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Chen SS, Torii H, Yotsukura E, Nishi Y, Negishi K. Implantation of a toric intraocular lens after repeated radial keratotomy procedures: A case report. Heliyon 2023; 9:e22500. [PMID: 38125435 PMCID: PMC10730715 DOI: 10.1016/j.heliyon.2023.e22500] [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: 12/18/2022] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Corneal alterations due to radial keratotomy (RK) complicate intraocular lens calculations, which may explain why there have been few reports of toric intraocular lens (TIOL) implantation after excessive or multiple operations. A 71-year-old male with a history of repeated RKs and at least 30 corneal incisions in each eye was referred for cataract surgery. Preoperatively, the best-corrected distance visual acuity was 0.7 decimal (0.15 logMAR) in the right eye and 0.9 decimal (0.05 logMAR) in the left eye. The refractive errors were -8.00 -3.00 × 80 and -6.00 -3.50 × 80, respectively. The total corneal cylindrical powers (real power; anterior and posterior) were, respectively, -0.90 D and -3.60 D at 9 a.m., compared to -1.60 D and -3.80 D at 1 p.m. Corneal astigmatism in the left eye was considered symmetric and diurnally stable; therefore, an XY1AT6 TIOL (Hoya, Tokyo, Japan; cylindrical power at the plane, +3.75 D) was implanted. A non-toric intraocular lens, the XY1 (Hoya), was implanted in the right eye. Six-month postoperative best-corrected distance visual acuities were 1.2 decimal (-0.08 logMAR) and 1.0 decimal (0.00 logMAR) in the right and left eyes, respectively. Post-operative manifest refractions were +0.00 -3.00 × 70 and -1.00 -2.00 × 85, respectively. The TIOL reduced refractive astigmatism in the left eye; therefore, we believe that even after multiple RKs, the TIOL can be a suitable candidate to correct astigmatism if the corneal astigmatism is diurnally stable and symmetric.
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Affiliation(s)
- Steve S.W. Chen
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Erisa Yotsukura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyo Nishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Iwamoto Y, Koh S, Inoue R, Soma T, Oie Y, Maeda N, Nishida K. Long-Term Corneal Refractive Power Changes Two Decades After Radial Keratotomy With Microperforations. Eye Contact Lens 2023; 49:258-261. [PMID: 37200044 DOI: 10.1097/icl.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/19/2023]
Abstract
ABSTRACT We retrospectively examined corneal refractive power in three patients who had been followed up for more than 20 years after radial keratotomy (RK) with microperforations (MPs). All patients underwent RK in both eyes and were referred to our clinic because of postoperative decreased vision. MP was observed in five of the six eyes at the initial visit. The corneal refractive power of the anterior and posterior surfaces of the 6-mm-diameter cornea was examined using Fourier analysis based on corneal shape analysis using anterior segment optical coherence tomography. The spherical components decreased in all three cases. The asymmetry and higher-order irregularity components and fluctuations in corneal refractive power were markedly greater in the two cases with MP in both eyes. Fluctuations in corneal refractive power were observed at more than 20 years after RK with MP. Therefore, careful observation is necessary, even after a long-term postoperative follow-up period.
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Affiliation(s)
- Yuri Iwamoto
- Department of Ophthalmology (Y.I., S.K., T.S., Y.O., K.N.), Osaka University Graduate School of Medicine, Osaka, Japan; Department of Innovative Visual Science (S.K., R.I.), Osaka University Graduate School of Medicine, Osaka, Japan; and SEED Co., Ltd (R.I.), Tokyo, Japan
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Santhiago MR, Dutra BAL, Morgado CR, Seiler TG, Wendelstein J, Awwad ST, Assaf JF, Ghanem RC, Ghanem VC, Talley Rostov AR, Wiley WF. Therapeutic visual rehabilitation in a patient with high hyperopia and flat cornea years after radial keratotomy. J Cataract Refract Surg 2023; 49:649-653. [PMID: 37257174 DOI: 10.1097/j.jcrs.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 51-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in both eyes was his chief complaint. He cannot tolerate contact lenses. Corrected distance visual acuity (CDVA) was 20/40 in both eyes. Manifest refraction was +5.25 -2.25 @ 90 (20/40) in the right eye and +6.25 -2.25 @ 105 (20/40) in the left eye. The patient had a history of radial keratotomy (RK) almost 30 years ago in both eyes and at the slitlamp presented 8 RK incisions, proportionally spaced between one another. All incisions were closed, and there were no relevant signs of scarring. The patient denied any history of ocular trauma, systemic disease, or medications. Corneal topography with different technologies revealed an irregular pattern with marked central flattening in both eyes, with some points below 30 diopters (D) (Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A862 and http://links.lww.com/JRS/A863, respectively). There were no signs of cataract, and fundus examination was normal. Optical coherence tomography (OCT) of the right eye revealed a more homogeneous thickness pattern, little variation between the thinnest and thickest areas, and adequate transparency (Figure 1JOURNAL/jcrs/04.03/02158034-202306000-00018/figure1/v/2023-05-31T172126Z/r/image-tiff). In the left eye, there is wide variability between the thinnest and thickest stromal points, with annular thinning and central thickening (Figure 2JOURNAL/jcrs/04.03/02158034-202306000-00018/figure2/v/2023-05-31T172126Z/r/image-tiff). Both eyes show marked epithelial irregularity. Considering this patient's current ocular status, how would you reach visual rehabilitation? Because he is contact lens intolerant, would you consider surface ablation, for example, photorefractive keratectomy (PRK) with mitomycin-C (MMC)? If that were the case, would you think of an optimized or a topography-guided (TG) treatment? Would you immediately consider a corneal transplant option? Would you instead consider a more conservative approach? Which one and why?
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Annadanam A, Soeken T, Shah M, Nallasamy N. Descemet membrane endothelial keratoplasty in a patient with iris-fixated intraocular lens and prior radial keratotomy: a case report. BMC Ophthalmol 2021; 21:340. [PMID: 34544369 PMCID: PMC8454097 DOI: 10.1186/s12886-021-02103-1] [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: 12/07/2020] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background Anterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, particularly in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation. Case presentation A 68-year-old woman with a history of RK with associated irregular astigmatism in both eyes and iris-fixated intraocular lens (IF-IOL) in the left eye presented with six months of decreased vision in the left eye. She was found to have Fuchs dystrophy and underwent DMEK surgery. She had an uncomplicated postoperative course, with uncorrected visual acuity improving to 20/20 three months after surgery. Conclusion To our knowledge, this is the first reported case of a highly successful DMEK surgery in a patient with prior RK and IF-IOL. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02103-1.
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Affiliation(s)
- Anvesh Annadanam
- W. K. Kellogg Eye Center, University of Michigan, 1000 Wall St, MI, 48105, Ann Arbor, USA
| | - Timothy Soeken
- W. K. Kellogg Eye Center, University of Michigan, 1000 Wall St, MI, 48105, Ann Arbor, USA
| | - Manjool Shah
- W. K. Kellogg Eye Center, University of Michigan, 1000 Wall St, MI, 48105, Ann Arbor, USA
| | - Nambi Nallasamy
- W. K. Kellogg Eye Center, University of Michigan, 1000 Wall St, MI, 48105, Ann Arbor, USA.
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Akella SS, Chuck RS, Lee JK. Descemet membrane endothelial keratoplasty for endothelial decompensation after previous radial keratotomy. Am J Ophthalmol Case Rep 2019; 15:100503. [PMID: 31317085 PMCID: PMC6611982 DOI: 10.1016/j.ajoc.2019.100503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To report Descemet membrane endothelial keratoplasty (DMEK) for endothelial decompensation in an eye with previous radial keratotomy. Observations A history of radial keratotomy may hasten endothelial dysfunction. Previously reported surgical treatments include penetrating kerotoplasty and Descemet stripping automated endothelial keratoplasty. Conclusions and Importance DMEK may be successfully used in post-RK eyes with good recovery of visual acuity and patient satisfaction.
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Affiliation(s)
- Sruti S Akella
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jimmy K Lee
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Moshirfar M, Y. Liu H, Vaidyanathan U, N. Somani A, C. Hopping G, R. Barnes J, B. Heiland M, B. Rosen D, N. Motlagh M, C. Hoopes P. Diagnosis and Management of Pseudoguttata: A Literature Review. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2019; 8:156-162. [PMID: 31598518 PMCID: PMC6778462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Corneal pseudoguttata (PG), also known as pseudoguttae or secondary guttata, is a transient, reversible endothelial edema commonly associated with anterior segment pathology. While considered rare, PG presents on slit-lamp examination more commonly than originally thought. We have clinically observed PG after refractive surgeries, in association with infectious keratitis, and following medication use. PG presents as dark lesions on slit-lamp exam with specular illumination, similar to primary corneal guttata. PG is distinct from guttata because PG resolves over time and does not involve Descemet's membrane. Other ocular findings that may be confused with guttata include endothelial blebs (EB) and endothelial denudation (ED). EB are possibly a type of PG that present after contact lens use or hypoxia. ED is a distinct entity that is characterized by loss of endothelial cells without involvement of Descemet's membrane. Confocal microscopy may be useful in differentiating these four endothelial lesions, with differences in border definition and the presence of hyperreflective areas two main distinctions. PG presents as a hyporeflective, elevated shape without clear borders on confocal microscopy. PG, EB, and ED can resolve with time without the need for surgical intervention, unlike corneal guttata. Treatment of the underlying condition will lead to resolution of both PG and EB.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA,Utah Lions Eye Bank, Murray, UT, USA,Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
| | - Harry Y. Liu
- Health Science Center, McGovern Medical School, University of Texas, Houston, TX, USA
| | - Uma Vaidyanathan
- Health Science Center, McGovern Medical School, University of Texas, Houston, TX, USA
| | - Anisha N. Somani
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Grant C. Hopping
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
| | - James R. Barnes
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
| | | | - David B. Rosen
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
| | | | - Phillip C. Hoopes
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
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Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty in Eyes With Previous Radial Keratotomy. Cornea 2018; 37:1351-1354. [PMID: 30157047 DOI: 10.1097/ico.0000000000001719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) performed in eyes with corneal endothelial decompensation and previous radial keratotomy (RK). METHODS Five consecutive eyes of 3 patients with previous RK underwent DMEK for endothelial decompensation; best spectacle-corrected visual acuity, maximum keratometry (Kmax), central corneal thickness, and intraoperative and postoperative complications were assessed. RESULTS By 6 months postoperative, all eyes had achieved a best spectacle-corrected visual acuity of ≥20/40 (≥0.5), 4/5 (80%) were ≥20/25 (≥0.8), and 2/5 (40%) were ≥20/20 (≥1.0). On average, central corneal thickness decreased by 122 μm, and Kmax decreased by 4.2 diopters. Successful rebubbling was performed on 1 eye at 3 weeks postoperatively; another eye experienced gaping of an old RK wound, that spontaneously resolved. CONCLUSIONS DMEK is technically feasible in eyes with previous RK and may provide excellent outcomes. A significant change in the anterior corneal contour and associated refractive power of the eye may be anticipated depending on the amount of preoperative corneal edema and the number of RK incisions.
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Shah SG, Shah GY. Non-Descemet stripping automated endothelial keratoplasty for post radial keratotomy corneal edema. Indian J Ophthalmol 2018; 66:1333-1335. [PMID: 30127163 PMCID: PMC6113808 DOI: 10.4103/ijo.ijo_1281_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An elderly male with monocular status presented with complaints of gradual loss of vision in his left eye. Slit-lamp evaluation revealed postradial keratotomy (RK) corneal decompensation. He underwent non-Descemet stripping automated endothelial keratoplasty (nDSAEK) in his left eye. Postoperatively, his visual acuity improved from counting finger at 1 m to 20/200, J5. Graft adherence was good. A preexisting epiretinal membrane with macular edema was noted, but our patient refused any further surgical intervention for the same. In conclusion, nDSAEK may be considered as an effective treatment modality for the management of post-RK corneal decompensation.
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Affiliation(s)
- Sushmita Gaurav Shah
- Cornea, Anterior Segment and Refractive Surgery Services, Eye Life Eye Hospital, Mumbai, Maharashtra, India
| | - Gaurav Y Shah
- Cornea, Anterior Segment and Refractive Surgery Services, Eye Life Eye Hospital, Mumbai, Maharashtra, India
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Solaimani M, Tabatabaei SA, Fallah Tafti Z. Tailored lamellar keratoplasty: a new technique. BMJ Case Rep 2017; 2017:bcr-2017-220262. [PMID: 28775086 DOI: 10.1136/bcr-2017-220262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a new method for treating complicated corneal gaps among patients who have previously undergone radial keratotomy (RK).After complete healing of a fungal keratitis in a patient who has undergone RK, we removed the oedematous corneal sector and put anterior tailored segment of a corneal button previously used for Descemet stripping endothelial keratoplasty. The patient's best-corrected visual acuity reached to 20/20 6 months later. This technique will compensate for oedematous parts without putting a significant effect on other parts such as purse string sutures.
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Affiliation(s)
- Mohammad Solaimani
- Ocular Trauma and Emergency Unit, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Seyed Ali Tabatabaei
- Ocular Trauma and Emergency Unit, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Zahra Fallah Tafti
- Ocular Trauma and Emergency Unit, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Abstract
PURPOSE OF REVIEW Descemet membrane endothelial keratoplasty (DMEK) has become a first-line treatment in corneal endothelial diseases because of its exceptional clinical outcomes and low complication rates. Because of its improved refractive predictability, DMEK is now also considered for managing cases with endothelial decompensation following previous refractive procedures, or in combination with those. This article reviews the clinical outcomes in these cases and discusses the possibility of refractive interventions following DMEK. RECENT FINDINGS DMEK has been successfully performed in eyes after laser in-situ keratomileusis, eyes after anterior chamber intraocular lens (IOL) implantation and aphakic eyes. Often, DMEK is combined with cataract surgery (triple-DMEK). Initial reports on reducing the refractive cylinder by toric IOL implantation are available. Although there are some reports on phacoemulsification and IOL implantation after phakic DMEK, reports on laser refractive procedures following DMEK are lacking. SUMMARY In contrast to earlier keratoplasty techniques, DMEK induces on average only mild refractive shifts owing to the 'natural' restoration of the cornea. As such, DMEK may be ideal in managing corneal decompensation in refractive patients. However, further studies are required to assess the safety and efficacy of DMEK after refractive treatment and of refractive procedures following DMEK.
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Rodriguez-Ausin P, Antolin-Garcia D, Santamaria Garcia L, Blazquez-Fernandez AB. Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty? ACTA ACUST UNITED AC 2016; 92:237-240. [PMID: 27956322 DOI: 10.1016/j.oftal.2016.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 11/15/2022]
Abstract
CASE REPORT A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs' dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular oedema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied. DISCUSSION Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity.
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Affiliation(s)
- P Rodriguez-Ausin
- Hospital Universitario de Torrejón de Ardoz, Torrejón de Ardoz, Madrid, España.
| | - D Antolin-Garcia
- Hospital Universitario de Torrejón de Ardoz, Torrejón de Ardoz, Madrid, España
| | - L Santamaria Garcia
- Hospital Universitario de Torrejón de Ardoz, Torrejón de Ardoz, Madrid, España
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