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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.
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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
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Quintin A, Hamon L, Langenbucher A, Seitz B. In situ donor keratometry in deceased patients as a novel screening technique for eye banking. Graefes Arch Clin Exp Ophthalmol 2023; 261:1619-1625. [PMID: 36629951 DOI: 10.1007/s00417-022-05871-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To investigate the potential role of keratometry on whole globes in situ of deceased patients by assessing its repeatability and comparing it with sterile donor tomography after excision and preservation in organ culture. METHODS A sequence of 5 measurements was taken from 40 eyes in situ of deceased patients < 24 h after death using the portable Retinomax K-plus 3 (Bon, Tokyo, Japan). Keratometry of whole globes in situ, from which sclerocorneal discs were taken for organ culture, was compared to those obtained after measuring these sclerocorneal disks through their cell culture flask in medium I after 5 ± 4 days using the anterior segment optical coherence tomograph Casia 2 (Tomey Corp., Nagoya, Japan), and to 964 different donor corneas in medium II. RESULTS Cronbach's alpha of the in situ keratometry was 0.891 and 0.942 for the steepest and flattest corneal power (P). The steepest (44.5D) and flattest (41.1D) P as well as the astigmatism (3.4D) of in situ corneas remained unchanged after preserving sclerocorneal discs in medium I (respectively 44.7D [p = 0.09]; 41.4D [p = 0.17]; 3.3D [p = 0.09]). The comparison of the in situ values with the 964 measured different donor corneas in medium II showed significantly (p < 0.001) higher P at the steep (45.4D) and flat (43.9D) meridian and smaller astigmatism (1.4D) for sterile donor tomography. CONCLUSIONS Measuring deceased patients' eyes in situ with the portable Retinomax K-plus 3 represents a feasible and reliably repeatable screening method in the eye bank. In comparison to donor tomography in medium I, it measures a similar power and astigmatism.
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Affiliation(s)
- Adrien Quintin
- Department of Ophthalmology, Saarland University Medical Centre (UKS), Kirrberger Straße 100, Bld. 22, 66424, Homburg, Saar, Germany.
| | - Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Centre (UKS), Kirrberger Straße 100, Bld. 22, 66424, Homburg, Saar, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Centre (UKS), Kirrberger Straße 100, Bld. 22, 66424, Homburg, Saar, Germany
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Hamon L, Quintin A, Mäurer S, Weinstein I, Langenbucher A, Seitz B, Daas L. Reliability and efficiency of corneal thickness measurements using sterile donor tomography in the eye bank. Cell Tissue Bank 2022; 23:695-706. [PMID: 34773544 PMCID: PMC9675654 DOI: 10.1007/s10561-021-09980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
To evaluate the reliability and efficiency of sterile pachymetric measurements of donor corneas based on tomographic data using two different methods: a "manual" and a "(semi-)automated" method. Twenty-five (25) donor corneas (50%) stored in MI and 25 (50%) in MII were imaged 5 times consecutively using an anterior segment OCT (AS-OCT). The central corneal thickness (CCT) was measured both with the manual measurement tool of the AS-OCT (= CCTm) and with a MATLAB self-programmed software allowing (semi-)automated analysis (= CCTa). We analyzed the reliability of CCTm and CCTa using Cronbach´s alpha (α) and Wilcoxon signed-Rank Test. Concerning CCTm, 68 measurements (54.4%) in MI and 46 (36.8%) in MII presented distortions in the imaged 3D-volumes and were discarded. Concerning CCTa, 5 (4%) in MI and 1 (0.8%) in MII were not analyzable. The mean (± SD) CCTm was 1129 ± 6.8 in MI and 820 ± 5.1 µm in MII. The mean CCTa was 1149 ± 2.7 and 811 ± 2.4 µm, respectively. Both methods showed a high reliability with a Cronbach´s α for CCTm of 1.0 (MI/MII) and for CCTa of 0.99 (MI) and 1.0 (MII). Nevertheless, the mean SD of the 5 measurements was significantly higher for CCTm compared to CCTa in MI (p = 0.03), but not in MII (p = 0.92). Sterile donor tomography proves to be highly reliable for assessment of CCT with both methods. However, due to frequent distortions regarding the manual method, the (semi-)automated method is more efficient and should be preferred.
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Affiliation(s)
- Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bldg. 22, 66421 Homburg/Saar, Germany
| | - Adrien Quintin
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bldg. 22, 66421 Homburg/Saar, Germany
| | - Stephanie Mäurer
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Isabel Weinstein
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bldg. 22, 66421 Homburg/Saar, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bldg. 22, 66421 Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bldg. 22, 66421 Homburg/Saar, Germany
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Kaluzny BJ, Mlyniuk P, Liberski S, Jimenez-Villar A, Machalińska A, Grulkowski I. Swept-source OCT for corneal graft quantitative evaluation in the eye bank and the correlation of the measurements to pre-excision values. Sci Rep 2022; 12:14834. [PMID: 36050445 PMCID: PMC9437096 DOI: 10.1038/s41598-022-19225-1] [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: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022] Open
Abstract
Quantitative evaluation of the human corneal grafts stored in the tissue banks is usually limited to endothelial cell density and central thickness. Swept-source OCT (SS-OCT) is capable of measuring the central curvatures of the corneal tissue prepared for transplantation without loss of sterileness, providing insights on its refractive state. The aim of the paper is to compare in vitro SS-OCT measurements with pre-excision values. Hand-held keratometry and ultrasound pachymetry was performed on 22 corneas before excision of corneoscleral button and insertion in the vial with Eusol-C solution (AlchimiaS.r.l, Nicolò, Italy). After 12 to 36 h of hypothermic storage the corneas were examined within the vials with custom built SS-OCT system maintaining a sterile environment. The anterior and posterior central curvatures, and central corneal thickness (CCT) were measured. Rotation of the corneoscleral button was controlled by making a 6-o'clock mark during excision. Mean pre-excision CCT was 626.45 ± 28.71 µm and 468.05 ± 52.96 µm when measured with SS OCT (r = 0.55; p < 0.001). Respective values for average keratometry were 7.74 ± 0.39 mm and 7.92 ± 0.57 mm (r = 0.6; p = 0.22). Although high differences were observed in corneal thickness, keratometric radius of curvature at the flat (r = 0.42; p < 0.001) and steep (r = 0.62; p = 0.014) meridian of the anterior corneal surface, as well as corneal anterior astigmatism (r = 0.3; p < 0.001), showed good correlation with pre-excision values. SS-OCT is capable of providing quantitative evaluation of the human corneal grafts in hypothermic storage. Good correlation between curvature measurements before excision and during banking in the vial indicates its clinical utility.
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Affiliation(s)
- Bartlomiej J Kaluzny
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Ul. K. Ujejskiego 75, 85-168, Bydgoszcz, Poland.,Oftalmika Eye Hospital, Bydgoszcz, Poland
| | - Patryk Mlyniuk
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Ul. K. Ujejskiego 75, 85-168, Bydgoszcz, Poland.,Oftalmika Eye Hospital, Bydgoszcz, Poland
| | - Slawomir Liberski
- Department of Ophthalmology, Poznan University of Medical Sciences, Ul. A. Szamarzewskiego 84, 61-848, Poznań, Poland.
| | - Alfonso Jimenez-Villar
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Ul. Grudziądzka 5, 87-100, Toruń, Poland
| | - Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Ireneusz Grulkowski
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Ul. Grudziądzka 5, 87-100, Toruń, Poland
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Zhu L, Makita S, Oida D, Miyazawa A, Oikawa K, Mukherjee P, Lichtenegger A, Distel M, Yasuno Y. Computational refocusing of Jones matrix polarization-sensitive optical coherence tomography and investigation of defocus-induced polarization artifacts. BIOMEDICAL OPTICS EXPRESS 2022; 13:2975-2994. [PMID: 35774308 PMCID: PMC9203103 DOI: 10.1364/boe.454975] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Here we demonstrate a long-depth-of-focus imaging method using polarization sensitive optical coherence tomography (PS-OCT). This method involves a combination of Fresnel-diffraction-model-based phase sensitive computational refocusing and Jones-matrix based PS-OCT (JM-OCT). JM-OCT measures four complex OCT images corresponding to four polarization channels. These OCT images are computationally refocused as preserving the mutual phase consistency. This method is validated using a static phantom, postmortem zebrafish, and ex vivo porcine muscle samples. All the samples demonstrated successful computationally-refocused birefringence and degree-of-polarization-uniformity (DOPU) images. We found that defocusing induces polarization artifacts, i.e., incorrectly high birefringence values and low DOPU values, which are substantially mitigated by computational refocusing.
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Affiliation(s)
- Lida Zhu
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shuichi Makita
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Daisuke Oida
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Arata Miyazawa
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Sky technology Inc., Tsukuba, Ibaraki, Japan
| | - Kensuke Oikawa
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Pradipta Mukherjee
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Antonia Lichtenegger
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Martin Distel
- Innovative Cancer Models, St. Anna Children’s Cancer Research Institute, Vienna, Austria
| | - Yoshiaki Yasuno
- Computational Optics Group, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Safi T, Daas L, Kiefer GL, Sharma M, Ndiaye A, Deru M, Alexandersson J, Seitz B. Semiquantitative Criteria in the Eye Bank That Correlate with Cornea Guttata in Donor Corneas. Klin Monbl Augenheilkd 2021; 238:680-687. [PMID: 34157770 DOI: 10.1055/a-1498-1846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cornea guttata may not be recognized in the eye bank and recent studies have displayed that guttae are transplanted in about 15% of cases in varying severities. The purpose of this study was to establish semiquantitative criteria for the detection of cornea guttata in donor corneas in the eye bank. METHODS In this retrospective cohort study, preoperative endothelial pictures of donor corneas were collected and classified according to the post-penetrating keratoplasty cornea guttata grade into three distinct groups: group 1 consists of healthy corneas with no guttae (guttata grade 0); group 2 constitutes corneas with mild asymptomatic cornea guttata (guttata grade +); and group 3 comprises corneas with advanced widespread cornea guttata (guttata grade ++/+++/++++). The preoperative pictures of each group were then individually analyzed using the following five semiquantitative criteria: The number and the area of the cell-depleted surfaces, the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions, the presence of blebs in the cell membrane, and the presence of groups of cells with a distinct whitish color. RESULTS In total, 262 patients were included in this study, with a total number of 1582 preoperative donor corneal endothelial pictures. Out of those pictures, groups 1, 2, and 3 encompassed 995 (62.9%), 411 (26.0%), and 176 (11.1%) pictures, respectively. Three out of the five eye bank criteria were found to correlate with postoperative cornea guttata with a highly significant p value of < 0.001. These three criteria are the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions and, the presence of blebs. The presence of groups of cells with a distinct whitish color was only a weak predictive factor for cornea guttata (p = 0.069). There was no statistically significant correlation between the number and the area of cell-depleted surfaces and postoperative cornea guttata with a p = 0.181. CONCLUSION Three semiquantitative criteria that can be detected in the eye bank using inverted light microscopy seem to correlate with postoperative cornea guttata: The presence of blebs, the presence of cell membrane defects and interruptions, as well as endothelial pictures with less than 50% of the cells having a hexagonal of circular shape. The presence of groups of cells with a distinct whitish color appears to be a weak predictor of cornea guttata.
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Affiliation(s)
- Tarek Safi
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Gian-Luca Kiefer
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Mansi Sharma
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Alassane Ndiaye
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Matthieu Deru
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Jan Alexandersson
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
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Quintin A, Hamon L, Mäurer S, Langenbucher A, Seitz B. OCT Application for Sterile Corneal Graft Screening in the Eye Bank. Klin Monbl Augenheilkd 2021; 238:688-692. [PMID: 34157771 DOI: 10.1055/a-1443-5451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Sterile donor tomography enables the detection of corneal tissues with refractive anomalies. The aim of this study was to determine the curvature and thickness of donor corneas to support proper selection in the eye bank. METHODS 704 donor corneas (Klaus Faber Center, LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, in Homburg/Saar) were measured using the anterior segment optical coherence tomograph (AS-OCT) CASIA 2 (Tomey Corp., Nagoya, Japan). The corneoscleral discs were measured in their cell culture flask, which was positioned in a holder on the chin rest of the AS-OCT, after conversion to medium II (with 6% dextran T-500). The measured raw data were analysed and processed in MATLAB (MathWorks Inc., Natick, Massachusetts, USA), after which the refractive power of the steep and flat meridian at the anterior and posterior surface and the central corneal thickness (CCT) of the donor corneas were determined. Results values are expressed as mean x̅ ± standard deviation SD. RESULTS The mean refractive power of the steep/flat meridian at the anterior surface was 45.4 ± 1.8 D/44.0 ± 1.3 D, the corresponding values for the posterior surface were - 6.2 ± 0.3 D/- 5.9 ± 0.2 D, and the mean CCT was 616.3 ± 85.1 µm. Of the 704 (100%) measured donor tissues, 590 (83.8%)/670 (95.2%) donor corneas showed no anomaly beyond respectively x̅ ± 2 SD/x̅ ± 3 SD among the 5 examined parameters. 72 (10.3%)/23 (3.3%) donor corneas had only 1 anomaly, 26 (3.7%)/10 (1.4%) had 2 anomalies, 10 (1.4%)/1 (0.1%), 3 anomalies, 5 (0.7%)/0 (0.0%), 4 anomalies, and 1 (0.1%)/0 (0.0%), 5 anomalies. CONCLUSIONS AS-OCT provides an objective and sterile screening method to identify corneal tissues with curvature anomalies in order to further optimise donor selection in the eye bank. To avoid postoperative refractive surprises, donor corneas with a total refractive power that deviates > ± 3 SD from the mean should not be used for penetrating or anterior lamellar keratoplasty, but may be suitable for posterior lamellar keratoplasty (DMEK or DSAEK). In the future, sterile donor tomography could enable: (1) the harmonisation of donor and recipient tomography, which may minimise residual astigmatism for a particular donor-recipient pair; and (2) the improvement of IOL power calculation in a classical triple procedure by means of regression analysis between pre- and postoperative total refractive power of corneal grafts.
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Affiliation(s)
- Adrien Quintin
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Stephanie Mäurer
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
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Nioi M, Napoli PE, Demontis R, Locci E, Fossarello M, d’Aloja E. Postmortem Ocular Findings in the Optical Coherence Tomography Era: A Proof of Concept Study Based on Six Forensic Cases. Diagnostics (Basel) 2021; 11:413. [PMID: 33670928 PMCID: PMC7997319 DOI: 10.3390/diagnostics11030413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Postmortem analysis of the ocular globe is an important topic for forensic pathology and transplantology. Although crucial elements may be gathered from examining cadaveric eyes, the latter do not routinely undergo in-depth analysis. The paucity of quantitative and objective data that are obtainable using current, invasive necroscopic techniques is the main reason for the limited interest in this highly specialized procedure. The aim of the current study is to describe and to object for the first time the postmortem ocular changes by mean of portable optical coherence tomography for evaluating ocular tissues postmortem. The design involved the postmortem analysis (in situ, and without enucleation) of 12 eyes by portable spectral-domain Optical Coherence Tomography. The scans were performed, in corneal, retinal and angle modality at different intervals: <6 h, 6th, 12th, and 24th hour and after autopsy (25th-72nd hour). The morphological changes in the cornea, sclera, vitreous humor and aqueous humor were easy to explore and objectify in these tissues in first 72 h postmortem. On the other hand, the "in situ" observation of the retina was difficult due to the opacification of the lenses in the first 24 h after death.
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Affiliation(s)
- Matteo Nioi
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
| | - Pietro Emanuele Napoli
- Eye Clinic, Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy; (P.E.N.); (M.F.)
| | - Roberto Demontis
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
| | - Emanuela Locci
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
| | - Maurizio Fossarello
- Eye Clinic, Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy; (P.E.N.); (M.F.)
| | - Ernesto d’Aloja
- Forensic Medicine Unit, Department of Clinical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (R.D.); (E.L.); (E.d.)
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Langenbucher A, Szentmáry N, Weisensee J, Wendelstein J, Cayless A, Menapace R, Hoffmann P. Prediction model for best focus, power, and spherical aberration of the cornea: Raytracing on a large dataset of OCT data. PLoS One 2021; 16:e0247048. [PMID: 33617531 PMCID: PMC7899355 DOI: 10.1371/journal.pone.0247048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyse corneal power based on a large optical coherence tomography dataset using raytracing, and to evaluate corneal power with respect to the corneal front apex plane for different definitions of best focus. Methods A large OCT dataset (10,218 eyes of 8,430 patients) from the Casia 2 (Tomey, Japan) was post-processed in MATLAB (MathWorks, USA). Using radius of curvature, corneal front and back surface asphericity, central corneal thickness, and pupil size (aperture) a bundle of rays was traced through the cornea. Various best focus definitions were tested: a) minimum wavefront error, b) root mean squared ray scatter, c) mean absolute ray scatter, and d) total spot diameter. All 4 target optimisation criteria were tested with each best focus plane. With the best-fit keratometer index the difference of corneal power and keratometric power was evaluated using a multivariate linear model. Results The mean corneal powers for a/b/c/d were 43.02±1.61/42.92±1.58/42.91±1.58/42.94±1.59 dpt respectively. The root mean squared deviations of corneal power from keratometric power (nK = 1.3317/1.3309/1.3308/1.3311 for a/b/c/d) were 0.308/0.185/0.171/0.209 dpt. With the multivariate linear model the respective RMS error was reduced to 0.110/0.052/0.043/0.065 dpt (R² = 0.872/0.921/0.935/0.904). Conclusions Raytracing improves on linear Gaussian optics by considering the asphericity of both refracting surfaces and using Snell’s law of refraction in preference to paraxial simplifications. However, there is no unique definition of best focus, and therefore the calculated corneal power varies depending on the definition of best focus. The multivariate linear model enabled more precise estimation of corneal power compared to the simple keratometer equation.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
- * E-mail:
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis-University, Budapest, Hungary
| | - Johannes Weisensee
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Jascha Wendelstein
- Department of Ophthalmology, Johannes Kepler University Linz, Linz, Austria
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, United Kingdom
| | - Rupert Menapace
- Department of Ophthalmology, Vienna University, Vienna, Austria
| | - Peter Hoffmann
- Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
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Quintin A, Hamon L, Mäurer S, Langenbucher A, Seitz B. Vergleich der sterilen Spendertomographie in der Hornhautbank mit der Tomographie des Transplantates nach perforierender Keratoplastik. Ophthalmologe 2020; 118:1038-1044. [PMID: 33258059 PMCID: PMC8492567 DOI: 10.1007/s00347-020-01256-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022]
Abstract
Zusammenfassung
Hintergrund
Seit 2018 verwenden wir die sterile Spendertomographie in der Hornhautbank routinemäßig, um refraktive Überraschungen nach Keratoplastik zu vermeiden. Ziel dieser Studie war es, Spendertomographieparameter mit Tomographieparametern des Transplantates nach perforierender Keratoplastik (PKP) zu vergleichen.
Methoden
Diese Studie umfasste 193 Spendergewebe der Hornhautbank, die für eine PKP verwendet wurden (Transplantatdurchmesser 8,2 ± 0,7 mm). Messungen wurden mit dem optischen Kohärenztomographen des vorderen Augenabschnittes (VAA-OCT) Casia 2 (Tomey Corp., Nagoya, Japan) präoperativ sowie postoperativ nach 5 ± 4 Monaten bei liegenden Fäden und nach 22 ± 4 Monaten ohne Fäden durchgeführt. Post- und präoperative Werte wurden mithilfe des Wilcoxon-Rangsummentests verglichen.
Ergebnisse
Postoperativ, bei liegenden (bzw. ohne) Fäden, war die Brechkraft (P) der Hornhautvorderfläche (v) im steilen Meridian (S) (PvS) unverändert (−0,2 dpt; p = 0,78) (um 2,7 dpt größer [p < 0,01]) und im flachen Meridian (F) (PvF) um 4,5 dpt (2,8 dpt) niedriger (p < 0,01) im Vergleich zu den Spendertomographiewerten. Der Astigmatismus (v) war um 4,3 dpt (5,4 dpt) größer (p < 0,01). An der Rückfläche (r) war PrS um 0,9 dpt (0,9 dpt) und PrF um 0,3 dpt (p < 0,01) (0,1 dpt [p = 0,42]) kleiner, während der Astigmatismus (r) um 0,7 dpt (0,9 dpt) größer war (p < 0,01). Die zentrale Hornhautdicke war um 55,7 μm (p < 0,01) (27,5 µm [p = 0,01]) kleiner. Die Gesamtbrechkraft ohne Fäden änderte sich nicht signifikant im Vergleich zur Hornhautbankmessung.
Schlussfolgerung
Zentrale Hornhautdicke, Brechkraft (P) und Astigmatismus veränderten sich postoperativ im Vergleich zu den Spendertomographiewerten, mit Ausnahme von P im steilen Meridian der Vorderfläche bei liegenden Fäden sowie von P im flachen Meridian der Rückfläche nach Entfernung aller Fäden. Die Gesamtbrechkraft ohne Fäden ändert sich allerdings nicht signifikant. Diese Informationen könnten für eine Verbesserung der Kunstlinsenberechnung bei klassischer „Triple-Procedure“ von Bedeutung sein.
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Affiliation(s)
- A Quintin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland.
| | - L Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland
| | - S Mäurer
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg/Saar, Deutschland
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Thickness and Curvature Changes of Human Corneal Grafts in Dextran-Containing Organ Culture Medium Before Keratoplasty. Cornea 2020; 40:733-740. [PMID: 33290320 DOI: 10.1097/ico.0000000000002543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the changes of corneal thickness and curvature of human corneal grafts in organ culture medium II, containing dextran T500 6%, before keratoplasty. METHODS We examined the tomography of 24 corneas from our eye bank transferred from medium I into medium II. Images were repeated hourly during 24 hours using an anterior segment optical coherence tomography. The central corneal thickness (CCT) was measured with the manual measurement tool of the anterior segment optical coherence tomography. The radii of curvature (anterior flat and steep and posterior flat and steep) were measured with a MATLAB self-programmed software for "sterile donor tomography." RESULTS The mean CCT (±SD) at baseline (T0) was 727 ± 156 μm. It reached 581 ± 103, 506 ± 84, 472 ± 79, and 456±7 μm after 6, 12, 18, and 24 hours, respectively. After 12 hours, 83% of the final deswelling was achieved. The radii of curvature (±SD) at baseline (T0) were (posterior flat, posterior steep, anterior flat, and anterior steep) 6.6 ± 0.5, 6.2 ± 0.5, 7.7 ± 0.4, and 7.4 ± 0.4 mm, respectively. After 24 hours, the radii of curvature reached 6.8 ± 0.1, 6.6 ± 0.3, 7.6 ± 0.1, and 7.4 ± 0.2 mm, respectively. CONCLUSIONS The kinetics of the deswelling process in medium II follow a hyperbolic curve. Considering a CCT of 506 μm at T12, we assume that a time interval of 12 hours in medium II might be enough for clinical purposes. This result might help to keep storage in medium II as short as possible to escape potential toxic effects of dextran in medium II. The radius of curvature does not seem to change within 24 hours for all measured surfaces.
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Seitz B, Daas L, Flockerzi E, Suffo S. [Descemet membrane endothelial keratoplasty DMEK - Donor and recipient step by step]. Ophthalmologe 2020; 117:811-828. [PMID: 32561987 DOI: 10.1007/s00347-020-01134-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 2020 Descemet membrane endothelial keratoplasty (DMEK) has become the gold standard in Germany for the treatment of corneal endothelial diseases; however, the widespread use of DMEK was initially limited due to problems with donor preparation and the difficulty of correctly and gently unfolding the endothelial Descemet membrane (EDM) in the anterior chamber. Following the situational donor selection, the safe single-handed donor preparation of the cornea without tearing or even rupturing the EDM, including the indispensable peripheral semicircular orientation marking. Also presented is a step by step atraumatic loading of the glass cartridge, the introduction of the EDM roll into the anterior chamber, and its safe step by step unfolding based on (1) the sequential use of jets of fluid, (2) repeated tapping on the peripheral/central cornea, (3) controlled flattening of the anterior chamber, (4) use of air bubbles of defined size and finally, the fixation of the EDM in correct orientation to the back of the host cornea with a gas bubble. Since every wrong step with DMEK can have far-reaching consequences for patient and surgeon, this step by step pragmatic approach should minimize the incidence of donor tissue damage and failure in patient maneuvers.
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Affiliation(s)
- Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland.
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
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Wertheimer CM, Brandt K, Kaminsky S, Elhardt C, Kassumeh SA, Pham L, Schulz-Hildebrandt H, Priglinger S, Anderson RR, Birngruber R. Refractive Changes After Corneal Stromal Filler Injection for the Correction of Hyperopia. J Refract Surg 2020; 36:406-413. [DOI: 10.3928/1081597x-20200429-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/29/2020] [Indexed: 11/20/2022]
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Seitz B, Daas L, Milioti G, Szentmàry N, Langenbucher A, Suffo S. Excimerlaser-assistierte perforierende Keratoplastik. Ophthalmologe 2019; 116:1221-1230. [DOI: 10.1007/s00347-019-00990-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Characterization of Corneal Donor Tissue Lesions by Anterior Segment Optical Coherence Tomography Compared With Eye Bank Technician Slit-Lamp Examination. Cornea 2018; 37:1318-1323. [PMID: 30044250 DOI: 10.1097/ico.0000000000001700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare anterior segment spectral-domain optical coherence tomography (OCT) with eye bank technician slit-lamp examination (SLE) in characterizing lesions in donor corneas. METHODS Twenty-nine donor corneas identified by eye bank technicians to have opacities or lesions potentially representing pathologic findings affecting the stroma were evaluated through the use of technician SLE, SLE photography, and OCT. Technicians were tasked with describing the lesion, estimating the lesion depth, and photographing their SLE findings. A masked grader evaluated the OCT images and measured the lesion depth using customized software. The lesions identified on OCT were then compared with those identified on SLE. RESULTS A total of 37 lesions were detected on SLE; 25 of the 37 lesions identified on SLE were matched to a lesion on OCT. SLE and OCT depth measurements were statistically significantly different (P = 0.0042, mean difference 4.8% ± 6.5%), and OCT graded lesions as slightly deeper. Of the 12 out of the 37 lesions that were noted on SLE (but not identified on OCT), these included 2 central and paracentral anterior stromal lesions (OCT showed loose epithelium), 5 peripheral anterior stromal lesions, and 5 corneas with LASIK. CONCLUSIONS Our study highlights both advantages and limitations of OCT compared with technician SLE in the evaluation of donor corneal tissue. Although OCT may miss some peripheral lesions and LASIK scars that are identifiable on SLE, OCT's depth resolution is helpful in differentiating whether shallow anterior opacities actually extend deeper into the stroma or are confined superficially to the epithelium.
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Mäurer S, Asi F, Rawer A, Damian A, Seitz B, Langenbucher A, Eppig T. Konzept zur 3‑D-Vermessung von Hornhautspendergewebe mithilfe eines klinischen OCT. Ophthalmologe 2018; 116:640-646. [DOI: 10.1007/s00347-018-0801-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nioi M, Napoli PE, Demontis R, Locci E, Fossarello M, d’Aloja E. Morphological analysis of corneal findings modifications after death: A preliminary OCT study on an animal model. Exp Eye Res 2018; 169:20-27. [DOI: 10.1016/j.exer.2018.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/09/2017] [Accepted: 01/15/2018] [Indexed: 11/16/2022]
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Seitz B, DAAS L, Bischoff-Jung M, Szentmáry N, Suffo S, El-Husseiny M, Viestenz A, Milioti G. Anatomy-based DMEK Wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach descemet membrane endothelial keratoplasty. Clin Anat 2017; 31:16-27. [DOI: 10.1002/ca.22900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 11/10/2022]
Affiliation(s)
- B. Seitz
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
| | - L. DAAS
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
| | - M. Bischoff-Jung
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
| | - N. Szentmáry
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
| | - S. Suffo
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
| | - M. El-Husseiny
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
| | - A. Viestenz
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
| | - G. Milioti
- Department of Ophthalmology; Saarland University Medical Center UKS; Homburg /Saar Saarland Germany
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