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van der Star L, Vasiliauskaitė I, Oellerich S, Groeneveld-van Beek EA, Ghaly M, Laouani A, Vasanthananthan K, van Dijk K, Dapena I, Melles GRJ, Kocaba V. Bowman Layer Onlay Grafting as a Minimally Invasive Treatment for the Most Challenging Cases in Keratoconus. Am J Ophthalmol 2024; 261:54-65. [PMID: 37935272 DOI: 10.1016/j.ajo.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To analyze the clinical outcomes after Bowman layer (BL) onlay grafting for the treatment of progressive, advanced keratoconus. DESIGN Prospective, interventional case series. METHODS Twenty-one eyes underwent BL onlay grafting. After removing the epithelium, a single or double BL graft was "stretched" onto the corneal surface, allowed to dry-in, and a soft bandage lens was placed until the graft was re-epithelialized. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), corneal tomography, and postoperative complication rates were analyzed for the total group and 2 subgroups (group 1: preoperative maximum keratometry [Kmax] <69 diopters [D; n = 7); group 2: preoperative Kmax ≥69 D [n = 14]). Follow-up ranged from 6 to 36 months (mean 21 ± 11 months). RESULTS All 21 surgeries were uneventful. Overall, Kmax changed from 76 ± 12 D preoperatively to 72 ± 9 D at 6 to 36 months postoperatively (P = .015). Kmax decreased by 6 D in group 2 (P = .002) but did not change in group 1. Average BSCVA remained stable for group 1 and improved from preoperatively 0.8 ± 0.4 to 0.4 ± 0.2 logarithm of the minimum angle of resolution postoperatively in group 2 (P = .032); BCLVA remained stable (P > .05). Within the first postoperative weeks, 2 eyes required BL graft repositioning after inadvertent bandage lens removal and 4 eyes underwent BL retransplantation for incomplete re-epithelialization. One eye underwent BL regrafting 12 months postoperatively after traumatic corneal erosion. All eyes showed a completely re-epithelialized graft at the last available follow-up. CONCLUSIONS BL onlay grafting is a completely extraocular, minimally invasive surgical technique, providing up to -6 D of corneal flattening in eyes with advanced progressive keratoconus, allowing for continued (scleral) contact lens wear and therefore preserving the BCLVA.
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Affiliation(s)
- Lydia van der Star
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Indrė Vasiliauskaitė
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Silke Oellerich
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Esther A Groeneveld-van Beek
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Mohamed Ghaly
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Achraf Laouani
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Keamela Vasanthananthan
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Korine van Dijk
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Isabel Dapena
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Gerrit R J Melles
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Amnitrans EyeBank Rotterdam (G.R.J.M., V.K.), Rotterdam, The Netherlands.
| | - Viridiana Kocaba
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Amnitrans EyeBank Rotterdam (G.R.J.M., V.K.), Rotterdam, The Netherlands
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Vasanthananthan K, Bourgonje VJA, Lie JT, Mulders-Al-Saady R, Groeneveld-van Beek EA, de Leeuw J, Miron A, Wijdh RHJ, Stoutenbeek R, Melles GRJ, Oellerich S, Kocaba V. Corneal Guttae After Descemet Membrane Endothelial Keratoplasty. Cornea 2024; 43:146-153. [PMID: 37088908 DOI: 10.1097/ico.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/09/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this study was to report on the occurrence of corneal guttae after Descemet membrane endothelial keratoplasty (DMEK). METHODS In this retrospective case series, 13 eyes of 13 patients who underwent DMEK at 2 tertiary referral centers between 2007 and 2021 (average available follow-up 73 ± 52 months, range 18-174 months) and showed corneal guttae during postoperative examinations were included. Eye bank images were retrospectively reviewed. RESULTS Occurrence of guttae was observed by specular microscopy in 13 eyes. In 11 cases, presence of guttae was confirmed by confocal microscopy and in 1 case by histology. Five eyes showed an increase in guttae density during the postoperative course. Surgery indications were Fuchs endothelial corneal dystrophy (n = 11), pseudophakic bullous keratopathy (n = 1), and DMEK graft failure after allograft rejection (n = 1); the latter eye had shown no signs of guttae after primary DMEK. Two eyes with guttae required a repeat DMEK due to graft failure. At the last available follow-up, all 11 remaining eyes had clear corneas and 10 eyes had a best-corrected visual acuity of ≥0.9 (decimal). During donor cornea processing in the eye bank, no guttae were observed on the donor tissue. CONCLUSIONS Corneal guttae can occur after DMEK including in eyes operated for indications other than Fuchs endothelial corneal dystrophy and most likely guttae were present on the donor graft but were not detectable by routine slit-lamp and light microscopy evaluation in the eye bank. Postoperative guttae density varies among patients and especially small isolated guttae do not seem to affect clinical outcomes.
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Affiliation(s)
- Keamela Vasanthananthan
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Vincent J A Bourgonje
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Jessica T Lie
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Rana Mulders-Al-Saady
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Esther A Groeneveld-van Beek
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Jacky de Leeuw
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Alina Miron
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Robert H J Wijdh
- Universitair Medisch Centrum Groningen, Groningen, the Netherlands; and
| | - Remco Stoutenbeek
- Universitair Medisch Centrum Groningen, Groningen, the Netherlands; and
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Viridiana Kocaba
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
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Fernández-Vega-Cueto L, Lisa C, Vasanthananthan K, Madrid-Costa D, Alfonso JF, Melles GRJ. Spontaneous corneal clearance after graft detachment in DMEK. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:170-174. [PMID: 36738920 DOI: 10.1016/j.oftale.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/04/2022] [Indexed: 02/05/2023]
Abstract
Descemet Membrane detachment is a potential complication after Descemet Membrane Endothelial Keratoplasty (DMEK). Here, we present a unique case of a DMEK surgery in a complicated eye that suffered a nearly complete DMEK graft detachment and later a graft opacification with a pseudo-anterior chamber. In Mid-November 2020, a planned DMEK was performed in a 64-year-old male patient due to corneal decompensation. Four months after DMEK, a fibrotic DMEK graft was seen across the anterior chamber with a pseudo-anterior chamber; however, the recipient cornea showed complete clearance with an endothelial cell count of about 1204 cells/mm2 and a best-corrected visual acuity of 20/25. Three months later, we observed a significant opacification of the detached graft, and the best-corrected distance visual acuity decreased to 20/63. We proceeded with the graft removal without performing a second DMEK. Ten months after graft removal, the cornea remained clear with an endothelial cell count of about 510 cells/mm2, and the best-corrected visual acuity was 20/25.
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Affiliation(s)
| | - C Lisa
- Instituto Oftalmológico Fernández-Vega, Oviedo, Asturias, Spain
| | - K Vasanthananthan
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
| | - D Madrid-Costa
- Instituto Oftalmológico Fernández-Vega, Oviedo, Asturias, Spain
| | - J F Alfonso
- Instituto Oftalmológico Fernández-Vega, Oviedo, Asturias, Spain
| | - G R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
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Demirkaya N, Vasanthananthan K, van der Meulen I, Lapid-Gortzak R. Implantation of the Black Artisan Iris-Claw Intraocular Lens: A Case Series. Case Rep Ophthalmol 2020; 11:553-560. [PMID: 33250756 PMCID: PMC7670364 DOI: 10.1159/000509528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
In this case series, we report the use of the black Artisan iris-claw intraocular lens (IOL) (Ophtec, The Netherlands) in 6 patients with various visually debilitating symptoms requesting occlusion of one eye. Between 2016 and 2019, 6 (5 female, 1 male) patients underwent implantation of the custom-made black Artisan iris-claw IOL after other management strategies had failed to relieve their symptoms. The black Artisan IOL is an opaque anterior chamber IOL that is fixated to the iris by enclavation. Data were obtained from the electronic patient records (Epic, Verona, WI, USA). All implantation surgeries were uneventful. In terms of outcomes, 4 patients (67%) were satisfied with the result. In 2 patients (33%), the dysphotopic symptoms were not resolved, and these patients opted for either an enucleation or an evisceration. In conclusion, a black Artisan IOL is a valuable and - if needed - reversible option in the management of patients suffering from monocular debilitating visual symptoms leading to disturbances of binocular vision. The clinical presentation leading to the implantation of a pupil-occluding IOL varies and patient satisfaction following implantation is variable. Careful preoperative evaluation of patient factors and expectations, and stepped-care management is recommended to minimize treatment failure. Pupil-occluding lens implantation is often the last step in the treatment of intractable visual complaints in eyes with complex ophthalmologic history, before evisceration or enucleation.
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Affiliation(s)
- Nazli Demirkaya
- Department of Ophthalmology, Amsterdam UMC, location Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands
| | - Keamela Vasanthananthan
- Department of Ophthalmology, Amsterdam UMC, location Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands
| | - Ivanka van der Meulen
- Department of Ophthalmology, Amsterdam UMC, location Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands.,Retina Total Eye Care, Driebergen, The Netherlands
| | - Ruth Lapid-Gortzak
- Department of Ophthalmology, Amsterdam UMC, location Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands.,Retina Total Eye Care, Driebergen, The Netherlands
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