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Eissa SA, El-Deeb MW, Hendawi MS. V4B implantable collamer lens versus Intacs corneal rings to manage anisometropic myopic amblyopia in children. Can J Ophthalmol 2017; 52:409-415. [PMID: 28774525 DOI: 10.1016/j.jcjo.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 12/23/2016] [Accepted: 01/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of phakic intraocular lens (PIOL) versus intrastromal corneal ring segments (Intacs), for correcting high myopic anisometropia in amblyopic children. DESIGN Nonrandomized prospective multi-center study. PARTICIPANTS Thirty children, aged between 4 and 12 years, with unilateral high myopic anisometropic amblyopia were included in this study. METHODS Patients who were prospectively subdivided into group A, with mean preoperative manifest refraction spherical equivalent (MRSE) of -12.96 ± 4.17 D, underwent unilateral phakic posterior chamber intraocular lens implantation. Patients with mean preoperative MRSE of -8.60 ± 1.16 D in group B were treated by Intacs corneal rings. Pre- and postoperative visual acuity, ocular examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients. RESULTS Group A revealed prevention of amblyopia with improvement in spectacle-corrected distance visual acuity, where 4-6 lines were achieved in 77% of children, 2-3 lines in 4%, and just 0-1 lines restricted to 19% of children. Improvement in stereoacuity was noted in 93.33% of group A cases, whereas group B showed fewer cases of successfully improved vision, with 4-6 lines in 70% of children, 2-3 lines in 3%, and just 0-1 lines restricted to 27% of children. Improvement in stereoacuity was noted in 86.66% of cases. Two cases of cataract and 1 case of glaucoma with 1 case of uveitis were noted in the implantable contact lens (ICL) group. CONCLUSIONS Posterior chamber PIOLs or Intacs may provide a safe alternative in treating anisometropic myopic patients. Intacs implantation is safer with fewer complications than ICL. However, ICL implantation is advantageous over the corneal ring segment procedure owing to the wide range of errors to correct.
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Affiliation(s)
- Sherif Ahmed Eissa
- Ophthalmology, Cairo University, and Ophthalmology and Refractive Surgery, Magrabi Hospital, Khamis Mushait, Kingdom of Saudi Arabia; Ophthalmology Department, Kasr Al Ainy, Cairo University, Egypt
| | - Mohamed Wagih El-Deeb
- Ophthalmology, Cairo University, and Ophthalmology and Refractive Surgery, New Mowasat Hospital, Salmiya, Kuwait; Ophthalmology Department, Kasr Al Ainy, Cairo University, Egypt..
| | - Mahmoud Salah Hendawi
- Ophthalmology, Cairo University, and Ophthalmology and Refractive Surgery, Al-Ourf Hospital, Jahra, Kuwait; Ophthalmology Department, Kasr Al Ainy, Cairo University, Egypt
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Morral M, Güell JL, El Husseiny MA, Elies D, Gris O, Manero F. Paired-eye comparison of corneal endothelial cell counts after unilateral iris-claw phakic intraocular lens implantation. J Cataract Refract Surg 2016; 42:117-26. [DOI: 10.1016/j.jcrs.2015.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 01/18/2023]
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Visual outcomes after femtosecond-assisted intracorneal MyoRing implantation: 18 months of follow-up. Graefes Arch Clin Exp Ophthalmol 2015; 254:917-22. [DOI: 10.1007/s00417-015-3231-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/12/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022] Open
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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Tomita M, Huseynova T. Evaluating the short-term results of KAMRA inlay implantation using real-time optical coherence tomography-guided femtosecond laser technology. J Refract Surg 2014; 30:326-9. [PMID: 24893357 DOI: 10.3928/1081597x-20140416-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/04/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the outcomes from using real-time optical coherence tomography (OCT)-guided femtosecond laser technology for pocket creation for KAMRA inlay (Acufocus, Inc., Irvine, CA) implantation surgery. METHODS One hundred fifty-one eyes underwent KAMRA inlay implantation using the real-time OCT-guided femtosecond laser for pocket creation. All patients had a history of prior LASIK. Uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, corrected near visual acuity, and manifest refraction spherical equivalent were evaluated preoperatively and postoperatively. The follow-up period was 3 months. RESULTS Mean manifest refraction spherical equivalent, uncorrected distance visual acuity, and uncorrected near visual acuity changed from -0.18 ± 0.33 to -0.95 ± 0.64, 20/16 to 20/20, and J8 to J2, respectively. Corrected distance visual acuity and corrected near visual acuity remained stable before and after KAMRA inlay implantation, 20/12 and J1, respectively. CONCLUSIONS Using real-time OCT-guided femtosecond laser technology increases the safety and accuracy of corneal KAMRA inlay implantation surgery with a history of prior LASIK with excellent visual and refractive outcomes.
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Abstract
PURPOSE To assess the effect of topical taprenepag isopropyl on each layer of the cornea by confocal microscopy. METHODS Thirty-two ocular hypertensive or glaucoma patients were randomized into a 2-period, crossover study of 14 days of 0.1% taprenepag alone and in unfixed combination with 0.005% latanoprost (combination therapy). Baseline and sequential slit-lamp biomicroscopy, fluorescein staining, central ultrasonic pachymetry, and confocal microscopy were performed. Confocal images were analyzed for the density of the central superficial and basal epithelium, midstromal keratocytes, and endothelium, as well as endothelial coefficient of variation and percentage of hexagonal cells, and reflectivity of anterior stromal and midstromal layers. RESULTS Corneal staining increased from baseline, reaching a peak at day 13 (69% and 63% of subjects treated with monotherapy and combination therapy, respectively), which resolved by day 35. A statistically significant increase in mean corneal thickness for both eyes and both treatments occurred on days 7 and 13 (range, 20-27 μm; P < 0.001) but recovered (≤ 6 μm) by day 35. No statistically significant changes were observed in the basal epithelial, midstromal, or endothelial cells. Mean ratio of average reflectivity of anterior stroma to midstroma increased on days 13 and 35 in period 1 for each treatment (range, 1.2-1.9; P < 0.001), and this increase persisted during period 2. CONCLUSIONS Anterior stromal reflectivity may remain increased even when biomicroscopic and confocal images of corneal layers remain normal or have recovered after topical taprenepag. This subclinical measure may be useful to detect a persistent adverse effect of a topical agent on the cornea.
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Salustiano R, Avila MP, Silva DS, Rannouche RZ, Salustiano LX, Paula AC. Endothelial analysis in patients having corneal intrastromal surgery with Cornealring for correction of Keratoconus. Semin Ophthalmol 2013; 28:19-24. [PMID: 23305435 DOI: 10.3109/08820538.2012.730096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Evaluate corneal endothelium by means of specular microscopy exam in patients with Keratoconus, before and after Cornealring® corneal intrastromal ring surgery. METHODS One hundred and two eyes of 67 patients, aged between 12 and 45, with the average age of 27.31 ± 8.15 years, 30 females and 37 males, were selected to be submitted to the implant of Cornealring® corneal ring segments in pre- and post-surgery (six months after the procedure) in the External Diseases and Cornea Ward of the Instituto Panamericano da Visão. RESULTS Of the 102 eyes treated, only those that received two rings of equal thickness up to 250 µ showed statistical significance between the initial and final mean number of endothelial cells (P = 0.008), a decrease of 10.1% in the mean coefficient of variation (P = 0.003), and a 9.75% decrease in initial and final hexagonal cell counts. The other eyes receiving rings of other thicknesses showed no statistically significant differences between the mean initial and final SM examinations. CONCLUSION A longer segment is necessary for the confirmation or not of the alterations found in this study, particularly regarding the thickness of the ring used, because with the new technologies and the improvement in the result of deep lamellar transplantation, the decrease in the cell count might represent a problem in the indication of this procedure following thick corneal ring implants.
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Affiliation(s)
- R Salustiano
- Department of Medicine, Service of Cornea and External Diseases, Federal University of Goiás - Centre for Excellence in Ophthalmology, Goiânia, Brazil
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Woodward MA, Edelhauser HF. Corneal endothelium after refractive surgery. J Cataract Refract Surg 2011; 37:767-77. [PMID: 21420604 DOI: 10.1016/j.jcrs.2011.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/28/2010] [Accepted: 10/29/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED The endothelium is vital to the health and optical clarity of the human cornea. The safety of procedures to correct refractive errors depends on preservation of an intact corneal endothelium. Disease states and genetic and environmental factors affect the corneal endothelium; an unstable corneal endothelium can impact the success of refractive surgery. Technological advances and recent laboratory findings have improved the ability to assess the endothelium. The status of the corneal endothelium after laser in situ keratomileusis, photorefractive keratectomy, phakic intraocular lenses, and adjuvants to these treatments has been the topic of numerous clinical trials. Safety guidelines for refractive surgery procedures should be followed to minimize deleterious effects on the corneal endothelium. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Hudson HL, Stulting RD, Heier JS, Lane SS, Chang DF, Singerman LJ, Bradford CA, Leonard RE. Implantable telescope for end-stage age-related macular degeneration: long-term visual acuity and safety outcomes. Am J Ophthalmol 2008; 146:664-673. [PMID: 18760765 DOI: 10.1016/j.ajo.2008.07.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate long-term safety and best-corrected visual acuity (BCVA) results of a telescope prosthesis in patients with end-stage age-related macular degeneration (AMD). DESIGN Prospective, open-label clinical trial with fellow-eye controls. METHODS Patients with end-stage AMD (bilateral geographic atrophy or disciform scars; BCVA, 20/80 to 20/800) received the telescope prosthesis at 28 centers. Methods were similar to those described in the one-year results, with follow-up visits continuing at 18 and 24 months. Main outcome measures included BCVA change from baseline, endothelial cell density (ECD) and morphometry, and incidence of complications. RESULTS At two years, data from 174 (92.6%) of 188 available patients were analyzed. Overall, 103 (59.5%) of 173 telescope-implanted eyes gained three lines or more (doubling of visual angle) of BCVA compared with 18 (10.3%) of 174 fellow control eyes (P < .0001). Mean BCVA improved 3.6 lines (standard deviation [SD], 1.9 lines) and 2.8 lines (SD, 2.3 lines) from baseline in eyes with the 3X and 2.2X device models, respectively. Mean ECD stabilized through two years, with 2.4% mean cell loss occurring from one to two years. There was no significant change in coefficient of variation or percentage of hexagonal endothelial cells from within six months to two years after surgery. The most common complication was inflammatory deposits. CONCLUSIONS Long-term results of this telescope prosthesis show the substantial BCVA improvement at one year is maintained at two years. Key indicators of corneal health demonstrate ECD change that reflects remodeling of the endothelium associated with the implantation procedure. ECD stabilizes over time, and there is no evidence of any ongoing endothelial trauma.
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Review of corneal endothelial specular microscopy for FDA clinical trials of refractive procedures, surgical devices, and new intraocular drugs and solutions. Cornea 2008; 27:1-16. [PMID: 18245960 DOI: 10.1097/ico.0b013e31815892da] [Citation(s) in RCA: 218] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Specular microscopy can provide a noninvasive morphologic analysis of the corneal endothelial cell layer from subjects enrolled in clinical trials. The analysis provides a measure of the endothelial cell physiologic reserve from aging, ocular surgical procedures, pharmaceutical exposure, and general health of the corneal endothelium. The purpose of this review is to discuss normal and stressed endothelial cell morphology, the techniques for determining the morphology parameters, and clinical trial applications.
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Sheng H, Parker EJ, Bullimore MA. An Evaluation of the Confoscan3 for Corneal Endothelial Morphology Analysis. Optom Vis Sci 2007; 84:888-95. [PMID: 17873775 DOI: 10.1097/opx.0b013e3181559c01] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We evaluated the ConfoScan3 confocal microscope and its associated software that allows automated analysis of the corneal endothelial morphology. METHODS Images were taken on 30 normal subjects and 29 contact lens wearers with the Konan SP-9000 specular microscope and the ConfoScan3. The Konan images were analyzed with the KSS-300 software (center method). The Confoscan3 images were first analyzed with the automated method and then edited manually (semiautomated method). The agreement between methods was evaluated by calculating the difference between pairs of measurements, determining the mean and standard deviation of these differences, and the 95% limits of agreement. RESULTS For normal subjects, all methods gave similar density values. The agreement with the Konan system was slightly better for the semiautomated method than the automated method. The automated method overestimated the degree of polymegethism (p < 0.001) and pleomorphism (p < 0.001). The semiautomated method showed substantial improvement. For contact lens wearers, agreement with the Konan system was poor for both automated and semiautomated methods. The automated method overestimated the degree of pleomorphism (p < 0.001) and the semiautomated method showed only modest improvement (p < 0.1). Both methods overestimated pleomorphism (automated p < 0.001; semiautomated p < 0.025). CONCLUSIONS When using ConfoScan3 to evaluate the corneal endothelium of normal subjects, investigators should manually edit the processed images to achieve results comparable with the Konan system. When evaluating contact lens wearers, values from the ConfoScan3 are not interchangeable with those from the Konan system.
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Affiliation(s)
- Huan Sheng
- The Ohio State University, College of Optometry, Columbus, Ohio, USA.
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Samimi S, Leger F, Touboul D, Colin J. Histopathological findings after intracorneal ring segment implantation in keratoconic human corneas. J Cataract Refract Surg 2007; 33:247-53. [PMID: 17276265 DOI: 10.1016/j.jcrs.2006.08.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 08/25/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate histopathological changes induced in keratoconic corneas after implantation of Intacs intracorneal ring segments (Addition Technology, Inc.). SETTING Departments of Ophthalmology and Pathology, Hospital Pellegrin, Bordeaux, France. METHODS This retrospective study included 8 keratoconic, contact-lens-intolerant eyes of 8 patients who had penetrating keratoplasty (PKP) after removal of Intacs inserts because of a poor refractive outcome or insert extrusion. Light microscopy was performed on all specimens after conventional staining. Immunohistochemistry was performed to identify cell types located next to the tunnel using AE1/AE3 cytokeratins, CD34, vimentin, collagen IV, and alpha-smooth muscle actin monoclonal antibodies. RESULTS Conventional histology showed hypoplasia of the epithelium immediately surrounding the channel. There was no evidence of an inflammatory response or foreign-body granuloma. Keratocyte density was decreased above and below the tunnel, and collagen IV synthesis was seen in the scar area. All samples stained negatively with alpha-smooth muscle actin, indicating that myofibroblasts were not present. These changes were no longer visible when PKP was performed more than 6 months after Intacs explantation. CONCLUSIONS Intacs induced keratocyte apoptosis, probably through a switch to a collagenous synthetic phenotype. Although histological changes seem to be entirely reversible after implant removal, longer follow-up is necessary to determine whether they accelerate corneal thinning and keratoconus progression via apoptosis and release of metalloprotease.
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Affiliation(s)
- Sépideh Samimi
- Ophthalmology and Pathology Departments, Hospital Pellegrin, Bordeaux, France
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Giasson CJ, Graham A, Blouin JF, Solomon L, Gresset J, Melillo M, Polse KA. Morphometry of Cells and Guttae in Subjects With Normal or Guttate Endothelium With a Contour Detection Algorithm. Eye Contact Lens 2005; 31:158-65. [PMID: 16021003 DOI: 10.1097/01.icl.0000165286.05080.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a semiautomatic method to analyze morphology of cells and guttae in corneal endothelium. METHODS Specular endothelial pictures from 42 and 21 subjects with healthy and guttate corneas, respectively, were analyzed independently by two observers with cell contour-extracting routines. One observer also analyzed healthy endothelia with the Corner method (Bambi). Differences between observers and between methods in mean cell area (MCA), coefficient of variation (CV), and percentage of cells with five, six, or seven sides were tested for significance with paired t tests. The Contour analysis of pictures with guttae included their mean area. RESULTS There were no significant differences in MCA, CV, or the percentage of cells with five, six, or seven sides between the measurements obtained on repeated analysis by the same observer or on a second analysis performed by a different observer with the Contour method. However, the differences between the Contour and Bambi methods were statistically significant for MCA (337.5 +/- 37.7 vs. 327.7 +/- 36.5), CV (0.32 +/- 0.05 vs. 0.30 +/- 0.05), and percentage of cells with six and seven sides, but not for the percentage of five-sided cells. In subjects with guttata, the MCA was 561 +/- 170 microm, and the mean area of guttae was 1,538 +/- 849 microm. CONCLUSIONS This detection algorithm is repeatable and reproducible, and it generates a cell border overlay useful in analyzing the morphology of cells and guttae. The analysis of corneal guttae could become a useful follow-up procedure to discriminate between patients with corneal guttata and Fuchs dystrophy.
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Affiliation(s)
- Claude J Giasson
- School of Optometry and Research Unit in Vision Health, University of Montréal, Montréal, Canada.
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Edelhauser HF, Sanders DR, Azar R, Lamielle H. Corneal endothelial assessment after ICL implantation. J Cataract Refract Surg 2004; 30:576-83. [PMID: 15050252 DOI: 10.1016/j.jcrs.2003.09.047] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2003] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the 3- to 4-year effects of the Implantable Contact Lens (ICL) on the corneal endothelium. SETTING Multicenter study. METHODS Noncontact specular microscopy was performed as a subgroup study in a Phase III U.S. Food and Drug Administration clinical trial. Endothelial cell images were collected in the central region of the cornea before surgery and 3, 12, 24, and 36 months after surgery, with a few at 48 months. The images were recorded and analyzed later by a central reading center. The cell density, coefficient of variation, and percentage of hexagonal cells were determined. RESULTS The cumulative endothelial cell loss was between 8.4% and 8.9% over the first 3 years and between 8.4% and 9.5% over the first 4 years depending on the method of calculation. The cell loss between baseline and 3 months was 2.1%; 3 months and 1 year, 0.9%; 1 year and 2 years, 2.3%; 2 years and 3 years, 3.2%; and 3 years and 4 years, -0.1%. The coefficient of variation decreased over the course of the study, and the proportion of cases with hexagonal cells increased slightly. CONCLUSIONS The cell loss between 1 year and 3 years in the absence of an increase in the coefficient of variation and/or a decrease in the percentage of hexagonal cells is most readily explained by prolonged corneal remodeling following the surgical procedure rather than ongoing cell loss. The cell loss observed between 3 years and 4 years (0.1% gain) was negligible. Regardless of the cause of the change in endothelial cell density over the first 3 years, the available 4-year data suggest there was no ongoing chronic loss.
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Pop M, Payette Y. Initial results of endothelial cell counts after Artisan Lens for Phakic Eyes. Ophthalmology 2004; 111:309-17. [PMID: 15019381 DOI: 10.1016/j.ophtha.2003.05.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2002] [Accepted: 05/23/2003] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the endothelial cell count change in eyes implanted with the iris-claw phakic Artisan lens for treatment of moderate to high myopia. DESIGN Prospective, multicenter clinical trial. PARTICIPANTS The first 765 eyes enrolled at 25 North American sites in the United States Food and Drug Administration Ophtec clinical trial of the myopic Artisan IOL. Outcome analyses of endothelial cell count measurements were based on those obtained before surgery and at 6, 12, and 24 months after surgery performed between October 1998 and December 2001. SETTING Multiple private and university practices. METHODS Percentage change in endothelial cell count from baseline to 6, 12, and 24 months were analyzed using specular microscopy. Upper limit of detecting endothelial cell density change was estimated using 3 repeated counts at preoperative and postoperative time frames. MAIN OUTCOME MEASURES Percentage change in endothelial cell loss. RESULTS The mean preoperative endothelial cell count was 2631+/-442 cells/mm(2). Percentage change from baseline at 6, 12, and 24 months was -0.09%+/-16.39%, -0.87%+/-16.35%, and -0.78%+/-17.41%. No statistically significative postoperative endothelial cell loss was found. The endothelial cell loss rate was higher among patients who wore spectacles before surgery and was correlated negatively with preoperative endothelial cell density (P<0.001). No relationships were noted between endothelial cell loss and either patient age or implant power. A 4.1% repeatability of measurements was found based on the average of 3 repeated counts, whereas single cell count estimates were associated with a 23% accuracy in detecting endothelial cell density change. In a worst-case scenario, adjusting for measurement accuracy, 9% of all eyes were at higher risk of a 10% loss of cell density at 12 months after surgery, although eyes at higher risk were found to have high preoperative endothelial cell counts (P<0.0001). CONCLUSIONS The Artisan iris-claw phakic intraocular lens did not result in significant loss of endothelial cell density up to 2 years after implantation of the myopic Artisan phakic lens.
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Affiliation(s)
- Mihai Pop
- Michel Pop Clinics, Montreal, Canada.
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Bourges JL, Trong TT, Ellies P, Briat B, Renard G. Intrastromal corneal ring segments and corneal anterior stromal necrosis. J Cataract Refract Surg 2003; 29:1228-30. [PMID: 12842696 DOI: 10.1016/s0886-3350(02)02036-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Poly(methyl methacrylate) refractive intracorneal ring segments (ICRS) can be removed for a refractive miscorrection or for early complications after implantation. We report the first case of a woman who experienced anterior stromal necrosis 5 years after an ICRS surgical procedure.
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