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Liu Y, He Y, Deng Y, Wang L. Lenticule addition keratoplasty for the treatment of keratoconus: A systematic review and critical considerations. Indian J Ophthalmol 2024; 72:S167-S175. [PMID: 38271413 DOI: 10.4103/ijo.ijo_695_23] [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: 03/11/2023] [Accepted: 09/09/2023] [Indexed: 01/27/2024] Open
Abstract
Keratoconus is a corneal disorder characterized by the progressive thinning and bulging of the cornea. Currently, the major goal of management is to halt its progression, restore normal corneal strength, prevent acute complications, and save vision. Penetrating keratoplasty and deep anterior lamellar keratoplasty as conventional surgical methods for advanced keratoconus are limited by relatively high rates of immune intolerance, slow post-operational recovery, high costs, and shortage of donor corneas. Recently, the development of lenticule addition keratoplasty enables the restoration of corneal thickness simply by implanting a lenticule into the stromal pocket created with the femtosecond laser, which can originate from cadaver corneas or more appealing, be extracted from patients via a small-incision lenticule extraction (SMILE) surgery. As the first systematic review in this field, we critically review publications on lenticule addition keratoplasty and provide our perspectives on its clinical application and the focus of future research.
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Affiliation(s)
- Yanling Liu
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yan He
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Mohr KM, Gyldenkerne AN, Hjortdal JØ. Impact of Small Incision Lenticule Extraction for High Myopia on Intraocular Pressure Measurements With Pneumotonometry. J Refract Surg 2023; 39:606-611. [PMID: 37675911 DOI: 10.3928/1081597x-20230728-01] [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: 09/08/2023]
Abstract
PURPOSE To evaluate the medium-term impact of small incision lenticule extraction (SMILE) on air-puff tonometry (APT) and how it may be corrected. METHODS In this controlled prospective study, 69 eyes from 69 patients treated with SMILE for high myopia (mean: -7.22 diopters) were included. Central corneal thickness (CCT), spherical equivalent refraction (SEQ), corneal power, and intraocular pressure (IOP) (assessed by APT) were measured before and 3 months after surgery. RESULTS The measured IOP decreased significantly after SMILE surgery (mean: -6.43 mm Hg), indicating a significant underestimation of the true IOP by APT. There was a significant correlation between change in SEQ, CCT, and apparent IOP. Correcting the apparent IOP measurement by applying a multiple regression correction did not provide significantly better estimates compared to adding 6.4 mm Hg to the measurement. CONCLUSIONS This study showed that previous SMILE surgery should be considered when interpreting APT measurements, because the measurements underestimate the true IOP. Multiple regressions cannot estimate the true IOP with certainty. For screening purposes, adding 6.4 mm Hg to the apparent IOP of a patient treated for high myopia may be sufficient. [J Refract Surg. 2023;39(9):606-611.].
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Gui Y, Wang S, He Y, Zhang S, Zhang Y. Progress of corneal morphological examination combined with biomechanical examination in preoperative screening for keratorefractive surgery. Indian J Ophthalmol 2023; 71:2369-2378. [PMID: 37322646 PMCID: PMC10417961 DOI: 10.4103/ijo.ijo_1377_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/26/2022] [Accepted: 03/28/2023] [Indexed: 06/17/2023] Open
Abstract
Although corneal refractive surgery has been proven to be excellent in terms of safety and effectiveness, the reduction of postoperative corneal ectasia remains one of the most concerned topics for surgeons. Forme fruste keratoconus (FFKC) is the most important factor that leads to postoperative corneal ectasia, and common preoperative screenings of the condition include corneal morphology examination and corneal biomechanical examination. However, there are limitations to the single morphological examination or biomechanical examination, and the advantages of the combination of the two have been gradually emerging. The combined examination is more accurate in the diagnosis of FFKC and can provide a basis for determining suspected keratoconus. It allows one to measure the true intraocular pressure (IOP) before and after surgery and is recommended for older patients and those with allergic conjunctivitis. This article aims to discuss the application, advantages, and disadvantages of single examination and combined examination in the preoperative screening of refractive surgery, so as to provide a certain reference value for choosing suitable patients for surgery, improving surgical safety, and reducing the risk of postoperative ectasia.
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Affiliation(s)
- Yujia Gui
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Shurong Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Yuxi He
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Shuangqing Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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Iglesias M, Kudsieh B, Laiseca A, Santos C, Nadal J, Barraquer R, Casaroli-Marano RP. Intraocular pressure after myopic laser refractive surgery measured with a new Goldmann convex prism: correlations with GAT and ORA. BMC Ophthalmol 2022; 22:79. [PMID: 35168601 PMCID: PMC8849021 DOI: 10.1186/s12886-022-02309-x] [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: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study is to describe measurements using a newly developed modified Goldmann convex tonometer (CT) 1 year after myopic laser refractive surgery. Intraocular pressure (IOP) measurements were compared with IOP values obtained by Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA). Methods Prospective double-masked study performed on thirty eyes of thirty patients that underwent laser in situ keratomileusis (LASIK; n = 19) or photorefractive keratectomy (PRK; n = 11). IOP was measured before and 3 and 12 months after surgery. Intraclass correlation coefficient (ICC) and Bland-Altman plot were calculated to assess the agreement between GAT, CT, IOPg (Goldmann-correlated IOP) and IOPcc (corneal-compensated IOP) from ORA. Results Twelve months after LASIK, IOP measured with CT showed the best correlation with IOP measured with GAT before surgery (GATpre) (ICC = 0.886, 95% CI: 0.703–0.956) (15.60 ± 3.27 vs 15.80 ± 3.22; p < 0.000). However, a moderate correlation was found for IOP measured with IOPcc and CT 12 months after LASIK (ICC = 0.568, 95% CI: − 0.185 – 0.843) (15.80 ± 3.22 vs 12.87 ± 2.77; p < 0.004). Twelve months after PRK, CT showed a weak correlation (ICC = − 0.266, 95% CI: − 3.896 – 0.663), compared to GATpre (17.30 ± 3.47 vs 16.01 ± 1.45; p < 0.642), as well as poor correlation (ICC = 0.256, 95% CI: − 0.332 – 0.719) with IOPcc (17.30 ± 3.47 vs 13.38 ± 1.65; p < 0.182). Conclusions Twelve months after LASIK, IOP measured with CT strongly correlated with GAT before surgery and could therefore provide an alternative method for measuring IOP after this surgery. More studies regarding this new convex prism are needed to assess its accuracy.
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Affiliation(s)
- María Iglesias
- Instituto Universitario Barraquer, Barraquer Ophthalmology Centre, Laforja 88, 08012, Barcelona, Spain.
| | - Bachar Kudsieh
- Department of Ophthalmology, Hospital Universitario Puerta De Hierro, 28222, Madrid, Spain
| | - Andrea Laiseca
- Instituto Universitario Barraquer, Barraquer Ophthalmology Centre, Laforja 88, 08012, Barcelona, Spain
| | - Cristina Santos
- Unitat Antropologia Biològica, Department Biologia Animal, Biologia Vegetal i Ecologia, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
| | - Jeroni Nadal
- Instituto Universitario Barraquer, Barraquer Ophthalmology Centre, Laforja 88, 08012, Barcelona, Spain
| | - Rafael Barraquer
- Instituto Universitario Barraquer, Barraquer Ophthalmology Centre, Laforja 88, 08012, Barcelona, Spain.,International University of Catalunya (UIC), 08017, Barcelona, Spain
| | - Ricardo P Casaroli-Marano
- Department of Surgery, School of Medicine and Hospital Clinic de Barcelona, University of Barcelona (UB), 08036, Barcelona, Spain
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Tian L, Zhang D, Guo L, Qin X, Zhang H, Zhang H, Jie Y, Li L. Comparisons of corneal biomechanical and tomographic parameters among thin normal cornea, forme fruste keratoconus, and mild keratoconus. EYE AND VISION 2021; 8:44. [PMID: 34784958 PMCID: PMC8596950 DOI: 10.1186/s40662-021-00266-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/23/2021] [Indexed: 12/27/2022]
Abstract
Background To compare the dynamic corneal response (DCR) and tomographic parameters of thin normal cornea (TNC) with thinnest corneal thickness (TCT) (≤ 500 µm), forme fruste keratoconus (FFKC) and mild keratoconus (MKC) had their central corneal thickness (CCT) matched by Scheimpflug imaging (Pentacam) and corneal visualization Scheimpflug technology (Corvis ST). Methods CCT were matched in 50 eyes with FFKC, 50 eyes with MKC, and 53 TNC eyes with TCT ≤ 500 µm. The differences in DCR and tomographic parameters among the three groups were compared. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic significance of these parameters. Back propagation (BP) neural network was used to establish the keratoconus diagnosis model. Results Fifty CCT-matched FFKC eyes, 50 MKC eyes and 50 TNC eyes were included. The age and biomechanically corrected intraocular pressure (bIOP) did not differ significantly among the three groups (all P > 0.05). The index of height asymmetry (IHA) and height decentration (IHD) differed significantly among the three groups (all P < 0.05). IHD also had sufficient strength (area under the ROC curves (AUC) > 0.80) to differentiate FFKC and MKC from TNC eyes. Partial DCR parameters showed significant differences between the MKC and TNC groups, and the deflection amplitude of the first applanation (A1DA) showed a good potential to differentiate (AUC > 0.70) FFKC and MKC from TNC eyes. Diagnosis model by BP neural network showed an accurate diagnostic efficiency of about 91%. Conclusions The majority of the tomographic and DCR parameters differed among the three groups. The IHD and partial DCR parameters assessed by Corvis ST distinguished FFKC and MKC from TNC when controlled for CCT.
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Affiliation(s)
- Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing Tongren Hospital, Beijing, 100730, China
| | - Di Zhang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.,School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Lili Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xiao Qin
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.,School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Hui Zhang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.,School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Haixia Zhang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.,School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Lin Li
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China. .,School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.
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Chow SC, Yeung BYM. A Review on Different Tonometers for Intraocular Pressure Measurement After Photorefractive Keratectomy or Small Incision Lenticule Extraction. Clin Ophthalmol 2020; 14:3305-3323. [PMID: 33116382 PMCID: PMC7569048 DOI: 10.2147/opth.s278167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023] Open
Abstract
This paper aims to review different tonometers for intraocular pressure measurement in eyes after photorefractive keratectomy or small incision lenticule extraction. An Entrez Pubmed search was performed on July 19th, 2020. There were 32 eligible articles investigated in the use of tonometers or biomechanical properties of cornea in post photorefractive keratectomy eyes and 11 articles investigated in post small incision lenticule extraction eyes. Corvis ST and dynamic contour tonometry were found to be accurate for intraocular pressure measurement in post photorefractive keratectomy eyes. For post small incision lenticule extraction eyes, Corvis ST was found to be more accurate than other tonometers. Other tonometers such as Goldmann applanation tonometer, noncontact tonometry, Tonopen, ocular response analyzer can also be used in post photorefractive keratectomy or small incision lenticule extraction eyes in clinical practice; however, it is important for ophthalmologists to take note of the chances of discrepancies.
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