Impact of Clear Corneal Incision Morphology on Incision-Site Descemet Membrane Detachment in Conventional and Femtosecond Laser-Assisted Phacoemulsification

Purpose. To compare and evaluate three-plane clear cornea incision (CCI) created with a femtosecond laser (Victus, B&L) and a metal keratome (2,2 mm steel). Materials and Mehtods. Sixty eyes of 60 patients were examined using anterior segment optical coherence tomography (AS-OCT) in early postoperative period (1 day, 1 week, 1 month) after phacoemulsification surgery. Images were used to measure incision length and incidence of epithelial or endothelial gaping, Descemet membrane detachment. Results. In the femtosecond group (34 eyes) the mean CCI length was 2.02 ± 0.05 mm versus keratome group (26 eyes) 2.04 ± 0.43mm. In laser group all incisions (100 %) were three-plane. In keratome group with manual incisions only 23 % were three-plane, 57.7 % were two-plane and 19.3 % were one-plane. Comparison of morphological features of femtosecond and keratome group: endothelial gaping 20.5 % versus 23 %, epithelial gaping 8.8 % versus 19 %. Descemet membrane detachment 17.6 % versus 34 %, respectively. Conclusion. All eyes in femtosecond group had three-plane profile visible on AS-OCT. Femtosecond CCIs showed better tunnel morphology compared to keratome group. Multiplane profile and minimal damaging of CCI will improve safety in the postoperative period.

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Epithelial downgrowth after Descemet membrane endothelial keratoplasty

European Journal of Ophthalmology ◽

10.1177/1120672120912413 ◽

2020 ◽

pp. 112067212091241

Author(s):

Viet Nhat Hung Le ◽

Florian Wabnig ◽

Bjoern Bachmann ◽

Claus Cursiefen

Keyword(s):

Anterior Segment ◽

Corneal Edema ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Visual Axis ◽

Corneal Incision ◽

Descemet Membrane ◽

Clear Corneal Incision ◽

Close Observation ◽

Histopathologic Evaluation

Purpose: To describe a patient with epithelial downgrowth after Descemet membrane endothelial keratoplasty. Methods: Case report. Results: A 73-year-old woman underwent triple Descemet stripping automated endothelial keratoplasty for cataract and corneal edema secondary to Fuchs endothelial dystrophy in the left eye elsewhere. Three years later, Descemet membrane endothelial keratoplasty was performed at our department due to graft failure. One month after the operation, her vision improved to 20/32 and maintained stable. At the 14-month visit, her visual acuity decreased, and a routine examination revealed epithelial downgrowth at the posterior surface of the cornea and partly beneath the graft, accompanied by presumed graft rejection. Therefore, repeat Descemet membrane endothelial keratoplasty with epithelial scraping and intracameral injection of 5-fluorouracil was indicated. She recovered 20/25 vision by 1 month after the surgery. However, small sheet-like epithelial downgrowth recurred 1 month later. The epithelial downgrowth was limited to the peripheral margin of the Descemet membrane endothelial keratoplasty graft and did not affect the visual axis. Epithelial downgrowth showed “islands” with connection between epithelial downgrowth and clear corneal incision on anterior segment optical coherence tomography images. Histopathologic evaluation of the removed Descemet membrane endothelial keratoplasty graft confirmed conjunctival epithelium as the source. Under close observation at the current 4-year follow-up, the epithelial downgrowth remained stable and localized and her vision increased to 20/20. Conclusion: Epithelial downgrowth can occur after Descemet membrane endothelial keratoplasty. The limited progression of epithelial downgrowth in this patient suggests that this condition after Descemet membrane endothelial keratoplasty even in the recurrence stage may cause less damage than expected and may only need to be observed closely if no progression occurs.

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Descemet Membrane Detachment in Femtosecond Laser-Assisted Cataract Surgery

Cornea ◽

10.1097/ico.0000000000000773 ◽

2016 ◽

Vol 35 (4) ◽

pp. 562-564 ◽

Cited By ~ 4

Author(s):

Ricardo M. Nosé ◽

Maria Daniela Rivera-Monge ◽

Adriana S. Forseto ◽

Walton Nosé

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Descemet Membrane ◽

Descemet Membrane Detachment

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Femtosecond Laser Versus Manual Clear Corneal Incision in Cataract Surgery

Journal of Refractive Surgery ◽

10.3928/1081597x-20131217-03 ◽

2014 ◽

Vol 30 (1) ◽

pp. 27-33 ◽

Cited By ~ 59

Author(s):

Leonardo Mastropasqua ◽

Lisa Toto ◽

Alessandra Mastropasqua ◽

Luca Vecchiarino ◽

Rodolfo Mastropasqua ◽

...

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Corneal Incision ◽

Clear Corneal Incision

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Incision-Site Descemet Membrane Detachment During and After Phacoemulsification

Eye & Contact Lens Science & Clinical Practice ◽

10.1097/icl.0000000000000120 ◽

2015 ◽

Vol 41 (5) ◽

pp. 273-276 ◽

Cited By ~ 3

Author(s):

Namrata Sharma ◽

Pooja Bandivadekar ◽

Tushar Agarwal ◽

Ritu Shah ◽

Jeewan S. Titiyal

Keyword(s):

Descemet Membrane ◽

Incision Site ◽

Descemet Membrane Detachment

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Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery

International Journal of Ophthalmology ◽

10.18240/ijo.2020.12.08 ◽

2020 ◽

Vol 13 (12) ◽

pp. 1895-1900

Author(s):

Wei Chen ◽

Jian Wu ◽

Yong Wang ◽

Jing Zhou ◽

Rong-Rong Zhu ◽

...

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Corneal Astigmatism ◽

Corneal Incision ◽

Surgically Induced Astigmatism ◽

Clear Corneal Incision ◽

Case Series Study ◽

Induced Astigmatism ◽

Surgically Induced ◽

Corneal Incisions

AIM: To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery. METHODS: This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism (range: +0.75 to +2.50 D) who had femtosecond laser-assisted steepest-meridian clear corneal incisions (single or paired). Corneal astigmatism was performed with the Pentacam preoperatively and 3mo postoperatively. Total corneal astigmatism and steepest-meridian measured in the 3-mm central zone were used to guide the location, size and number of clear corneal incision. The vector analysis of astigmatic change was performed using the Alpins method. RESULTS: Totally 138 eyes of 138 patients were included. The mean preoperative corneal astigmatism was 1.31±0.41 D, and was significantly reduced to 0.69±0.34 D (equivalent to difference vector) after surgery (P<0.01). The surgically-induced astigmatism was 1.02±0.54 D. The correction index (ratio of target induced astigmatism and surgically-induced astigmatism: 0.72±0.36) as well as the magnitude of error (difference between surgically-induced astigmatism and target induced astigmatism: -0.29±0.51) represented a slight under correction. For angle of error, the arithmetic mean was 1.11±13.70, indicating no significant systematic alignment errors. CONCLUSION: Femtosecond-assisted steepest-meridian clear corneal incision is a fast, customizable, adjustable, precise, and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.

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