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Hao Y, Zhu B, Wu T, Guo X. Sutureless lamellar keratoplasty with lenticule from small incision lenticule extraction for treating limbal dermoid: A case report. Exp Ther Med 2024; 27:57. [PMID: 38234620 PMCID: PMC10790163 DOI: 10.3892/etm.2023.12345] [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: 11/05/2022] [Accepted: 08/15/2023] [Indexed: 01/19/2024] Open
Abstract
The present study reports the case of a superficial limbal dermoid surgically treated without suture by using a new technique of lamellar keratoplasty with allogenic lenticule from small incision lenticule extraction. The limbal lesion area was circumscribed by a trephine marker and lamellae were peeled off the anterior corneal stroma and sclera. After excision of the dermoid, the liquid on the bed was dried as much as possible and an appropriate stromal lenticule was attached to the implant bed without fibrin glue or suture. A bandage contact lens was applied to fix the graft. During postoperative follow-ups, the anterior segment optical coherence tomography, corneal refractive power, corneal topography and best-corrected visual acuity were examined to evaluate the surgical results. On the first day after the operation, the patient reported tearing and pain at the site. At one week after the operation, the patient reported no discomfort and conjunctival sutures were removed. At one month after the operation, the thickness of the lesion area was similar to that of the adjacent cornea, and the corneal curvature and refractive power of the lesion area were higher than that of the adjacent cornea. At three months after the operation, the patient was satisfied with the cosmetic outcome and no sign of corneal neovascularization, graft rejection or pseudo-pterygium formation was observed. The astigmatic error remained at 2.50 D. The present case provides insights into a potential treatment option for patients who need lamellar keratoplasty and may provide its benefit in contrast to conventional lamellar keratoplasty.
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Affiliation(s)
- Yanjun Hao
- Department of Pediatric Ophthalmology, Tianjin Aier Eye Hospital, Tianjin 300190, P.R. China
| | - Bin Zhu
- Department of Tear Duct Disorders, Shanxi Aier Eye Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Tao Wu
- Department of Tear Duct Disorders, Shanxi Aier Eye Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Xuming Guo
- Department of Ocular Surface and Refraction, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Burcu A, Yalnız-Akkaya Z, Şingar Özdemir E, Özbek-Uzman S. Donor Cornea Use in Scleral Surface Reconstruction. Turk J Ophthalmol 2021; 51:192-198. [PMID: 34461694 PMCID: PMC8411283 DOI: 10.4274/tjo.galenos.2020.27116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 investigate the indications for and results of treating scleral surface problems with donor corneal grafts that are not used in keratoplasty surgery or are left over from keratoplasty. Materials and Methods: The records of 16 patients in whom corneal tissue was used to repair a scleral tissue defect or cover an exposed glaucoma drainage implant were evaluated retrospectively. Partial-thickness grafts were prepared using a combined microkeratome system with artificial anterior chamber in 10 eyes and by manual dissection in 3 eyes. Full-thickness grafts were used in 3 eyes. Results: There were 8 female and 8 male patients aged 5-79 years (mean: 39.37±24.68). Indications for the use of corneal tissue on the scleral surface were limbal dermoid excision (n=2), pterygium surgery (n=1), intraocular lens removal and scleral fixation intraocular lens (SFIOL) implantation (n=1), exposed SFIOL suture coverage (n=1), trauma (n=2), scleral tissue loss due to repeated glaucoma surgeries (n=5), and exposed glaucoma drainage implant (n=4). The patients were followed for 6-42 months (mean: 14.37±9.14). None of the patients had graft infection, thinning, immunological graft rejection, or vision loss during follow-up. Tectonic lamellar grafts did not adversely affect final visual acuity in any case. At final examination, a good combination of graft and recipient tissue, a smooth ocular surface, and a cosmetic appearance were achieved in all eyes. Conclusion: Donor corneas that are not suitable for corneal transplantation or left over from the cornea transplant can be used in patients with scleral tissue loss due to various pathologies and in the treatment of glaucoma drainage implant erosion. In these cases, the use of corneal grafts provides a good ocular surface restoration and cosmetic appearance. The effectiveness and safety of this method should be investigated with large patient series and long follow-up times.
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Affiliation(s)
- Ayşe Burcu
- University of Health Sciences Turkey Ankara Training and Research Hospital, Ankara, Turkey
| | - Züleyha Yalnız-Akkaya
- University of Health Sciences Turkey Ankara Training and Research Hospital, Ankara, Turkey
| | - Evin Şingar Özdemir
- University of Health Sciences Turkey Ankara Training and Research Hospital, Ankara, Turkey
| | - Selma Özbek-Uzman
- University of Health Sciences Turkey Ankara Training and Research Hospital, Ankara, Turkey
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Abstract
PURPOSE To search for novel geometric parameters for corneal limbal dermoids that enable the prediction of clinical and surgical outcomes. METHODS We reviewed the medical records and anterior segment photographs of 85 eyes of 85 patients with corneal limbal dermoids that had been surgically excised. Patients were assigned to the following 4 cohorts (multiple assignments allowed): postoperative visual acuity (cohort 1, n = 65), amblyopia (cohort 2, n = 67), postoperative scar formation (cohort 3, n = 51), and preoperative spontaneous progression of dermoids (cohort 4, n = 39). For geometric profiling, 11 geometric parameters of lesions, including orientation, angular width, and 9 ratio parameters, were preoperatively defined in each patient based on the digital anterior-segment photographs. Each geometric parameter and demographic variable were analyzed for correlation with postoperative outcomes (cohorts 1-3) and preoperative spontaneous dermoid progression (cohort 4). RESULTS The mean patient age at surgery was 6.0 ± 6.3 years. Among the geometric and demographic parameters analyzed, the invaded angular axis of dermoid to corneal diameter ratio had the highest r coefficient (r = 0.728) in cohort 1 and best stratified patients in cohort 2 (cutoff > 0.48) and cohort 3 (cutoff > 0.56). No parameters were correlated with spontaneous dermoid progression in cohort 4. CONCLUSIONS We devised geometric parameters to evaluate corneal limbal dermoids before surgery for the prediction of surgical outcomes. The invaded angular axis of dermoid to corneal diameter ratio value was the most significant factor associated with postoperative visual acuity, amblyopia development, and postoperative scarring.
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Trujillo-de Santiago G, Sharifi R, Yue K, Sani ES, Kashaf SS, Alvarez MM, Leijten J, Khademhosseini A, Dana R, Annabi N. Ocular adhesives: Design, chemistry, crosslinking mechanisms, and applications. Biomaterials 2019; 197:345-367. [PMID: 30690421 PMCID: PMC6687460 DOI: 10.1016/j.biomaterials.2019.01.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/16/2018] [Accepted: 01/05/2019] [Indexed: 12/12/2022]
Abstract
Closure of ocular wounds after an accident or surgery is typically performed by suturing, which is associated with numerous potential complications, including suture breakage, inflammation, secondary neovascularization, erosion to the surface and secondary infection, and astigmatism; for example, more than half of post-corneal transplant infections are due to suture related complications. Tissue adhesives provide promising substitutes for sutures in ophthalmic surgery. Ocular adhesives are not only intended to address the shortcomings of sutures, but also designed to be easy to use, and can potentially minimize post-operative complications. Herein, recent progress in the design, synthesis, and application of ocular adhesives, along with their advantages, limitations, and potential are discussed. This review covers two main classes of ocular adhesives: (1) synthetic adhesives based on cyanoacrylates, polyethylene glycol (PEG), and other synthetic polymers, and (2) adhesives based on naturally derived polymers, such as proteins and polysaccharides. In addition, different technologies to cover and protect ocular wounds such as contact bandage lenses, contact lenses coupled with novel technologies, and decellularized corneas are discussed. Continued advances in this area can help improve both patient satisfaction and clinical outcomes.
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Affiliation(s)
- Grissel Trujillo-de Santiago
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA; Microsystems Technologies Laboratories, MIT, Cambridge, 02139, MA, USA; Centro de Biotecnología-FEMSA, Tecnológico de Monterrey, Monterrey, NL 64849, Mexico
| | - Roholah Sharifi
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA
| | - Kan Yue
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA
| | - Ehsan Shrizaei Sani
- Chemical and Biomolecular Engineering Department, University of California - Los Angeles, Los Angeles, CA 90095, USA
| | - Sara Saheb Kashaf
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA
| | - Mario Moisés Alvarez
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA; Microsystems Technologies Laboratories, MIT, Cambridge, 02139, MA, USA; Centro de Biotecnología-FEMSA, Tecnológico de Monterrey, Monterrey, NL 64849, Mexico
| | - Jeroen Leijten
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA; Department of Developmental BioEngineering, Faculty of Science and Technology, Technical Medicine, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Ali Khademhosseini
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA; Chemical and Biomolecular Engineering Department, University of California - Los Angeles, Los Angeles, CA 90095, USA; Department of Bioengineering, University of California - Los Angeles, Los Angeles, CA 90095, USA; Center for Minimally Invasive Therapeutics (C-MIT), California NanoSystems Institute (CNSI), University of California - Los Angeles, Los Angeles, CA 90095, USA; Department of Radiology, David Geffen School of Medicine, University of California - Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Reza Dana
- Massachusetts Eye and Ear Infirmary and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | - Nasim Annabi
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02139, MA, USA; Chemical and Biomolecular Engineering Department, University of California - Los Angeles, Los Angeles, CA 90095, USA; Center for Minimally Invasive Therapeutics (C-MIT), California NanoSystems Institute (CNSI), University of California - Los Angeles, Los Angeles, CA 90095, USA.
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