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Yu J, Shalaby WS, Shiuey EJ, Rapuano CJ, Yonekawa Y, Hammersmith KM, Nagra PK, Syed ZA. Graft Outcomes After Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery. Cornea 2023; 42:584-589. [PMID: 36729415 DOI: 10.1097/ico.0000000000003207] [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: 01/23/2022] [Accepted: 11/02/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Corneal pathology can obstruct the visualization required for surgical management of coexisting posterior segment diseases, and use of a temporary keratoprosthesis (TKP) permits combined penetrating keratoplasty (PK) and vitreoretinal surgery. We evaluated graft outcomes after TKP for combined PK and vitreoretinal surgery and analyzed risk factors for graft failure. METHODS We reviewed the electronic medical records for patients who underwent TKP for PK combined with vitreoretinal surgery at Wills Eye Hospital between May 2007 and April 2021. Overall, 28 variables were analyzed. The main outcome measure was corneal graft failure, defined as irreversible graft edema or opacification. RESULTS A total of 46 eyes of 46 patients underwent combined surgery and were included in the study. The mean age at surgery was 55.7 ± 18.6 years (range 19-86 years), and the mean follow-up was 31.8 ± 30.5 months (range 1.6-114.0 months). Multivariable analysis revealed 2 factors significantly associated with graft failure: history of trauma (hazard ratio = 5.38; 95% confidence interval, 1.53-18.91; P = 0.009) and intraocular silicone oil after transplant (hazard ratio = 5.67; confidence interval 1.66-19.44; P = 0.006). Corneal graft failure occurred in 60.9% of all cases over the course of follow-up, but the absence of both variables yielded a 33.3% failure rate. CONCLUSIONS Although outcomes vary, previous ocular trauma and the presence of intraocular silicone oil are risk factors for failure that may facilitate patient selection and improve counseling about long-term graft potential after TKP for combined PK and vitreoretinal surgery.
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Affiliation(s)
- Julia Yu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | | | - Eric J Shiuey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - Christopher J Rapuano
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - Yoshihiro Yonekawa
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Retina Service, Wills Eye Hospital, Philadelphia, PA
| | - Kristin M Hammersmith
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - Parveen K Nagra
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - Zeba A Syed
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
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Lai FHP, Wong EWN, Lam WC, Lee TC, Wong SC, Nagiel A, Lam RF. Endoscopic vitreoretinal surgery: Review of current applications and future trends. Surv Ophthalmol 2020; 66:198-212. [PMID: 33278403 DOI: 10.1016/j.survophthal.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Endoscopy provides unique optical properties to circumvent anterior segment opacities and visualize difficult-to-access anatomical regions, including retroirideal, retrolental, ciliary body, and anterior retinal structures. We summarize the basic principles and utilization of endoscopic vitreoretinal surgery, along with recent technological advances in the field base on a structured literature search in Pubmed, Embase, and Google Scholar database up to February, 2020. Endoscopy has been used in the management of retinal detachment, ischemic retinopathies with neovascular glaucoma, severe ocular trauma, endophthalmitis, lens-related disorders in the posterior segment, pediatric vitreoretinal diseases, and implantation of retinal prostheses. Ongoing development of endoscopic technology aims to provide higher resolution images with endoscopes of smaller diameter. New surgical techniques supported by the adoption of endoscopy are available to manage challenging surgical scenarios. Endoscopy can be a useful adjunct to microscope wide-angle viewing systems in the management of complex vitreoretinal diseases.
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Affiliation(s)
| | | | - Wai Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong; Department of Ophthalmology and Vision Science, University of Toronto, Ontario, Canada
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sui Chien Wong
- Great Ormond Street Hospital for Children, London, England; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, England; Royal Free Hospital, London, England
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Fung Lam
- Department of Ophthalmology, Caritas Medical Centre, Hong Kong
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Yeo DCM, Nagiel A, Yang U, Lee TC, Wong SC. Endoscopy for Pediatric Retinal Disease. Asia Pac J Ophthalmol (Phila) 2018; 7:200-207. [PMID: 29862672 DOI: 10.22608/apo.2018154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Endoscopic vitrectomy is a useful and unique adjunct to microincision vitreoretinal surgery. The optical properties of endoscopy allow for some clinically advantageous approaches that are not possible with regular microscope viewing systems, namely, the ability to both bypass optically signficant anterior segment opacities and directly visualize dificult-to-access retroirideal, retrolental, and anterior retinal structures in their natural anatomical configuration. The surgical benefits include improved surgical access to the pars plana, pars plicata, ciliary sulcus, ciliary body, and peripheral lens, along with unique access to anterior traction in complex pediatric anterior detachments, particularly in retinopathy of prematurity. This review will focus on the development and surgical utility of intraocular endoscopy, provide an update on its current uses in the era of microincision vitreoretinal surgery, and highligh its role in pediatric vitreoretinal diseases.
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Affiliation(s)
- Damien C M Yeo
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, England
| | - Aaron Nagiel
- Children's Hospital Los Angeles, Los Angeles, California
| | - Unikora Yang
- Children's Hospital Los Angeles, Los Angeles, California
| | - Thomas C Lee
- Children's Hospital Los Angeles, Los Angeles, California
| | - Sui Chien Wong
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, England
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, England
- Royal Free Hospital, London, England
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Yonekawa Y, Hacker HD, Lehman RE, Beal CJ, Veldman PB, Vyas NM, Shah AS, Wu D, Eliott D, Gardiner MF, Kuperwaser MC, Rosa RH, Ramsey JE, Miller JW, Mazzoli RA, Lawrence MG, Arroyo JG. Ocular blast injuries in mass-casualty incidents: the marathon bombing in Boston, Massachusetts, and the fertilizer plant explosion in West, Texas. Ophthalmology 2014; 121:1670-6.e1. [PMID: 24841363 DOI: 10.1016/j.ophtha.2014.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/31/2014] [Accepted: 04/08/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report the ocular injuries sustained by survivors of the April 15, 2013, Boston Marathon bombing and the April 17, 2013, fertilizer plant explosion in West, Texas. DESIGN Multicenter, cross-sectional, retrospective, comparative case series. PARTICIPANTS Seventy-two eyes of 36 patients treated at 12 institutions were included in the study. METHODS Ocular and systemic trauma data were collected from medical records. MAIN OUTCOME MEASURES Types and severity of ocular and systemic trauma and associations with mechanisms of injury. RESULTS In the Boston cohort, 164 of 264 casualties were transported to level 1 trauma centers, and 22 (13.4%) required ophthalmology consultations. In the West cohort, 218 of 263 total casualties were transported to participating centers, of which 14 (6.4%) required ophthalmology consultations. Boston had significantly shorter mean distances to treating facilities (1.6 miles vs. 53.6 miles; P = 0.004). Overall, rigid eye shields were more likely not to have been provided than to have been provided on the scene (P<0.001). Isolated upper body and facial wounds were more common in West largely because of shattered windows (75.0% vs. 13.6%; P = 0.001), resulting in more open-globe injuries (42.9% vs. 4.5%; P = 0.008). Patients in Boston sustained more lower extremity injuries because of the ground-level bomb. Overall, 27.8% of consultations were called from emergency rooms, whereas the rest occurred afterward. Challenges in logistics and communications were identified. CONCLUSIONS Ocular injuries are common and potentially blinding in mass-casualty incidents. Systemic and ocular polytrauma is the rule in terrorism, whereas isolated ocular injuries are more common in other calamities. Key lessons learned included educating the public to stay away from windows during disasters, promoting use of rigid eye shields by first responders, the importance of reliable communications, deepening the ophthalmology call algorithm, the significance of visual incapacitation resulting from loss of spectacles, improving the rate of early detection of ocular injuries in emergency departments, and integrating ophthalmology services into trauma teams as well as maintaining a voice in hospital-wide and community-based disaster planning.
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Affiliation(s)
- Yoshihiro Yonekawa
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henry D Hacker
- Department of Ophthalmology, Scott & White Eye Institute, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Roy E Lehman
- Department of Ophthalmology, Scott & White Eye Institute, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Casey J Beal
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Peter B Veldman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neil M Vyas
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Wu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dean Eliott
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew F Gardiner
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark C Kuperwaser
- Department of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert H Rosa
- Department of Ophthalmology, Scott & White Eye Institute, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Jean E Ramsey
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A Mazzoli
- Department of Defense and Veterans Administration Vision Center of Excellence, Bethesda, Maryland; Department of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mary G Lawrence
- Department of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jorge G Arroyo
- Department of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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