Visual acuity outcomes after deep anterior lamellar keratoplasty: a case-control study

2010 ◽  
Vol 94 (10) ◽  
pp. 1295-1299 ◽  
Author(s):  
D. T. H. Tan ◽  
A. Anshu ◽  
A. Parthasarathy ◽  
H. M. Htoon
Keyword(s):  
Visual Acuity ◽  
Case Control Study ◽  
Case Control ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Control Study

scholarly journals Cataract Surgery in Very Old Patients: A Case-Control Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4658
Author(s):  
Hanan Nussinovitch ◽  
Erez Tsumi ◽  
Raimo Tuuminen ◽  
Boris Malyugin ◽  
Yotam Lior ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Case Control Study ◽  
Surgical Techniques ◽  
Case Control ◽  
Dissipated Energy ◽  
Old Patients ◽  
Very Old ◽  
Very Old Patients ◽  
Control Study

Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age.

Femtosecond laser-assisted deep anterior lamellar keratoplasty: A safer option in keratoconus surgery

2021 ◽  
pp. 112067212110590
Author(s):  
Cristina Monterosso ◽  
Marco Antonini ◽  
Antonio Di Zazzo ◽  
Daniele Gaudenzi ◽  
Luigi Caretti ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Persistent Epithelial Defect ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Best Corrected Visual Acuity ◽  
Persistent Epithelial Defects

Purpose To evaluate postoperative safety of femtosecond laser deep anterior lamellar keratoplasty performed with an innovative anvil profile in keratoconus patients. Methods This is a single-center, retrospective cohort study. We reviewed medical records of 89 keratoconus patients that underwent femtosecond laser deep anterior lamellar keratoplasty surgery (46 eyes) and manual deep anterior lamellar keratoplasty (47 eyes). Inclusion criteria required: age > 18 years old, best-corrected visual acuity < 0.3 LogMAR, continuous suture of the graft, postoperative immunomodulant regimen with dexamethasone 0.1% for 6 months and at least 12 months follow-up. Previous eye surgery, hydrops, and other ocular disease were excluded. The main outcome measures were postoperative events: rejections, persistent epithelial defects, and graft failures. Results During the follow-up (20 ± 6 months) graft rejection was diagnosed in 0 of femtosecond laser deep anterior lamellar keratoplasty versus 6 (17%) of manual deep anterior lamellar keratoplasty [ p 0.027], persistent epithelial defect in 0 of femtosecond laser deep anterior lamellar keratoplasty versus in 4 (11%) of manual deep anterior lamellar keratoplasty [ p 0.048] and graft failure occurred in 4 (11%) of manual deep anterior lamellar keratoplasty. The best-corrected visual acuity, after removal of sutures, was better in the femtosecond laser deep anterior lamellar keratoplasty group 0.09 ± 0.08 LogMAR versus 0.16 ± 0.13 LogMAR in manual deep anterior lamellar keratoplasty [ p 0.035] group although refractive spherical equivalent and cylinder, topographic average keratometry and cylinder were similar. Conclusions Anvil-shaped femtosecond laser deep anterior lamellar keratoplasty in keratoconus surgery increases safety and readiness of recovery, decreasing the incidence of corneal rejection, epithelial defects, graft failures, and producing better best-corrected visual acuity after removal of sutures.

scholarly journals Multimodal imaging of Hurler syndrome-related keratopathy treated with deep anterior lamellar keratoplasty

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Elodie Da Cunha ◽  
Cristina Georgeon ◽  
Nacim Bouheraoua ◽  
Marc Putterman ◽  
Françoise Brignole-Baudouin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Multimodal Imaging ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Imaging Features ◽  
Hurler Syndrome ◽  
Hematopoietic Stem ◽  
First Choice ◽  
Anterior Lamellar Keratoplasty ◽  
Sd Oct

Abstract Background Hurler syndrome-associated keratopathy is an exceedingly rare corneal disorder that requires corneal transplantation in advanced stages. Precise assessment of the corneal condition is necessary for deciding which type of keratoplasty (i.e., deep anterior lamellar or penetrating) should be proposed. We aimed to confront the results of multimodal imaging with those of histology in a case of Hurler syndrome-associated keratopathy. Case presentation A 16-year-old patient with Hurler’s syndrome treated with hematopoietic stem cell transplantation was referred for decreased vision related to advanced keratopathy. The patient was treated with deep anterior lamellar keratoplasty (DALK) in both eyes with uncomplicated outcome. Visual acuity improved from 0.1 (20/200) preoperatively to 0.32 (20/63) and 0.63 (20/32) after transplantation. The corneal endothelial cell density was 2400 cells/mm2 in both eyes 3 years after transplantation. In vivo confocal microscopy (IVCM) and spectral domain optical coherence tomography (SD-OCT) were performed preoperatively. The corneal buttons retrieved during keratoplasty were processed for histology. In SD-OCT scans, corneal opacities appeared as diffuse stromal hyperreflectivity associated with increased corneal thickness. IVCM showed diffuse cytoplasmic granular hyperreflectivity and rounded/ellipsoid aspects of keratocytes, presence of small intracellular vacuoles, and hyperreflective epithelial intercellular spaces. Bowman’s layer was thin and irregular. The corneal endothelium was poorly visualized but no endothelial damage was observed. Histology showed irregular orientation and organization of stromal lamellae, with the presence of macrophages whose cytoplasm appeared clear and granular. A perinuclear clear halo was visible within the epithelial basal cells. Bowman’s layer featured breaks and irregularities. Conclusions The observed corneal multimodal imaging features in mucopolysaccharidosis-related keratopathy were concordant with histology. Compared with standard histology, multimodal imaging allowed additional keratocyte features to be observed. It revealed both morphological and structural changes of all corneal layers but the endothelium. This information is essential for therapeutic management which should include DALK as the first-choice treatment in case of impaired visual acuity.

scholarly journals Deep Anterior Lamellar Keratoplasty followed by Toric Lens Implantation for the Treatment of Concomitant Anterior Stromal Diseases and Cataract

2017 ◽  
Vol 1 (1) ◽  
pp. oapoc.0000008 ◽  
Author(s):  
Vincenzo Scorcia ◽  
Andrea Lucisano ◽  
Vincenzo Savoca Corona ◽  
Valentina De Luca ◽  
Adriano Carnevali ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cataract Surgery ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Toric Iol ◽  
Iol Implantation ◽  
Anterior Lamellar Keratoplasty ◽  
Topographic Astigmatism

Purpose To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) followed by phacoemulsification and toric intraocular lens (IOL) implantation for the treatment of concomitant stromal disease and cataract. Methods In this retrospective non-comparative interventional case series, ten eyes affected by stromal disease and cataract underwent DALK followed by phacoemulsification with toric IOL implantation after a minimum period of 5 months from complete suture removal. In each case, topographic astigmatism, refraction, visual acuity, and endothelial cell density were recorded before DALK and 1, 6, and 12 months after cataract surgery. In addition, IOL rotation was evaluated using anterior segment optical coherence tomography. Results Big-bubble DALK was performed in all eyes but one that received manual dissection. Topographic astigmatism averaged 5.6 ± 2.2 diopters (D) after suture removal; refractive astigmatism decreased to 0.55 ± 0.61 D as early as one month after cataract surgery and did not change substantially throughout the follow-up period. In all patients, one month after phacoemulsification uncorrected and best spectacle-corrected visual acuity were, respectively, ≥20/40 and ≥20/25 with a residual spherical equivalent of 0.00 ± 0.84 D. At the latest follow-up visit, in all cases the IOL rotation was ≤5 degrees from the intended position and the endothelial cell loss within 8.5%. No complications were recorded. Conclusions DALK followed by phacoemulsification with toric IOL implantation optimizes visual and refractive outcomes in patients with concomitant stromal disease and cataract. In comparison with a combined procedure, the sequential approach offers better predictability of the postoperative refraction in the absence of an increased risk of complications.

Comparison of corneal densitometry between big-bubble and visco-bubble deep anterior lamellar keratoplasty

2019 ◽  
Vol 104 (3) ◽  
pp. 336-340 ◽  
Author(s):  
Vincenzo Scorcia ◽  
Valentina De Luca ◽  
Andrea Lucisano ◽  
Donatella Bruzzichessi ◽  
Marco Balestrieri ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Visual Outcomes ◽  
Corneal Densitometry ◽  
Group I ◽  
Anterior Lamellar Keratoplasty ◽  
Significant Difference ◽  
Viscoelastic Substance ◽  
Big Bubble

AimsTo evaluate deep corneal densitometry and visual outcomes after big-bubble (BB-DALK) and visco-bubble (VB-DALK) deep anterior lamellar keratoplasty performed in patients with keratoconus.MethodsProspective comparative study of 50 advanced keratoconic patients who underwent DALK surgery; 25 eyes (group I) were completed with BB-DALK and 25 eyes (group II) with VB-DALK after the failure of pneumatic dissection. Best spectacle-corrected visual acuity (BSCVA), corneal tomographic parameters and endothelial cell count were recorded 1, 3, 6, 12 and 24 months after surgery. Densitometric analysis of the deep corneal interface was obtained using Scheimpflug tomography at each visit; values recorded were compared between the two groups and statistically analysed.ResultsBSCVA was significantly better in the BB-DALK group than the VB-DALK group (0.39±0.29 vs 0.65±0.23 logarithm of the minimum angle of resolution, respectively) for the first 3 months; and in the same time period, densitometry was significantly higher in the VB-DALK group than those recorded in the BB-DALK group (23.97±5.34 vs 17.13±4.44 grayscale units). However, densitometric values and visual acuity did not differ significantly in the two groups at 1 year. No statistically significant difference for the other variables analysed at any time frame was found.ConclusionThe use of viscoelastic substance in the VB-DALK technique may induce modification of interface stromal reflectivity resulting in reduced visual acuity up to 3 months postoperatively. However, this initial negative effect on the interface quality does not affect the long-term visual outcome, with densitometric values and visual outcomes similar in the two groups from 6 months postoperatively.

Current status of eye disorders caused by docetaxel administration every 3 weeks: A case-control study in Japanese patients

2019 ◽  
Vol 26 (3) ◽  
pp. 655-665 ◽  
Author(s):  
Yusuke Noguchi ◽  
Yugo Kawashima ◽  
Megumi Maruyama ◽  
Hiroko Kawara ◽  
Yoko Tokuyama ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Case Control Study ◽  
Japanese Patients ◽  
Case Control ◽  
Current Status ◽  
Eye Drops ◽  
Eye Disorders ◽  
Control Study

Purpose Docetaxel is known to cause eye disorders. In this study, current status of eye disorders caused by docetaxel administration every 3 weeks in Japanese patients was examined. Methods This case-control study targeted patients who were newly administered docetaxel at the Kyoto Okamoto Memorial Hospital between 1 July 2015 and 30 June 2018. Eye disorder occurrence was defined as an event in which the pharmacist confirmed the symptoms in a patient interview and the ophthalmologist diagnosed the disorder. Results Of the 89 subjects, 7 (7.9%) had eye disorders. The symptoms were watering eyes (7.9%), a stye and eye discharge (2.2% each), corneal and conjunctival disorder, visual acuity reduction, and blepharedema (1.1% each). Four patients who presented with watering eyes, eye discharge, or corneal and conjunctival disorder showed improvement with the use of eye drops such as artificial tears. Two patients who presented with a stye showed improvement with the use of oral cefcapene. One patient with mild symptoms showed spontaneous improvement. However, one patient had irreversible visual acuity reduction. The multivariate logistic regression analysis revealed that a cumulative docetaxel dose of ≥300 mg/m2 (odds ratio: 15.50, 95% confidence interval: 1.37–175.00, p = 0.027) and concomitant cyclophosphamide use (odds ratio: 13.20, 95% confidence interval: 1.13–153.00, p = 0.039) were significant risk factors associated with eye disorders. Conclusion In conclusion, it was determined that docetaxel-related eye disorders might be influenced by the cumulative dose of docetaxel and concomitant cyclophosphamide use. In addition, relatively mild symptoms improved with medication.

scholarly journals Risk factors influencing survival of acellular porcine corneal stroma in infectious keratitis: a prospective clinical study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Saiqun Li ◽  
Meng Li ◽  
Li Gu ◽  
Lulu Peng ◽  
Yuqing Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Graft Survival ◽  
Graft Failure ◽  
Corneal Stroma ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Infectious Keratitis ◽  
Anterior Lamellar Keratoplasty

Abstract Background A worldwide lack of donor corneas demands the bioengineered corneas be developed as an alternative. The primary objective of the current study was to evaluate the efficacy of acellular porcine corneal stroma (APCS) transplantation in various types of infectious keratitis and identify risk factors that may increase APCS graft failure. Methods In this prospective interventional study, 39 patients with progressive infectious keratitis underwent therapeutic lamellar keratoplasty using APCS and were followed up for 12 months. Data collected for analysis included preoperative characteristics, visual acuity, graft survival and complications. Graft survival was evaluated by the Kaplan–Meier method and compared with the log-rank test. Results The percentage of eyes that had a visual acuity of 20/40 or better increased from 10.3% preoperatively to 51.2% at 12 months postoperatively. Twelve patients (30.8%) experienced graft failure within the follow-up period. The primary reasons given for graft failure was noninfectious graft melting (n = 5), and the other causes included recurrence of primary infection (n = 4) and extensive graft neovascularization (n = 3). No graft rejection was observed during the follow-up period. A higher relative risk (RR) of graft failure was associated with herpetic keratitis (RR = 8.0, P = 0.046) and graft size larger than 8 mm (RR = 6.5, P < 0.001). Conclusions APCS transplantation is an alternative treatment option for eyes with medically unresponsive infectious keratitis. Despite the efficacy of therapeutic lamellar keratoplasty with APCS, to achieve a good prognosis, restriction of surgical indications, careful selection of patients and postoperative management must be emphasized. Trial registration Prospective Study of Deep Anterior Lamellar Keratoplasty Using Acellular Porcine Cornea, NCT03105466. Registered 31 August 2016, ClinicalTrails.gov

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in the treatment of stromal corneal dystrophies

2021 ◽  
Vol 2 (2) ◽  
pp. 116-122
Author(s):  
Ahmed Reda ◽  
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Visual Outcome ◽  
Corneal Dystrophy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Safety Outcomes

AIM: To compare the efficacy and safety of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in the treatment of stromal corneal dystrophy. METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity [best-corrected visual acuity (BCVA) (LogMAR)] and corneal endothelial cell count (ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference (WMD) and risk ratios (RRs), respectively, along with their respective 95% confidence intervals (CIs). RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy (59.71% males) were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively (WMD=401.62 cell/mm2, 95%CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower (RR=0.30, 95%CI: 0.14-0.64, P=0.002; RR=0.09, 95%CI: 0.02-0.46, P=0.004, respectively) when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet’s membrane perforations and postoperative double anterior chamber (All P<0.001). CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

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