14,699 research outputs found
Endothelial keratoplasty combined with scleral fixation intraocular lens
No full textdescribe, for the first time, the surgical management of two aphakic patients with corneal decompensation treated with concomitant ultrathin-Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and implantation of two different scleral-fixated (SF) intraocular lenses (IOLs), namely sutureless SF (SSF) Carlevale IOL (Soleko, Italy; Figure 1) or Morcher Type 90L IOL (Morcher GmbH, Germany; Figure 2). Both IOLs are hydrophilic acrylic. The Carlevale IOL is 13.2 mm long with a 6.5 mm optic plate, foldable and injectable through a 2.2 mm corneal tunnel. A T-shaped harpoon protrudes off the closed haptics and is designed to be externalized underneath a partial thickness scleral flap (Figure 1). The Morcher Type 90L IOL is 15 mm long with a 6.5 mm optic plate. The two C-loop haptics have an eyelet for the passage of the sutures for the scleral fixatio
Eye Banking: One Cornea for Multiple Recipients
No full textPurpose: Corneal transplantation is the most frequently performed transplant procedure. In much of the world, the demand for donor tissue heavily outstrips supply. With developments within lamellar corneal graft surgery, the use of split corneal donor tissue to increase donor tissue supply seems a pragmatic solution to reduce the supply and demand mismatch. This is especially important with tissue supply expected to be affected by the COVID-19 pandemic. Methods: A literature review of techniques was performed, enabling multiple transplants to be derived from a single donor and simulation of a model to quantify the number of corneas potentially saved. Results: Studies on splitting corneal donor tissue have demonstrated that up to 5 recipients may benefit from 1 donor scleral button. The impact of splitting donor tissue may provide a saving of up to 25.3% of donor graft tissue. Conclusions: Splitting and preparing the donor tissue within an eye bank will improve tissue validation and donor tissue availability and may increase surgeon efficiency
Free-floating DMEK in the host anterior chamber: Surgical management
No full textPurpose: To describe a method to visualize and manage a completely detached Descemet membrane endothelial keratoplasty (DMEK) tissue scroll in the anterior chamber. Methods: A 56-year-old male patient with pseudophakic bullous keratopathy, who underwent uncomplicated DMEK surgery, had a complete graft detachment diagnosed at 1-week follow-up. The graft was reattached using a new technique, that is, the free-floating graft was stained in the anterior chamber with trypan blue, immediately followed by air injection to separate the host stroma from the dye. The stained DMEK graft was opened by gentle tapping and attached to the host stroma by air tamponade. Result: This technique allowed sufficient staining of DMEK tissue to further evaluate and correct the graft orientation inside the anterior chamber without compromising the stroma. The DMEK graft was attached 1 week after the reattachment procedure. The cornea cleared confirming the functionality of the endothelial cells. Conclusions: The technique described may be useful in the cases of complete detachment of DMEK tissue and poor visualization of the DMEK tissue orientation. Staining with trypan blue under a “protective” air bubble can provide sufficient visualization to ensure the unfolding of DMEK tissue and reduce the risk of host stromal staining
Impact of COVID-19 on keratoconus patients waiting for corneal cross linking
No full textpurpose: royal college of ophthalmologist recent guidance recommended delaying cross-linking services during the COVID-19 pandemic. this study investigates the effects of such delays in the delivery of cross-linking services in patients with keratoconus progression. methods: retrospective observational study of 46 patients with keratoconus progression, whose cross-linking was delayed due to the COVID-19 pandemic. demographic and clinical details were obtained from assessments on the day of listing, and subsequent review on the day of the procedure. topographic indices included keratometry of the posterior and anterior corneal surface, maximum keratometry (K-max), thinnest corneal thickness, ABCD progression and progression based on standard criteria recommendations (1.5 D K-max & 20 microns thinning). results: a total of 46 eyes were analysed with an average time between being listed for CXL and having the procedure done was 182 +/- 65 days. the delay due to COVID-19 was of 3 months. In this time period they had a significant worsening of all keratometric indices and lost almost one line of visual acuity (0.19 +/- 0.19 to 0.26 +/- 0.18 LogMAR, p: 0.03). thirty two eyes (70%) demonstrated progression in accordance with the ABCD progression criteria, while 18 eyes (39%) showed either an increase in K-max of more than 1.5D or a thinning in corneal thickness of at least 20 mu m. conclusions: the treatment delay for the keratoconus patients caused further progression and vision worsening. we recommend that corneal collagen crosslinking needs to be considered as a high priority intervention
Thinning rate over 24 months in ultrathin DSAEK
No full textAim: To describe the changes in corneal graft thickness following ultrathin Descemet’s Stripping Automated Endothelial Keratoplasty (UT-DSAEK) comparing pre- and postoperative values over a 24-month period. Methods: In this retrospective single-center case series, patients who received eye bank-prepared tissues for UT-DSAEK surgery were included. Preoperative and postoperative graft thickness measurements were determined in the eye bank and in clinic using anterior segment optical coherence tomography (AS-OCT) images. Graft thickness measurements and their percentage change between preoperative values and values at 1 day, 1 week and 1, 6, 12, 24 months were calculated. Results: In total, 47 eyes of 47 patients with a mean age of 69 ± 11 years (29 males) were included. Twnty-three patients had Fuchs’ endothelial dystrophy (49%) and the remaining 24 had pseudophakic bullous keratopathy (51%). In total, 29/47 eyes underwent UT-DSAEK alone (62%) and 18/47 received combined cataract surgery as a triple procedure (38%). Preoperative donor graft thickness was 92 ± 28 μm. Compared to preoperative values, where graft thickness increased to 194 ± 101.3 μm at 1 day, 151.1 ± 71.4 μm at 1 week, and 108.4 ± 52.5 μm at 1 month. Graft thickness continued to gradually decrease over time until 6 months (91.7 ± 33.6 μm), and then plateaued at 12 months (83.9 ± 25.0 μm), showing minimal changes at 2 years (101.4 ± 37.5 μm). Conclusion: Preoperative DSAEK graft thickness measurements as reported by the eye bank are a valid approximation of DSAEK graft thickness at 6 months after surgery and these measurements tend to stabilize over time up to 2 years after surgery
Changes in pupillometry associated with dissipated energy during phacoemulsification
No full textpurpose: to investigate the effect of ultrasound level during phacoemulsification on pupil dynamics. methods: comparative retrospective study on patients who underwent routine cataract surgery at the royal liverpool university hospital. clinical parameters, anterior chamber measurements, axial length, surgeon grade, time of surgery, level of ultrasound used (cumulative dissipated energy, CDE), intra- and post-operative complications were collected. pupil diameters were collected before and 4 +/- 1 weeks after surgery in static scotopic, mesopic, photopic pupil conditions. also, pupil dynamic measurements after luminous stimulus were recorded. changes in static pupil diameters, relative dilation at 3.5 s after luminous stimulus, and time to reach 75% and 95% of maximum dilation were measured. results: forty-eight eyes of 24 patients (13 males) were included with a mean age of 73.1 +/- 14.6 years. mean CDE value was 18.11 +/- 10.56. mean scotopic pupil diameters decreased by 0.24 +/- 0.48 mm (p = 0.021) in the operated eye. significant correlation was found between reduction in scotopic pupil diameter and CDE (p = 0.05). a generalized linear model confirmed that the level of CDE was significantly associated with reduction in scotopic pupil diameter (p = 0.026). patients who underwent surgeries with lower CDE (0 < CDE <= 10 and 10 < CDE <= 20) did not experience significant changes in scotopic pupil diameter after surgery (p = 0.28 and p = 0.79, respectively) as opposed to those with higher CDE (CDE > 20; p = 0.03). conclusion: phacoemulsification cataract surgery and the cumulative dissipated energy may be associated with changes in pupil behaviour
Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK
No full textObjective: To compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK). Methods and analysis: Comparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures. Results: 56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01. Conclusion: Pl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern
Una interpretación de a-ka-na-jo ( a3-ka-na-jo)
No full textThe author studies the word a-ka-na-jo in the PY Cn 328 tablet and taking into account some factors she proposes αγναιος as the reading of this word.The author studies the word a-ka-na-jo in the PY Cn 328 tablet and taking into account some factors she proposes αγναιος as the reading of this word
Femtosecond Laser–Assisted Deep Anterior Lamellar Keratoplasty for Keratoconus: Multi-surgeon Results
No full textPurpose: To compare the clinical outcomes in femtosecond laser–assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting. Design: Single-center, comparative, retrospective interventional case series. Methods: POPULATION: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016. SETTING: Moorfields Eye Hospital, London. OBSERVATIONS: Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MAIN OUTCOME MEASURES: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40. Results: We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P =. 825). Conclusion: Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting
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