scholarly journals Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Vincent M. Borderie ◽  
Sara Touhami ◽  
Cristina Georgeon ◽  
Otman Sandali
Keyword(s):  
Visual Acuity ◽  
Predictive Factors ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
First Choice ◽  
Anterior Lamellar Keratoplasty ◽  
Big Bubble

Objective. Big bubble (BB)-deep anterior lamellar keratoplasty (DALK) has become the reference transplantation technique for corneal stromal disorders. Type 1 BB is the desired aspect but it is not constant. We aimed to determine the predictive factors of type 1 BB success. Methods. Observational cohort study including 77 consecutive eyes of 77 patients undergoing DALK by one surgeon at a single reference center without any selection. Clinical and spectral domain optical coherence tomography data were collected pre- and postoperatively. Results. Stromal scars were found in 91.8% of cases and were located in the anterior (90.9%), mid (67.5%), and posterior (36.4%) stroma. Type 1 BB (49.3% of cases) was significantly associated with the absence of scars in the posterior stroma, stage 1–3 keratoconus, and deep trephination. Among eyes with posterior scars, type 1 BB was associated with higher minimal corneal thickness, maximum-minimum corneal thickness < 220 μm, and diagnosis other than keratoconus. Eyes with type 1 BB featured significantly thinner residual stromal bed (22 ± 8 µm versus 61 ± 28 µm), thinner corneas at 12, 24, and 36 months, and better visual acuity at 12 months compared with eyes with no type 1 BB. Conversely, no significant differences between both groups were observed for graft survival, visual acuity at 24 and 36 months, and endothelial cell density at 12 and 36 months. Conclusion. OCT assessment before DALK is useful for choosing trephination depth that should be as deep as possible and for looking for posterior scars. The BB technique may not be the most appropriate method in keratoconus with posterior scars. Follow-up data do not support the need for conversion to penetrating keratoplasty when type 1 BB cannot be obtained nor does it support the need for performing a penetrating keratoplasty as a first-choice procedure in eyes with posterior stromal scars.

Microbubble technique in failed deep anterior lamellar keratoplasty: 2-year outcomes

2018 ◽  
Vol 28 (2) ◽  
pp. 243-245 ◽  
Author(s):  
Stefano Lippera ◽  
Giuseppe Pallotta ◽  
Piero Ferroni ◽  
Myrta Lippera ◽  
Leopoldo Spadea ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Corneal Thickness ◽  
Long Term Results ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Best Corrected Visual Acuity ◽  
Big Bubble

Purpose: To compare the long-term results of big-bubble technique and microbubble techniques to complete stroma dissection after failure of achieving a big-bubble. Methods: A total of 35 eyes with keratoconus underwent lamellar keratoplasty with the big-bubble technique (15 eyes) or the microbubble technique (15 eyes). Conversion to penetrating keratoplasty was performed in 3 eyes of the big-bubble group and in 2 eyes of the microbubble group. Best-corrected visual acuity, corneal thickness, corneal astigmatism, and endothelial cell count were assessed preoperatively and at 12 and 24 months after surgery. Results: Mean preoperative visual acuity was 0.29 ± 0.18 in the big-bubble group and 0.25 ± 0.15 in the microbubble group. Postoperatively, all patients showed a regular interface between donor and recipient tissue. At 24 months, mean best-corrected visual acuity was 0.84 ± 0.16 in the big-bubble group and 0.68 ± 0.17 in the microbubble group (p = 0.013), and mean central corneal thickness was 530 ± 39 µm in the big-bubble group and 545 ± 30 µm in the microbubble group. Astigmatism was 2.41 ± 1.29 D and 3.59 ± 1.48 D (p = 0.036), respectively, while endothelial cell density was 1,671 ± 371 in the big-bubble group and 1,567 ± 275 in the microbubble group. Conclusions: The microbubble technique appears to be a valid alternative as it was safe and provided good functional results.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in corneas showing a high or low graft rejection risk

2018 ◽  
Vol 29 (3) ◽  
pp. 295-303
Author(s):  
Edgar Javier Infantes Molina ◽  
Javier Celis Sánchez ◽  
José Maria Tenias Burilllo ◽  
David Diaz Valle ◽  
José Manuel Benítez-Del-Castillo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
High Risk ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Low Risk ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Best Corrected Visual Acuity

Purpose: To compare visual, topographic and topometric outcomes in patients subjected to deep anterior lamellar keratoplasty or penetrating keratoplasty showing a high or low risk of graft rejection. Setting: Complejo Hospitalario La Mancha Centro, Ciudad Real, Spain. Materials and methods: Data were reviewed for consecutive patients with a corneal stroma disease undergoing deep anterior lamellar keratoplasty or penetrating keratoplasty over the period 2009–2015 at our centre by the same surgeon. The outcome measures examined were 2-year follow-up best-corrected visual acuity, refractive error, topographic astigmatism, intraocular pressure, endothelial cell density and central corneal thickness. Results: Of 115 eyes enrolled, 46 underwent deep anterior lamellar keratoplasty (15 low risk, 31 high risk) and 69 penetrating keratoplasty (23 low risk, 46 high risk). Mean postoperative best-corrected visual acuity (logMAR) in the low- and high-risk groups, respectively, were 0.31 and 0.26 for deep anterior lamellar keratoplasty (p = 0.32) and 0.40 and 0.51 for penetrating keratoplasty (p = 0.28). The values for the high-risk deep anterior lamellar keratoplasty versus high-risk penetrating keratoplasty patients were 0.26 and 0.51, respectively (p = 0.004). Mean postoperative spherical equivalents were −2.60 D for low-risk deep anterior lamellar keratoplasty versus −2.29 D for high-risk deep anterior lamellar keratoplasty (p = 0.19), and −0.41 D for low-risk penetrating keratoplasty versus −0.13 D for high-risk penetrating keratoplasty (p = 0.51). Conclusion: Final best-corrected visual acuity and visual acuity gains were better for deep anterior lamellar keratoplasty, mainly in corneas with a high rejection risk. Despite a better corneal thickness recorded in the deep anterior lamellar keratoplasty group, the other variables examined were comparable. Deep anterior lamellar keratoplasty emerged as an effective alternative to penetrating keratoplasty for patients with a disease affecting the corneal stroma.

scholarly journals Comparison of Long-Term Outcomes of the Lamellar and Penetrating Keratoplasty Approaches in Patients with Keratoconus

2021 ◽  
Vol 10 (11) ◽  
pp. 2421
Author(s):  
Dominika Janiszewska-Bil ◽  
Barbara Czarnota-Nowakowska ◽  
Katarzyna Krysik ◽  
Anita Lyssek-Boroń ◽  
Dariusz Dobrowolski ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Adverse Events ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Cell Loss ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Cell Loss ◽  
Anterior Lamellar Keratoplasty ◽  
Significant Difference

We compared the visual and refractive outcomes, intraocular pressure (IOP), endothelial cell loss (ECL), and adverse events in keratoconus patients after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) with the best corrected visual acuity (BCVA) below 0.3 (logMAR 0.52). This is a prospective, comparative cohort study of 90 eyes (90 patients) with a clinical diagnosis of keratoconus. Patients underwent a complete eye examination before the surgical approach, 6 and 12 months postoperatively that consisted of BCVA, refractive astigmatism (AS), central corneal thickness (CCT), IOP, and ECL. Secondary outcomes were adverse events related to the surgical procedure. With lower ECL and less adverse events, DALK was revealed to be beneficial over PK with similar visual outcomes. Results: There was no significant difference between the BCVA in the DALK and PK groups (at 6 months: 0.49 ± 0.17 vs. 0.48 ± 0.17; p = 0.48; at 12 months: 0.54 ± 0.17 vs. 0.52 ± 0.14; p = 0.41). The mean value of AS was significantly lower after the PK procedure when compared to DALK, after both 6 and 12 months of follow up (p < 0.001). The CCT in the DALK group was significantly lower when compared to the PK group (at 6 months: 452.1 ± 89.1 µm vs. 528.9 ± 69.9 µm, p < 0.0001; at 12 months: 451.6 ± 83.5 µm vs. 525.5 ± 37.1 µm). The endothelial cell loss at 12 months after surgery was significantly lower after DALK when compared to PK (p < 0.0001). DALK transplantation should be considered as an alternative procedure in the surgical treatment of keratoconus.

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.

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.

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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