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Nuzzi R, Burato C, Tridico F, Nuzzi A, Caselgrandi P. Advantages of Double Running Sutures in Astigmatism After Penetrating Keratoplasty. Clin Ophthalmol 2022; 16:797-802. [PMID: 35321045 PMCID: PMC8934865 DOI: 10.2147/opth.s355538] [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: 01/03/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy
- Correspondence: Raffaele Nuzzi, Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy, Email
| | - Claudio Burato
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Federico Tridico
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessia Nuzzi
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, University of Milan, Milan, Italy
| | - Paolo Caselgrandi
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy
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Deshmukh R, Nair S, Vaddavalli PK, Agrawal T, Rapuano CJ, Beltz J, Vajpayee RB. Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 2021; 67:1200-1228. [PMID: 34808143 DOI: 10.1016/j.survophthal.2021.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.
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Affiliation(s)
| | - Sridevi Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Tushar Agrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
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Comparison of Long-Term Outcomes of Femtosecond Laser-Assisted Keratoplasty with Conventional Keratoplasty. Cornea 2016; 35:293-8. [DOI: 10.1097/ico.0000000000000739] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Birnbaum F, Wiggermann A, Maier PC, Böhringer D, Reinhard T. Clinical results of 123 femtosecond laser-assisted penetrating keratoplasties. Graefes Arch Clin Exp Ophthalmol 2012; 251:95-103. [PMID: 22573413 DOI: 10.1007/s00417-012-2054-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 04/01/2012] [Accepted: 04/23/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Postoperative astigmatism following penetrating keratoplasty is a major problem after corneal transplantation. The main goal of new trephination techniques such as femtosecond laser or excimer-laser trephination is to improve refractive and visual outcomes. The femtosecond laser technique makes profiled corneal trephinations such as the top hat or mushroom profile possible. We present the postoperative outcome of femtosecond laser-assisted penetrating keratoplasties. METHODS We performed 123 femtosecond laser-assisted penetrating keratoplasties in 119 patients. The main outcome measures were intraoperative specifics, astigmatism, and irregularity in Orbscan corneal topography, as well as the occurrence of immune reactions and side-effects. RESULTS All sutures have been removed in 49 of these 123 eyes. Their mean follow-up was 13.9 ± 4.5 months. Time to complete suture removal (n = 49) was 12.0 ± 3.7 months in the mushroom group and 9.8 ± 2.1 months in the top hat group. Mean astigmatism in Orbscan topography was 6.4 ± 3.0 diopters in the mushroom and 5.8 ± 4.6 diopters in the top hat group (all sutures out). CONCLUSIONS Femtosecond laser-assisted penetrating keratoplasty is a safe surgical technique. Due to the steps in profiled trephinations, the wound area is larger and theoretically the wound healing is, thus, faster and more stable. Complete suture removal is possible at an earlier time point compared to conventional penetrating keratoplasty. However, refractive results are not superior to those following conventional trephination.
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Affiliation(s)
- Florian Birnbaum
- Eye Hospital, Klinikum Bremen-Mitte gGmbH, St.-Jürgenstr. 1, 28177 Bremen, Germany.
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The intrastromal corneal ring in penetrating keratoplasty-long-term results of a prospective randomized study. Cornea 2011; 30:780-3. [PMID: 21436688 DOI: 10.1097/ico.0b013e318206caa9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Postoperative astigmatism after penetrating keratoplasty is a major problem in corneal transplantation. The purpose of this prospective randomized study was to evaluate the efficacy and safety of an intrastromal corneal ring after penetrating keratoplasty. METHODS Twenty patients were included, 10 of whom received an intracorneal ring (group 1) and 10 who did not (group 2, control group). Astigmatism in Orbscan corneal topography, occurrence of immune reactions, and occurrence of side effects were this study's main outcome criteria. RESULTS Mean follow-up time was 27.6 ± 5.3 months. Mean astigmatism (Orbscan) was 4.4 diopters in group 1 and 4.4 diopters in group 2 (P = 0.695). Spontaneous suture rupture occurred in 5 patients with corneal ring but in none of those in the control group. We observed 3 immune reactions in 3 patients with corneal ring, whereas group 2 experienced no rejection (P < 0.05). Endothelial cell loss was 15.1% in the group with the ring and 8.7% in the control group. That difference was not statistically significant (P = 0.146). CONCLUSIONS The use of the intrastromal corneal ring after penetrating keratoplasty caused no reduction in postoperative astigmatism. However, its use was statistically significantly associated with adverse events.
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Birnbaum F, Maier P, Reinhard T. Perspektiven der Femtosekundenlaser-assistierten Keratoplastik. Ophthalmologe 2011; 108:807-16. [PMID: 21909868 DOI: 10.1007/s00347-011-2334-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Acar BT, Vural ET, Acar S. Does the type of suturing technique used affect astigmatism after deep anterior lamellar keratoplasty in keratoconus patients? Clin Ophthalmol 2011; 5:425-8. [PMID: 21499568 PMCID: PMC3076118 DOI: 10.2147/opth.s18889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the effect of three different suturing techniques on astigmatism after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. METHODS In this retrospective study, 54 eyes of 54 patients with advanced keratoconus underwent DALK with three suturing techniques: single running, interrupted running, and combined interrupted and running. Postkeratoplasty astigmatism was evaluated during examinations 1, 3, and 6 months postoperatively and 2 months after completing suture removal. RESULTS Twenty-four eyes had single running sutures, 16 eyes had interrupted sutures, and in 14 eyes the suturing technique used was combined interrupted and running sutures. Mean age was 25.6 ± 5.9 years, 27.3 ± 6.8 years, and 26.5 ± 5.7 years (P = 0.422), and postoperative astigmatism 1 month after surgery was 3.79 ± 1.19 D, 5.56 ± 1.78 D, and 4.21 ± 1.55 D in the three groups, respectively (P = 0.012). However, 2 months after completing the suture removal, final postoperative astigmatism was 3.43 ± 1.44 D, 3.87 ± 1.38 D, and 3.71 ± 1.46 D (P = 0.846). Final astigmatism less than 4 D was seen in 18 cases (75%) in the single running group, nine cases (56.2%) in the interrupted running group, and nine cases (64.2%) in the combined interrupted and running group (P = 0.08). CONCLUSION Postkeratoplasty astigmatism is comparable with three different suturing techniques used in patients with keratoconus after completing suture removal in DALK. Due to earlier suture removal in DALK, the type of suturing technique used is not considerably important.
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Affiliation(s)
- Banu Torun Acar
- Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey
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Song HB, Choi HJ, Kim MK, Wee WR. The Short-Term Effect of Limbal Relaxing Incision and Compression Suture on Post-Penetrating Keratoplasty Astigmatism. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.10.1142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Beom Song
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Wong Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Naydis I, Klemm M, Hassenstein A, Richard G, Katz T, Linke S. Astigmatismus nach perforierender Keratoplastik. Ophthalmologe 2010; 108:252-9. [DOI: 10.1007/s00347-010-2272-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim SJ, Wee WR, Lee JH, Kim MK. The effect of different suturing techniques on astigmatism after penetrating keratoplasty. J Korean Med Sci 2008; 23:1015-9. [PMID: 19119446 PMCID: PMC2610637 DOI: 10.3346/jkms.2008.23.6.1015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 02/22/2008] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to compare the effects on astigmatism after penetrating keratoplasty with three different suture techniques. In this prospective study, 38 eyes of 38 patients underwent penetrating keratoplasty with three suturing techniques: interrupted, single running, and double running. Topographic astigmatism was measured at 2, 6, 12, and 18 months after keratoplasty. During 18 months after surgery, the interrupted suture group had higher astigmatism than the double running suture group. There was no significant difference in the amounts of astigmatism during the first year after keratoplasty between the single running and the double running suture group. However, at 18 months after surgery, when all sutures were out, the double running suture group (3.60+/-1.58 diopters) showed significantly less astigmatism than the single running group (5.65+/-1.61 diopters). In conclusion, post-keratoplasty astigmatism was the least in the double running suture group of the three suturing techniques at 18 months after penetrating keratoplasty.
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Affiliation(s)
- Sang Jin Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Jin Hak Lee
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Birnbaum F, Schwartzkopff J, Böhringer D, Reinhard T. [Penetrating keratoplasty with intrastromal corneal ring. A prospective randomized study]. Ophthalmologe 2008; 105:452-6. [PMID: 17899113 DOI: 10.1007/s00347-007-1623-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the efficacy and safety of Krumeichs' intrastromal corneal ring following penetrating keratoplasty. Postoperative astigmatism and occurrence of complications were the main criteria of this study. MATERIAL AND METHODS A total of 20 patients were included in this prospectively randomized study (10 patients with and 10 patients without corneal ring). Follow-up examinations were performed 6 weeks, 4, 12, and 18 months postoperatively, including best corrected visual acuity and Orbscan corneal topography. RESULTS The mean follow-up time is currently 18.9+/-2.8 months. The mean astigmatism (Orbscan) is 3.9 D in the group with ring and 4.0 D in the group without a ring. Spontaneous suture rupture occurred in five patients with corneal ring. CONCLUSIONS The use of the intrastromal corneal ring following penetrating keratoplasty caused no reduction of postoperative astigmatism. The reason for the spontaneous suture ruptures is unclear.
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Affiliation(s)
- F Birnbaum
- Universitäts-Augenklinik Freiburg, Killianstrasse 5, 79106 Freiburg.
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Bartels MC, van Rooij J, Geerards AJM, Mulder PGH, Remeijer L. Comparison of complication rates and postoperative astigmatism between nylon and mersilene sutures for corneal transplants in patients with Fuchs endothelial dystrophy. Cornea 2006; 25:533-9. [PMID: 16783141 DOI: 10.1097/01.ico.0000214218.60249.e5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to evaluate corneal astigmatism and suture-related complications for transplants sutured with nylon and transplants sutured with Mersilene in primary corneal transplants for Fuchs endothelial dystrophy. METHODS A retrospective, observational, and comparative study between transplants sutured with either nylon 10-0 or 11-0 (n = 108) or Mersilene 11-0 (n = 58) was done. One hundred sixty-six eyes of 140 patients who received a primary penetrating keratoplasty for Fuchs endothelial dystrophy between 1995 and 2001 at the Rotterdam Eye Hospital in Netherlands were included. RESULTS Overall, transplant survival did not differ between groups (log-rank test; P = 0.24). During the first 2 years after transplantation, significantly lower astigmatism was seen in transplants sutured with nylon (P = 0.03). Transplants sutured with Mersilene had a significantly higher risk of surgical intervention to correct astigmatism or wound dehiscence after transplantation (hazard ratio, 2.83; 95% confidence interval, 1.34-6.01). Time to first infiltrate, metaplasia (marked scarring along the sutures), or cheesewiring was significantly less in the Mersilene group (P < 0.01). There was a tendency toward a higher risk of complications associated with loose or broken sutures in the nylon group (hazard ratio, 2.00; 95% confidence interval, 0.57-6.98), which was more pronounced after 2 years. CONCLUSIONS During the first years after corneal transplant surgery, Mersilene sutures are associated with a higher risk of complications and more interventions to correct suture-related problems. However, after 2 years, the grafts seem to be able to retain Mersilene sutures with less risk of suture-related complications as compared with grafts with retained nylon sutures. These favorable long-term effects of Mersilene sutures may outweigh its short-term disadvantage in patients with Fuchs endothelial dystrophy.
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Alió JL, Javaloy J, Osman AA, Galvis V, Tello A, Haroun HE. Laser in situ keratomileusis to correct post-keratoplasty astigmatism; 1-step versus 2-step procedure. J Cataract Refract Surg 2005; 30:2303-10. [PMID: 15519079 DOI: 10.1016/j.jcrs.2004.04.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the correction of post-penetrating keratoplasty (PKP) astigmatism using laser in situ keratomileusis (LASIK). Visual and refractive outcomes were evaluated after LASIK was performed in 1 step (lamellar cut and ablation in 1 procedure) or 2 steps (lamellar cut then ablation in 2 successive procedures). SETTING Department of Cornea and Refractive Surgery, Vissum-Instituto Oftalmológico de Alicante, University of Miguel Hernández, Alicante, Spain. METHODS In this prospective observational study, 22 consecutive eyes were divided into 2 groups depending on the LASIK procedure performed to correct post-PKP astigmatism. Group 1 (1-step LASIK) included 11 eyes and Group 2 (2-step LASIK), 11 eyes. The patients were followed for 6 months. RESULTS A statistically significant improvement was obtained in Group 2 with a mean vector analysis result of the cylinder of -4.37 diopters (D) +/- 1.79 (SD) (P = .018). In Group 1, the mean astigmatism correction was 2.38 +/- 1.71 D. The number of reoperations and residual refractive defects were significantly better in Group 2. CONCLUSION The 2-step technique improved the accuracy of excimer laser correction of post-PKP astigmatism.
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Affiliation(s)
- Jorge L Alió
- Instituto Oftalmológico de Alicante, University of Miguel Hernández, Alicante, Spain.
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Busin M, Zambianchi L, Garzione F, Maucione V, Rossi S. Two-stage Laser in situ Keratomileusis to Correct Refractive Errors After Penetrating Keratoplasty. J Refract Surg 2003; 19:301-8. [PMID: 12777025 DOI: 10.3928/1081-597x-20030501-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of a two-stage laser in situ keratomileusis (LASIK) procedure on eyes with high astigmatism and/or anisometropia after penetrating keratoplasty. METHODS Eleven postoperative penetrating keratoplasty eyes were included in a prospective, non-controlled study. All patients had at least 4.00 D of astigmatism and/or at least 3.00 D of anisometropia and were spectacle and contact lens intolerant. Two-stage LASIK was performed; in the first stage a hinged corneal flap 160 microm in thickness and 9 mm in diameter was created. After stabilization of corneal shape (1 to 3 months after keratotomy), the corneal flap was lifted and laser refractive treatment (second stage) was performed. RESULTS After the first stage, a statistically significant reduction in refractive astigmatism (P<.01) was recorded. In all eyes but one, best spectacle-corrected visual acuity was maintained or improved after the procedure. Three months after the second stage, refractive astigmatism in 8 of 11 eyes (73%) was within +/- 1.00 D, and spherical equivalent refraction in 9 of 11 eyes (82%) was within +/- 1.00 D of intended correction. Preoperative irregular astigmatism persisted in three patients (3 eyes) who could not be corrected within +/- 1.00 D of refractive astigmatism and/or +/- 1.00 D of intended spherical equivalent refraction. In one eye, an interface infiltrate developed shortly after creation of the flap, and resulted in limited melting. CONCLUSIONS A two-stage LASIK procedure improved visual acuity and refraction in postoperative penetrating keratoplasty eyes with high astigmatism and/or anisometropia. Complications were uncommon but can lead to loss of vision.
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Affiliation(s)
- Massimo Busin
- Villa Serena Hospital, Department of Ophthalmology, Forli, Italy.
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Alio JL, Shah S, Barraquer C, Bilgihan K, Anwar M, Melles GRJ. New techniques in lamellar keratoplasty. Curr Opin Ophthalmol 2002; 13:224-9. [PMID: 12165704 DOI: 10.1097/00055735-200208000-00006] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the past years, several lamellar keratoplasty surgical techniques have been developed, modified or improved in the past years, including microkeratome assisted anterior and posterior lamellar keratoplasty, anterior lamellar keratoplasty using air-dissection or visco-dissection, sutureless posterior lamellar keratoplasty, LASIK for postkeratoplasty astigmatism, and excimer laser assisted keratophakia for keratoconus or to manage complications after LASIK. These procedures may continue to gain interest as alternative procedures for a penetrating keratoplasty in the treatment of various corneal disorders.
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Affiliation(s)
- Jorge L Alio
- Instituto Oftalmologico de Alicante, Alicante, Spain
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Busin M, Arffa RC, Zambianchi L, Lamberti G, Sebastiani A. Effect of hinged lamellar keratotomy on postkeratoplasty eyes. Ophthalmology 2001; 108:1845-51; discussion 1851-2. [PMID: 11581060 DOI: 10.1016/s0161-6420(01)00702-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism. DESIGN Noncomparative, interventional case series. PARTICIPANTS A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant. INTERVENTION A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery. MAIN OUTCOME MEASURES Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography. RESULTS At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications. CONCLUSIONS Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.
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Affiliation(s)
- M Busin
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Busin M, Arffa RC, Sebastiani A. Endokeratoplasty as an alternative to penetrating keratoplasty for the surgical treatment of diseased endothelium: initial results. Ophthalmology 2000; 107:2077-82. [PMID: 11054335 DOI: 10.1016/s0161-6420(00)00371-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To test the feasibility of a new surgical technique aimed at replacing diseased corneal endothelium while minimizing visual recovery time. DESIGN Noncomparative, prospective, clinic-based, interventional case series. PARTICIPANTS A total of seven patients with aphakic bullous keratopathy (n = 2), pseudophakic bullous keratopathy (n = 4), or Fuchs' corneal dystrophy (n = 1) participated. INTERVENTION All patients underwent a surgical procedure including removal of the epithelium, creation of a 9.5-mm corneal flap, substitution of an underlying 6.5-mm button of deep stroma and endothelium with a 7.0-mm donor button, and suturing of the flap back into position using a 10-0 running nylon suture. In the two most recently operated patients, anterior lamella, 160 microm in thickness, was removed from the donor button before transplantation. MAIN OUTCOME MEASURES Visual acuity, refraction, keratometry, corneal topography. RESULTS All corneas were clear, and the surface reepithelialized within 4 weeks after surgery. Regular astigmatism of less than 4 diopters was recorded in all cases as early as 4 weeks after surgery. Epithelial interface ingrowth with extensive melting of the corneal flap was observed in one patient 3 months after surgery and was managed by removal of the flap and resuturing of the donor button. CONCLUSIONS Endokeratoplasty represents a promising alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium.
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Affiliation(s)
- M Busin
- University of Ferrara, Department of Ophthalmology, Ferrara, Italy
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Busin M, Mönks T, al-Nawaiseh I. Different suturing techniques variously affect the regularity of postkeratoplasty astigmatism. Ophthalmology 1998; 105:1200-5. [PMID: 9663222 DOI: 10.1016/s0161-6420(98)97021-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to determine the effect of various suturing techniques on the regularity of postkeratoplasty astigmatism. DESIGN A prospective clinical trial. PARTICIPANTS Sixty-two consecutive patients undergoing penetrating keratoplasty by the same surgeon (MB) participated. INTERVENTION Each patient was assigned to one of four groups according to the suturing technique used (a = 16 interrupted 10-0 nylon sutures; b = 2 running 10-0 nylon sutures, each with 8 bites; c = 2 running 10-0 nylon sutures, each with 12 bites; d = 2 running 10-0 nylon sutures, each with 16 bites). This was the only parameter permitted to be changed in the standard keratoplasty procedure used for all cases. Corneal topography was performed 1, 3, and 6 months after surgery. The astigmatic patterns seen on the corneal maps then were classified into regular (symmetric or asymmetric bowtie patterns) or irregular (distorted bowtie, multiaxial, or other patterns). MAIN OUTCOME MEASURES Regularity of postkeratoplasty corneal astigmatism was measured. RESULTS At all postoperative examination times, the percentage of irregular astigmatic patterns was highest in group a and lowest in group d (chi-square test: P < 0.005). Groups b and c showed intermediate values. The entity of the astigmatic error as measured by the simulated K-readings of the topographic maps did not differ significantly in the four groups. CONCLUSIONS A suturing technique using 2 running sutures with 16 bites each can minimize irregular postkeratoplasty astigmatism as long as sutures are in place, when compared with interrupted sutures or double-running sutures of less than 16 bites.
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Gross RH, Poulsen EJ, Davitt S, Schwab IR, Mannis MJ. Comparison of astigmatism after penetrating keratoplasty by experienced cornea surgeons and cornea fellows. Am J Ophthalmol 1997; 123:636-43. [PMID: 9152069 DOI: 10.1016/s0002-9394(14)71076-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We compared surgically induced astigmatism after penetrating keratoplasty performed by supervised cornea fellows and experienced cornea surgeons. METHODS Data were collected by retrospective chart review of 166 cases (166 eyes) of penetrating keratoplasty: 63 performed by two cornea surgeons and 103 by four cornea fellows. Astigmatism was calculated using scalar and vector methods. Vector analysis was performed on 109 of 166 eyes. Two techniques were compared: intraoperative keratometry and suture adjustment and the torque-antitorque running suture technique with no intraoperative keratometry or suture adjustment. RESULTS Mean surgically induced scalar astigmatism changed from preoperative astigmatism by 3.27 diopters (fellows) and 2.94 diopters (attending surgeons). In 109 cases, surgically induced vector cylinder changed from peroperative astigmatism by 4.21 diopters at 98 degrees (fellows) and 4.25 diopters at 114 degrees (surgeons). Surgically induced vector astigmatism changed from preoperative astigmatism by 4.67 diopters at 93 degrees in the first 6 months (fellows) and by 3.79 diopters at 103 degrees in the second 6 months. Analysis of x-axis and y-axis components of the surgically induced vector cylinder showed that the majority of the astigmatism was induced in the y-axis and that this difference was significant (P < .001) in all comparisons, independent of technique or surgeon group. CONCLUSIONS Penetrating keratoplasty performed by supervised cornea fellows resulted in similar rates of surgically induced vector astigmatism, surface asymmetry, and surface regularity as that by experienced surgeons. Fellows induced significantly more with-the-rule astigmatism, but this tendency decreased with further training. Penetrating keratoplasty astigmatic outcomes were not significantly different whether or not intraopertive keratometry and suture adjustment were utilized. This study supports the concept that increased experience with corneal transplantation improves the outcome of penetrating keratoplasty by using the criterion of postoperative astigmatism as a measures.
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Affiliation(s)
- R H Gross
- Department of Ophthalmology, University of California, Davis, Sacramento 95816-7051, USA
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