1,721,122 research outputs found
Microkeratome-assisted superficial anterior lamellar keratoplasty
No full textMicrokeratome-assisted superficial anterior lamellar keratoplasty (SALK) is a type of lamellar keratoplasty designed to eliminate superficial corneal opacities (ie, haze postexcimer laser treatment, postinfectious superficial scars of any origin, corneal dystrophies and degenerations with superficial opacities, etc.) while minimizing postoperative refractive error, as well as the time necessary for visual rehabilitation.The procedure includes the following: (1) microkeratome-assisted removal of a superficial lamella from the recipient cornea ("free cap" 160 Î1⁄4m thick and 9.0 mm large); (2) microkeratome-assisted preparation of a donor lamella of the same thickness and diameter from a donor cornea mounted on an artificial anterior chamber; and (3) fixation of the donor graft onto the recipient bed by means of overlay sutures. Alternatively, instead of overlay sutures, in most cases a simple bandage contact lens can be successfully used to keep the graft in place. Sutures or contact lenses may be removed few days after surgery (healing is similar to that experienced by patients after laser in situ keratomileusis), and final refraction is possible within 1 month from surgery.SALK shares the same advantages of other types of lamellar keratoplasty: It is an extraocular procedure, preserves the host endothelium, and therefore postoperative steroidal treatment can be minimized, thus avoiding possible side effects (eg, development of glaucoma and/or cataract). However, several other advantages are unique to SALK: The technique is simple, easy to perform (the learning curve is comparable to that of laser in situ keratomileusis), and can be standardized. Most of all, the time necessary for visual rehabilitation after SALK is much shorter than that usually needed when thicker grafts are transplanted. © 2006 Lippincott Williams & Wilkins, Inc
A New Lamellar Wound Configuration for Penetrating Keratoplasty Surgery
No full textA modified penetrating keratoplasty procedure with a new lamellar configuration of the surgical wound was performed on 8 eyes with endothelial decompensation. This technique allows complete suture removal by 3 months postoperatively, substantially shortening the time necessary for visual rehabilitation. Refractive astigmatism before and after suture removal was minimized to 4 diopters or less in all of the eyes in our preliminary series. Because the anterior surface of the donor button is smaller than the posterior one (diameter, 7.0 mm and 9.0 mm, respectively), more endothelial cells can be transplanted while maintaining the anterior graft surface at a safe distance from the corneoscleral limbus. Finally, no expensive instrumentation is required for this procedure except for an artificial anterior chamber if whole globes are not available. The surgical technique and clinical results are presented in this article
Long-term Results of Sutureless Phacoemulsification With Implantation of a 7-mm Polymethyl Methacrylate Intraocular Lens-Reply
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A prospective study comparing endoglide and busin glide insertion techniques in descemet stripping endothelial keratoplasty
No full text[No abstract available
Quadruple procedure for visual rehabilitation of endothelial decompensation following phakic intraocular lens implantation
No full textPURPOSE: To evaluate the clinical outcomes of combined phakic intraocular lens (phakic IOL) explantation, phacoemulsification, posterior chamber intraocular lens (PCIOL) implantation, and Descemet stripping automated endothelial keratoplasty (DSAEK) performed for phakic IOL-related endothelial decompensation.DESIGN: Retrospective, interventional case series.METHODS: SETTING: Private hospital. study POPULATION: Ten eyes of 7 patients who developed endothelial decompensation after phakic IOL implantation and were treated with a combined procedure of phakic IOL explantation, phacoemulsification, PCIOL implantation, and DSAEK. MAIN OUTCOME MEASURES: Best spectacle-corrected visual acuity (BSCVA), manifest refractive error, endothelial cell count, and intraoperative and postoperative complications.RESULTS: Mean postoperative follow-up was 25.2 ± 28.6 months (range 3-84 months). BSCVA at last visit was 7/10 or better in 6 eyes, 4/10 in 1 eye, and 2/10 or worse in 3 eyes, of which all had myopic maculopathy or deep amblyopia. Mean postoperative spherical equivalent was -3.4 ± 1.2 diopters. Mean endothelial cell loss in comparison to preoperative donor endothelial cell density was 21.3% ± 7.7%. Minor PCIOL decentration was seen in 1 patient, and IOL exchange was required in another patient owing to high postoperative refractive error. One graft rejection leading to graft failure was seen and was excluded from endothelial cell loss calculation. Conclusion An operation combining phakic IOL removal, DSAEK, cataract removal, and PCIOL implantation can offer fast visual rehabilitation with good visual results and graft survival
Sustained Gentamicin Release by Presoaked Medicated Bandage Contact Lenses
No full textCurrent therapeutic regimens for external ocular infections require instillation of antibiotics up to every quarter of an hour in concentrations higher than those commercially available. As an alternative to topically applied gentamicin eye drops, the possibility of sustained gentamicin release by bandage contact lenses was investigated. Ten hydrogel bandage contact lenses (61.4% HEMA and 38.6% water content) were soaked overnight in a 0.5% solution of sterile, unpreserved, commercially available gentamicin, and fitted thereafter on ten eyes of healthy adult volunteers. Gentamicin concentrations in the tear film were determined 10, 30, and 60 minutes, and 4, 8, 24, 48, 72, and 96 hours after fitting, using agar diffusion bioassay. Bactericidal concentrations (>1.6 μg/ml) were found up to 3 days after contact lens fitting in all subjects. No toxic topical or systemic effects were seen. © 1988, American Academy of Ophthalmology, Inc. All rights reserved
Does thickness matter: Ultrathin Descemet stripping automated endothelial keratoplasty
No full textPURPOSE OF REVIEW: Descemet stripping automated endothelial keratoplasty (DSAEK) has become worldwide the procedure of choice for the replacement of diseased corneal endothelium. More recently, ultrathin DSAEK (UT-DSAEK) has been introduced to guarantee better visual outcomes preserving good donor graft manipulation. RECENT FINDINGS: As DSAEK may still have major challenges such as suboptimal visual acuity and relatively slow visual rehabilitation, fairly new techniques such as UT-DSAEK and Descemet membrane endothelial keratoplasty (DMEK) have been introduced to allow much quicker and optimal visual rehabilitation. This article goes through the most recent findings and results of these techniques. SUMMARY: UT-DSAEK is a procedure that shares the improved visual outcome and lower immunologic rejection rate of DMEK over DSAEK, while minimizing all types of postoperative complications. In addition, similar to DSAEK and unlike DMEK, UT-DSAEK can be performed in all types of eyes, even in those with complicated anatomy or poor anterior chamber visualization. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reply [Re: Busin et al.: The ongoing debate: Descemet membrane endothelial keratoplasty versus ultrathin Descemet stripping automated endothelial keratoplasty (Ophthalmology. 2020;127:1160e1161)]
No full texthen the intended graft thickness is <100 μm, as in ultrathin DSAEK, there is a greater probability of obtaining a regular and symmetric graft, thus resulting in better vision.3 Although highly functional vision can still be achieved in a large number of cases, raising the bar for DSAEK must also involve standardized graft preparation that yields consistent graft qualit
The Ongoing Debate: Descemet Membrane Endothelial Keratoplasty Versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty
No full textCurrently, the ability to perform DMEK is widely perceived as the hallmark of superior technical prowess in the field of corneal surgery, thereby unduly driving many novice surgeons to solely perform DMEK. Beyond the analysis of empirical evidence from published data, surgical decision-making must be informed by pragmatic and pru- dent determination of the right procedure for the right patient by the right surgeon. Ultimately, both DMEK and ultrathin DSAEK represent valuable tools in the surgical armamentarium of any corneal specialist
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