [PK], cataract extraction, and intraocular lens [IOL] implantation) and 126 patients who underwent SS (cataract extraction and IOL implantation in a second session after PK) between January 2009 and December 2018 were evaluated retrospectively. One eye of the patients who were followed up for at least 1 year was included in the study. The two groups were compared in terms of indications, corrected distance visual acuity (CDVA), refractive results, complications, and graft survival. Results In the CS and SS groups, the median age was 63 (30-79) and 43 (18-73) years (p<0.001) and the median follow-up time was 51 (13-152) and 64.5 (13-154) months (p=0.011), respectively. The most common PK indications were traumatic corneal scar (20.5%) and endothelial dystrophy (15.9%) in the CS group versus keratoconus (24.6%) and stroma dystrophy (17.5%) in the SS group. In the CS and SS groups, 50% vs 69% of patients had CDVA ≥0.4 (p=0.04); 45.5% vs 25.4% had CDVA (0.1-0.3) (p=0.04); and 54.5% vs 73% had spherical equivalent ≤±2.0 D (p=0.02). The most common postoperative complications were glaucoma (20.5% vs 15.9%, p=0.48) and allograft reaction (9.1% vs 23%, p=0.04). Graft survival rates were 95.2% vs 86.5% (p=0.10) at 1 year and 75.9% vs 68.9% (p=0.47) at 5 years, respectively. Conclusion Over long-term follow-up, the groups were similar in terms of graft survival. For this reason, each patient must be evaluated separately whether to perform a combined or sequential surgery. Given the lower refractive error and higher expectation of final visual acuity, SS can be more advantageous especially in young patients.
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Affiliation(s)
- Selma Özbek Uzman
- University of Health Sciences Turkey, Ankara Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Züleyha Yalnız Akkaya
- University of Health Sciences Turkey, Ankara Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Emrah Düzova
- University of Health Sciences Turkey, Ankara Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Evin Şingar
- University of Health Sciences Turkey, Ankara Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Ayşe Burcu
- University of Health Sciences Turkey, Ankara Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
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Woo SE, Lee SH. Corneal Collagen Cross-linking for Corneal Ulcer from Moraxella Group. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.2.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Earn Woo
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Si Hyung Lee
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Secondary Intraocular Lens Implantation After Simultaneous Penetrating Keratoplasty and Cataract Extraction for Coexisting Corneal and Lens Opacities. Cornea 2019; 38:397-402. [PMID: 30640247 DOI: 10.1097/ico.0000000000001861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the results of a new approach to the 2-stage surgical management of coexisting visually significant corneal opacities and cataract. METHODS A retrospective analysis of eyes with corneal opacities and cataract that were surgically treated with simultaneous penetrating keratoplasty and cataract surgery, followed by secondary intraocular lens (IOL) implantation after removal of corneal sutures, was conducted. The parameters used for assessment were the following: mean percentage of graft endothelial cell loss after IOL implantation, deviation of the postoperative mean spherical equivalent from the target refraction, and mean uncorrected distance visual acuity (UDVA). RESULTS Twenty-nine eyes were included in the study. The mean baseline UDVA was 1.94 ± 0.46, and the mean baseline best-corrected distance visual acuity was 1.56 ± 0.42. The mean interval between the 2 surgical interventions was 13.3 ± 2.2 months. Just before secondary IOL implantation, the mean endothelial cell density was 2198 ± 311 cells. The mean percentage of corneal endothelial cell loss was 7.3% at 6 months after IOL implantation (P = 0.16). Before IOL implantation, the mean spherical equivalent was +11.75 ± 3.38 D. After IOL implantation, the mean spherical equivalent improved to -0.19 ± 0.93 D (P = 0.003) at 6 months. The mean UDVA improved to 0.34 ± 0.18 (P = 0.017), whereas the mean corrected distance visual acuity improved to 0.18 ± 0.29 at 6 months (P = 0.016). All grafted corneas maintained their clarity until the final follow-up visit. CONCLUSIONS Postponing IOL implantation some months after simultaneous penetrating keratoplasty and cataract extraction has a negligible effect on the corneal graft endothelium and achieves near postoperative target refraction with significant improvement in UDVA.
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Bonzano C, Di Zazzo A, Barabino S, Coco G, Traverso CE. Collagen Cross-Linking in the Management of Microbial Keratitis. Ocul Immunol Inflamm 2018; 27:507-512. [DOI: 10.1080/09273948.2017.1414856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Chiara Bonzano
- Clinica Oculistica, Di.N.O.G.M.I. University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Di Zazzo
- Department of Ophthalmology, IRCCS, GB Bietti Foundation, Rome, Italy
| | - Stefano Barabino
- Clinica Oculistica, Di.N.O.G.M.I. University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Coco
- Ophthalmology Department, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Enrico Traverso
- Clinica Oculistica, Di.N.O.G.M.I. University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
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Changing Indications in Penetrating Keratoplasty: A Systematic Review of 34 Years of Global Reporting. Transplantation 2017; 101:1387-1399. [PMID: 27336399 DOI: 10.1097/tp.0000000000001281] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Penetrating keratoplasty (PK) ranks among the oldest and most common kinds of human tissue transplantation. Based on the hypothesis that reported indications for PK significantly vary between global regions and over time, the present systematic review aimed to provide a thorough overview of global PK indications as reported in peer-reviewed manuscripts. METHODS A literature search of PubMed and MEDLINE was conducted to retrieve articles published from January 1980 to May 2014. Indications for PK within 7 global regions were compared using a modified classification system for PK indications and analyzed via multivariate regression. RESULTS A total of 141 publications from 37 countries were included, recording 180 865 PK cases. Postcataract surgery edema was the predominant indication in North America (28.0%) and ranked second in Europe (20.6%), Australia (21.1%), the Middle East (13.6%), Asia (15.5%), and South America (18.6%). Keratoconus was the leading indication in Europe (24.2%), Australia (33.2%), the Middle East (32.8%), Africa (32.4%), and South America (22.8%). It ranked third in North America (14.2%). Keratitis was the primary indication in Asia (32.3%). Fuchs endothelial corneal dystrophy was the fourth most common indication in North America (12.9%) and Europe (10.2%) and fifth in South America (3.8%). Multivariate analysis supported these results and revealed individual regional changes over time. CONCLUSIONS Systematic analysis reveals characteristic chronological and regional differences in reported global PK indications. Leading reported indications for PK between 1980 and 2014 were keratoconus (Europe, Australia, the Middle East, Africa, and South America), pseudophakic bullous keratopathy/aphakic bullous keratopathy (North America), and keratitis (Asia).
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Effectiveness of cataract phacoemulsification with toric intraocular lenses in addressing astigmatism after keratoplasty. J Cataract Refract Surg 2014; 40:2044-9. [DOI: 10.1016/j.jcrs.2014.03.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 11/30/2022]
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Al-Mohaimeed MM. Graft survival and visual outcome after simultaneous penetrating keratoplasty and cataract extraction. Int J Ophthalmol 2013; 6:385-9. [PMID: 23826538 DOI: 10.3980/j.issn.2222-3959.2013.03.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 04/08/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP). METHODS We described a retrospective study of 101 patients who had undergone simultaneous cataract extraction and PKP at King Khaled Eye Specialist Hospital between January 1, 2001, and December 31, 2002. All patients were followed up postoperatively with maximum follow-up 68 months. RESULTS The mean age of patients was 61 years. The mean overall follow-up was 27 months. The most common indications for surgery were corneal scarring (45.5%), previous failed graft (15.8%), corneal ulcer (12.9%), Fuchs endothelial dystrophy (8.9%), stromal dystrophy (2.9%), and other conditions (14.5%). Overall, 69 grafts (68.3%) remained clear at final follow-up. Previous glaucoma or postoperative glaucoma had no statistically significant effects on graft outcome (P>0.05).The graft rejection rate (17.8%) was a significant risk factor for failure (P=0.00). Age, gender, indications for surgery, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome (P>0.05). Postoperative visual acuity was significantly associated with preoperative visual acuity (P<0.01). CONCLUSION The present study provides evidence that performing a combined procedure results in more rapid visual rehabilitation and good graft clarity.
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Affiliation(s)
- Mansour M Al-Mohaimeed
- Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia
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Prabhu SS, Kaakeh R, Sugar A, Smith DG, Shtein RM. Comparative cost-effectiveness analysis of descemet stripping automated endothelial keratoplasty versus penetrating keratoplasty in the United States. Am J Ophthalmol 2013; 155:45-53.e1. [PMID: 22967866 PMCID: PMC3522781 DOI: 10.1016/j.ajo.2012.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To perform a comparative cost-effectiveness analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for corneal endothelial disease. DESIGN Retrospective cost-effectiveness analysis. METHODS This cost-effectiveness analysis was performed from a third-party payer perspective with a 5-year time horizon. Probabilities of outcomes and complications of each of the procedures were calculated based on review of the published literature. A model was constructed to compare the costs and utilities associated with DSAEK and PK. Costs of donor tissue preparation, surgery, follow-up, postoperative complications, and procedures were considered. Utility values were based on quality-adjusted life years associated with visual acuity outcomes. Both costs and utilities were discounted at 3% per year. Sensitivity analyses were performed on key model inputs. RESULTS Base case analysis found DSAEK to be less costly compared with PK ($9362 vs $10 239), with greater utility (3.15 vs 2.47 quality-adjusted life years). Sensitivity analyses revealed that even at graft failure rates for DSAEK approaching the rates for PK, DSAEK would still reduce costs. Varying the dislocation rate in our model showed that even at dislocation rates approaching 50%, DSAEK remained less costly. Further, with DSAEK rejection rates as high as 28%, DSAEK would remain a dominant procedure over PK. CONCLUSIONS Comparative cost-effectiveness analysis of DSAEK versus PK indicates favorable cost and utility outcomes associated with DSAEK for treatment of corneal endothelial disease. Longer follow-up of DSAEK outcomes will provide more accurate information regarding long-term cost-effectiveness of the procedure.
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Affiliation(s)
- Shreya S. Prabhu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Rola Kaakeh
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI
| | - Alan Sugar
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Dean G. Smith
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI
| | - Roni M. Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
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Bettis DI, Hsu M, Moshirfar M. Corneal Collagen Cross-linking for Nonectatic Disorders: A Systematic Review. J Refract Surg 2012; 28:798-807. [DOI: 10.3928/1081597x-20121011-09] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/11/2012] [Indexed: 01/18/2023]
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Laaser K, Bachmann BO, Horn FK, Cursiefen C, Kruse FE. Descemet membrane endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation: advanced triple procedure. Am J Ophthalmol 2012; 154:47-55.e2. [PMID: 22465365 DOI: 10.1016/j.ajo.2012.01.020] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/22/2012] [Accepted: 01/23/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the functional and morphologic outcome of Descemet membrane endothelial keratoplasty (DMEK) combined with phacoemulsification and intraocular lens implantation in patients suffering from endothelial dysfunction and cataract. DESIGN Retrospective, single-center, consecutive case series. METHODS Triple-DMEK (DMEK with simultaneous cataract surgery) was performed in 61 consecutive eyes of 56 patients using corneal donor tissue pre-stored in either short-term culture (Optisol-GS) at 4 C or organ culture (Dulbecco's modified Eagle's medium, CorneaMax medium) at 34 C. Main outcome measures included the number of air injections necessary for graft attachment as well as best-corrected visual acuity (BCVA [logMAR]), central corneal thickness (CCT), endothelial cell density (ECD), refractive spherical equivalent, refractive cylinder, and topographic cylinder at 1, 3, and 6 months postoperatively. RESULTS BCVA increased from 0.6 ± 0.23 logMAR preoperatively (n = 54) to 0.19 ± 0.22 logMAR at 6 months (n = 27) after surgery (P ≤ .05). ECD of donor corneas decreased from 2573 ± 235 cells/mm(2) (n = 61) to 1550 ± 326 cells/mm(2) (n = 29) after 6 months (P ≤ .05). CCT decreased from 651 ± 69 μm (n = 54) preoperatively to 521 ± 65 μm (n = 27) after 6 months (P ≤ .05). Refractive spherical equivalent was -0.3 ± 2.8 D (n = 27) preoperatively and 0.9 ± 1.5 D 6 months (n = 27) after surgery. A total of 54.5% of eyes were within 1 D of emmetropia (n = 12) and 77.3% were within 2 D of emmetropia (n = 17) 6 months (n = 22) after surgery. Refractive cylinder was -0.9 ± 1.0 D preoperatively (n = 49) and -1.5 ± 1.0 D 6 months (n = 23) after surgery. The change in refractive cylinder within the first month was statistically significant (P ≤ .05; Wilcoxon test). Topographic cylinder was 2.1 ± 1.7 D preoperatively (n = 58) and 1.7 ± 1.1 D 6 months (n = 28) after surgery. Between 3 and 6 months a significant change in topographic cylinder towards lower values was measured (P ≤ 0.05; Wilcoxon test). Optimized spherical results were achieved by selecting intraocular lenses based on a hyperopic shift of -0.75 D. CONCLUSION DMEK combined with cataract surgery (triple procedure) can routinely be performed in cases of endothelial dystrophy and cataract. The addition of cataract surgery to DMEK had no adverse effect on endothelial function or graft adhesion and did not increase the likelihood of postoperative complications.
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Affiliation(s)
- Kathrin Laaser
- Department of Ophthalmology, University Hospital Erlangen, Erlangen, Germany.
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New endothelial keratoplasty, phacoemulsification, and intraocular lens implantation triple procedure: Comparison with conventional triple procedure. J Cataract Refract Surg 2010; 36:1142-8. [DOI: 10.1016/j.jcrs.2010.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/19/2009] [Accepted: 01/12/2010] [Indexed: 11/23/2022]
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Dunlap K, Chak G, Aquavella JV, Myrowitz E, Utine CA, Akpek E. Short-term visual outcomes of Boston type 1 keratoprosthesis implantation. Ophthalmology 2010; 117:687-92. [PMID: 20096462 DOI: 10.1016/j.ophtha.2009.09.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 09/14/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report the short-term visual outcomes after keratoprosthesis implantation. DESIGN Retrospective multi center case series (Wilmer Eye Institute and University of Rochester Eye Institute). PARTICIPANTS One hundred twenty-two patients (126 eyes) with corneal diseases that were deemed ineligible to receive donor corneal transplants. INTERVENTION Patients underwent a Boston type I keratoprosthesis procedure for visual rehabilitation. MAIN OUTCOME MEASURES The medical records of the patients were reviewed to assess intraoperative and postoperative complications, uncorrected and best-corrected visual acuity, as well as the degree of refractive error at various time points. RESULTS One hundred four patients (82.5%) achieved improved vision within 6 months after surgery. An overwhelming majority of those patients who had improved vision had a manifest refraction of plano. The mean spherical refractive error was -0.57 diopters (D) and mean astigmatism was 0.10 D. Cumulatively, 7.1% patients achieved their best-corrected vision at 1 day, 24.6% at 1 week, and 70.6% at 3 months. The patients who achieved their best-corrected visual acuity after the first 3-month period most often were the ones who required multiple surgeries owing to preexisting or postoperative complications. CONCLUSIONS Boston keratoprosthesis seems to provide rapid visual recovery with excellent uncorrected acuity in the early postoperative period. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
- Karen Dunlap
- Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287-9238, USA
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Traish AS, Colby KA. Approaching cataract surgery in patients with fuchs' endothelial dystrophy. Int Ophthalmol Clin 2010; 50:1-11. [PMID: 20057291 DOI: 10.1097/iio.0b013e3181c5728f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Aisha S Traish
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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Nguyen DQ, Mumford LL, Jones MNA, Armitage WJ, Cook SD, Kaye SB, Tole DM. The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion. Eye (Lond) 2008; 23:1295-301. [DOI: 10.1038/eye.2008.301] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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21
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Ultraviolet A/Riboflavin Corneal Cross-linking for Infectious Keratitis Associated With Corneal Melts. Cornea 2008; 27:590-4. [DOI: 10.1097/ico.0b013e318169d698] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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