Management of Corneal Ectasia after LASIK with Phototherapeutic Keratectomy Combined with Photorefractive Keratectomy and Collagen Cross-Linking

Background. To evaluate the efficacy of phototherapeutic keratectomy (PTK) combined with photorefractive keratectomy (PRK) and riboflavin with ultraviolet-A collagen cross-linking (CXL), performed sequentially on the same day, in the management of corneal ectasia after LASIK. Methods. This retrospective review comprised consecutive patients with corneal ectasia after LASIK. The patients were administered PTK and PRK on the previous corneal flap, and CXL was given on the same day by the same surgeon. The main outcome measures included age, sex, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent refraction, cylinder equivalent refraction, steep and flat keratometries (K), central corneal thickness (CCT), endothelial cell count, corneal haze, and ectasia stability. Mean follow-up period was 6, 12, and 24 months. Results. Sixteen eyes of twelve patients were included in the study. Twenty-four months after administration of PTK combined with PRK and CXL, a significant improvement in UDVA was observed. Mean cylinder equivalent refraction was significantly reduced at 6, 12, and 24 months postoperatively. However, no significant reduction was observed in spherical equivalent refraction. A significant reduction in the flat K and steep K values was observed. No significant change in mean CCT value was observed. Mean endothelial cell count and morphology were unchanged between preoperative and postoperative patients. In addition, no obvious corneal haze was observed. Conclusions. PTK combined with PRK and CXL on the same day is a safe and effective treatment in improving visual acuity in selected patients with corneal ectasia after LASIK.

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Standardized Flanged Intrascleral Intraocular Lens Fixation with the Double-Needle Technique for Cataract Luxation in the Vitreous Chamber during Phacoemulsification

Journal of Ophthalmology ◽

10.1155/2021/9998482 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Gianluca Besozzi ◽

Chiara Posarelli ◽

Maria Carmela Costa ◽

Alessio Montericcio ◽

Giuseppe Nitti ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Count ◽

Intraocular Lens ◽

Spherical Equivalent ◽

Refractive Outcome ◽

Endothelial Cell Count ◽

Corrected Visual Acuity ◽

Target Refraction ◽

Best Corrected Visual Acuity

Purpose. To assess the visual and refractive outcome of immediate intraoperative vitrectomy and intrascleral intraocular lens implantation using a “standardized” sutureless Yamane technique during cataract luxation in the vitreous chamber as a complication of phacoemulsification. Design. A prospective, interventional, consecutive case series. Materials and Methods. Twelve patients underwent vitrectomy and intrascleral intraocular lens fixation using a standardized Yamane technique as the primary procedure during complicated phacoemulsification. Patients were evaluated preoperatively and 6 months postoperatively for best-corrected distance visual acuity, correspondence to the preoperative refractive target in the spherical equivalent, endothelial cell count, and complications. Results. Mean preoperative best-corrected visual acuity was 1.16 ± 0.3 logarithm of the minimum angle of resolution (logMAR), the endothelial cell count was 1910.5 ± 297.64, and target refraction at baseline was −0.197 ± 0.087. Postoperatively, best-corrected visual acuity was significantly improved; the mean value was 0.05 logMAR ± 0.06. Mean baseline target refraction in the spherical equivalent was −0.20 ± −0.09 (range: −0.08 to −0.37), and mean final refraction was −0.44 ± −0.14 (range: −0.25 to −0.75) with no significant difference p = 0.87 . No complication was registered intra- and postoperatively. Conclusion. Standardization of the Yamane technique seemed a valuable option for patients who had complicated phacoemulsification to achieve a predictable refractive outcome. Synopsis. The predictable refractive outcome could be achieved with the immediate standardized Yamane technique in patients with intraoperative cataract luxation in the vitreous chamber during phacoemulsification.

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The utility of contact lens-assisted corneal cross-linking (CACXL) in progressive keratoconus patients with thin corneas

European Journal of Ophthalmology ◽

10.1177/11206721211070915 ◽

2022 ◽

pp. 112067212110709

Author(s):

Bilgehan Sezgin Asena ◽

Mahmut Kaskaloglu

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Count ◽

Contact Lens ◽

Corneal Thickness ◽

Hydroxypropyl Methylcellulose ◽

Cross Linking ◽

Demarcation Line ◽

Endothelial Cell Count ◽

The Mean

Purpose To evaluate efficacy and safety of contact lens-assisted corneal cross-linking (CACXL) among progressive keratoconus patients with thin corneas. Setting Private eye hospital Design Cross-sectional study Methods Thirty-six eyes of 36 consecutive patients with progressive keratoconus and thinnest corneal thickness of 380–400 µm after epithelium removal were included. CACXL was performed based on use of a dextran-free isotonic (>0.1%) riboflavin solution with hydroxypropyl methylcellulose (HPMC, 1.1%) after epithelial removal and placement of a riboflavin-soaked contact lens without an ultraviolet filter on the cornea and ultraviolet irradiance. Data on best distance corrected (CDVA) and uncorrected (UDVA) visual acuity, manifest sphere (D), manifest cylinder (D), K1 (D), K2 (D), mean keratometry (D) and Kmax (D) values, endothelial cell count and mean depth of demarcation line were recorded preoperatively and at the postoperative 1-year Results Post-operative 1-year data revealed significant increases in UDVA (0.23 ± 0.15 vs. 0.17 ± 0.13 D, p < 0.001) and CDVA (0.44 ± 0.18 vs. 0.36 ± 0.17 D, p < 0.001) values and a significant reduction in the mean Kmax (from 56 ± 3.3D to 55 ± 3.2 D, p < 0.001), K2 (from 49.7 ± 3.2 D to 49.52 ± 3.11 D, p = 0.049), manifest sphere (from −1.93 ± 2.21 D to −1.55 ± 2.02 D, p = 0.001) and manifest cylinder (from −2.83 ± 1.67 D to −2.39 ± 1.36 D, p < 0.001) values along with a similar endothelial cell count. The mean depth of demarcation line was mean 230 (SD17.05, range 200 to 262) at postoperative 1-month. Conclusions Our findings indicate favourable 1-year postoperative outcome of CACXL in progressive keratoconus patients with thin cornea in terms of improved visual acuity and keratectasia status as well as endothelial safety.

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Epi-off-lenticule-on corneal collagen cross-linking in thin keratoconic corneas

International Ophthalmology ◽

10.1007/s10792-020-01526-x ◽

2020 ◽

Vol 40 (12) ◽

pp. 3403-3412

Author(s):

Carlo Cagini ◽

F. Riccitelli ◽

M. Messina ◽

F. Piccinelli ◽

G. Torroni ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Corneal Thickness ◽

Endothelial Cell Density ◽

Cross Linking ◽

Corneal Transplant ◽

Collagen Cross Linking ◽

Corneal Collagen

Abstract Purpose To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) performed on overlaying a corneal lenticule to thin recipient corneas of progressive keratoconus (KC) patients. Methods In this study were enrolled eyes of patients affected by progressive KC with a minimum corneal thickness less than 400 µm, after overlaying a lenticule of human corneal stroma prepared with the femtosecond laser. The lenticules used were 100 µm thick and of 8.5 mm diameter in all the cases. Both the host cornea and the lenticules were subjected to epithelial debridement. CXL was carried out according to the standard protocol. Visual acuity, refraction, slit-lamp examination, endothelial cell density, pachymetry and keratometry, anterior segment tomography (AS-OCT) and confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Results CXL was performed in 10 eyes of 8 patients (main age 23), corneal thickness range 379–414 µm, mean 387.6 µm. One patient was lost at follow-up. In all other cases, visual acuity and the endothelial cell density remained stable over a 12-month follow-up. Preoperative mean K1 and mean K2 were 46.91 ± 1.9 and 50.75 ± 2.93, respectively, and at 12 months mean K1 was 47.36 ± 2.66 and mean K2 50.53 ± 3.35. The AS-OCT clearly showed a demarcation line in all patients at 1, 3 (mean depth 283 µm and 267 µm, respectively) and in some cases at 6 months. Reduced keratocyte density and stromal oedema were observed immediately up to 1 month after treatment, while a slight subepithelial haze was present at 1-month and completely disappeared by 6 months. Conclusion This new technique seems to offer a therapeutic opportunity for young patients suffering from progressive KC with very thin corneas, in which the standard treatment is not indicate, and delay or avoid the need for a corneal transplant.

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Comparison between the protective effect of Ophthalmic Viscoelastics on the corneal endothelium in phacoemulsification

QJM ◽

10.1093/qjmed/hcaa058.028 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S M A Saleh ◽

R M F Elghazawy ◽

A I Elawamry ◽

R G Zaki

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Protective Effect ◽

Cell Count ◽

Corneal Endothelium ◽

Hydroxypropyl Methylcellulose ◽

Methyl Cellulose ◽

Endothelial Cell Count ◽

Significant Difference ◽

Group 2

Abstract Background Phacoemulsification is one of the most common surgical interventions done worldwide; the ultrasound power used to emulsify and remove the cataractous lens is hazardous to corneal endothelium and can lead to permenant damage. Thats why ophthalmic viscoelastics have been developed and used to protect the corneal endothelium and ensure safety of intraocualr surgeries. Objective To study the effect of different concentrations of methyl cellulose on the corneal endothelium during phacoemulsification using specular microscopy. Patients and Methods Sixty patients with Immature Senile Cataract (IMSC) are equally distributed into two groups according to the concentration of Hydroxypropyl Methylcellulose (HPMC) used during phacoemulsification. In the first group HPMC 2% was used and in the second group HPMC 2.4% was used. Preoperative and one month postoperative examination was done including visual acuity testing, slit lamp examination using Topcon SL-3C, intraocular pressure measurement using Goldmann Applanation Tonometer (GAT), fundus examination, corneal edndothelium assessment by Tomey Specular Microscope EM-3000. Results Preoperatively, no significant difference was observed in age, sex, visual acuity, introcular pressure and endothelial cell count among the two groups. Postoperatively, the two groups had a significant decrease in endothelial cell count, but the decrease was less in group 2 using Methyl cellulose 2.4% (13.494%) than in group 1 using Methyl cellulose 2% (14.515%).There was an equal and significant increase in visual acuity in the two groups. Discussion Many studies have been done to compare the efficacy of different viscoelastics (OVDs) in the protection of corneal endothelium during phacoemulsification. In our study we compared the protective effect of two different concentrations of HydroxyPropyl MethylCellulose (2% &2.4%) on the corneal endothelium during phacoemulsification. We compared the demographic data as regarding age and sex of the patients in the two groups, also we compared the preoperative endothelial cell count in the two groups using Specualr Microscopy and the result showed no significant difference between the 2 groups. The endothelial cell loss was comparable in the 2 groups, in group 1 it was 362.267 ± 52.020 (14.515 % ± 1.458) and in group 2 it was 335.667 ± 21.170 (13.494% ±0.667) with slightly better protection in the second group. So these results shows that HPMC 2.4% gives better protection than HPMC 2% on corneal endothelium during phacoemulsification on terms of the postoperative endothelial cell count and the endothelial loss after phacoemulsification. Many studies have been done to compare the efficacy and the protective effect of different viscoelastics during phacoemulsification for example the studies done by Miller et al, Maar et al, Vajpayee et al and Storr-Paulsen et al, these studies showed results similar to our study as regards the protective effect of methyl cellulose with its different concentrations on the corneal endothelium during phacoemulsification, so both concentrations (2% and 2.4%) can be used safely and effectively in phacoemulsification to decrease the endothelial loss and ensure patients safety. Conclusion Methyl cellulose 2.4% and Methyl cellulose 2% were comparable in their ability to protect the corneal endothelium during phacoemulsification, in general both viscoelastics can be efficiently and safely used in performing phacoemulsification.

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Effect of the retention ring-assisted continuous application of riboflavin in pulsed-light accelerated corneal collagen cross-linking on the progression of keratoconus

10.21203/rs.2.72/v2 ◽

2019 ◽

Author(s):

Chung Young Kim ◽

Mee Kum Kim

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Corneal Thickness ◽

Endothelial Cell Density ◽

Cross Linking ◽

Pulsed Light ◽

Continuous Application ◽

Collagen Cross Linking ◽

Corneal Collagen

Abstract Background: To investigate the efficacy and safety of the retention ring-assisted continuous application of 0.1% riboflavin in pulsed-light accelerated corneal collagen cross-linking on the progression of keratoconus. Methods: The medical records of 20 eyes of 18 patients with progressive keratoconus who received collagen cross-linking at Seoul National University Hospital were retrospectively reviewed. Isotonic 0.1% riboflavin was continuously applied for 10 minutes using an 8.0-mm retention ring before the irradiation and accelerated cross-linking was applied with 30-mW pulsed-ultraviolet light at a wavelength 365 nm for eight minutes (1 second on/1 second off; 30 mW/cm2, cumulative dose of 7.2J/cm2) without further intermittent application of riboflavin. Visual acuity, refractive error, topographic index, corneal thickness, and endothelial cell density were evaluated before the operation and at 1, 3, 6, and 12 months. Results: The best corrected visual acuity in logMAR improved from preoperative 0.43 to 0.17 in 12 months (p = 0.050). Maximum keratometry decreased from 51.8 D to 50.4 D at six months (p = 0.015) and 50.1 D at 12 months (p = 0.0003). Astigmatism decreased from preoperative 5.5 D to 4.1 D at 12 months (p < 0.0001). Thinnest corneal thickness decreased at three and six months but recovered in 12 months (p > 0.05). Endothelial cell density decreased at postoperative one month (p = 0.02) but gradually recovered in 12 months (p > 0.05). Conclusions: Retention ring-assisted continuous application of riboflavin for ten minutes in pulsed-light accelerated cross-linking is a comparably safe and effective treatment for halting the progression of keratoconus in 12 months when compared to outcomes of the standard Dresden protocol shown in previous reports.

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Corneal collagen cross-linking in paediatric patients affected by keratoconus

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2016-310108 ◽

2017 ◽

Vol 102 (2) ◽

pp. 248-252 ◽

Cited By ~ 4

Author(s):

Karl Anders Knutsson ◽

Giorgio Paganoni ◽

Stanislav Matuska ◽

Oriella Ambrosio ◽

Giulio Ferrari ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Conventional Technique ◽

Endothelial Cell Density ◽

Cross Linking ◽

Demarcation Line ◽

Paediatric Patients ◽

Collagen Cross Linking ◽

Corneal Collagen

Background/aimsTo evaluate the effectiveness of corneal collagen cross-linking (CXL) in paediatric patients.MethodsFifty-two eyes of 43 paediatric patients with progressive keratoconus were enrolled in a prospective cohort study. Corneal CXL was performed using a conventional technique with instillation of 0.1% riboflavin solution containing dextran 20% for 30 min during the soaking phase and during the 30 min ultraviolet A irradiation (3 mW/cm2). Visual outcomes, topographic keratometry, maximum keratometry (K-max), refractive astigmatism, demarcation line and endothelial cell density were measured postoperatively.ResultsA significant decrease of K-max from 59.30±7.08 to 57.07±6.46 (p<0.001) was observed 2 years after treatment. Uncorrected visual acuity improved from 0.59±0.41 LogMAR (logarithm of the minimum angle resolution) to 0.46±0.33 LogMAR (p=0.06) 2 years after the procedure, while best spectacle corrected visual acuity improved from 0.17±0.11 LogMAR to 0.15±0.12 LogMAR (p=0.17). Twenty-five eyes had K-max values of 60 dioptres (D) or greater. In this subgroup, K-max significantly decreased from 64.94±4.99 D to 62.25±4.42 D at 2 years (p<0.001). The demarcation line of the CXL treatment had a mean value of 249±74 µm and did not show a significant correlation with K-max flattening (Spearman r=0.019, p=0.899). Endothelial cell density remained stable 2 years after the procedure, changing from 2800±363 to 2736±659 cells/mm2 (p=0.90).ConclusionCXL is an effective treatment for avoiding keratoconus progression in paediatric patients. The procedure is safe and successful in stabilising keratoconus in eyes with more advanced forms of the disease, characterised by topographic K-max values greater than 60 D.

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A Comparative Study of Two Types of Implantation Surgery Methods for Implantable Collamer Lenses

Journal of Ophthalmology ◽

10.1155/2021/4074773 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Hao Liu ◽

Denghao Dong ◽

Chunlin Chen ◽

Jian Ye

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Count ◽

Anterior Chamber ◽

Operation Time ◽

Corneal Endothelial Cell ◽

Distance Visual Acuity ◽

Endothelial Cell Count ◽

Group 2 ◽

Group 1

Purpose. To investigate the effects of two different surgical methods of implantable collamer lens (ICL) implantation on the operation time, visual outcomes, corneal endothelial cell count, and intraocular pressure (IOP). Methods. This was a contralateral eye comparison study, a total of 192 eyes from 96 patients were included, and the two eyes from the same patient were randomly assigned to two groups (group 1 and group 2, with 96 eyes in each group). In group 1, after making the corneal incision, ophthalmic viscosurgical devices (OVDs) were first injected into the anterior chamber followed by ICL implantation. In group 2, the ICL was first implanted into the anterior chamber followed by OVDs injection. The operation time, uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, corneal endothelial cell count, and IOP were recorded and analyzed. Results. The operative time in group 1 was significantly longer than that in group 2 ( P = 0.002 < 0.05). There were significant differences between IOP measured 2 hours following surgery of the two groups ( P = 0.026 < 0.05), Furthermore, the rate of IOP change 2 hours following the operation was significantly higher in group 1 than in group 2 ( P = 0.019 < 0.05). There were significant differences in the anterior chamber angle 2 hours after surgery compared with that before surgery in both groups ( P = 0.014 < 0.05 and P = 0.029 < 0.05, respectively). No significant differences were observed in the other parameters measured (all P > 0.05). Conclusion. The two ICL implantation methods had similar clinical outcomes and effects on the corneal endothelial cell count. Additionally, the implantation of an intraocular lens prior to injecting OVDs reduces the operation time and lowers the rate of IOP rise in the early postoperative period, making it safe and effective for ICL implantation.

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Current and new indications for corneal cross-linking in the therapy of corneal diseases

OphthaTherapy Therapies in Ophthalmology ◽

10.24292/01.ot.300921.1 ◽

2021 ◽

Vol 8 (3) ◽

pp. 186-193

Author(s):

Katarzyna Przewłócka ◽

Piotr Kanclerz

Keyword(s):

Visual Acuity ◽

Invasive Surgery ◽

Refractive Surgery ◽

Cross Linking ◽

Bullous Keratopathy ◽

Common Indication ◽

Corneal Ectasia ◽

Corneal Refractive Surgery ◽

Collagen Cross Linking ◽

Corneal Collagen

Corneal collagen cross-linking, a technique used in ophthalmology, involves the creation of new bonds between collagen fibers, thus leading to stabilization and corneal stiffening. The most common indication for corneal collagen cross-linking procedures is to prevent the progression of corneal ectasia,\ i.e., keratoconus, pellucid marginal degeneration, and ectasia after corneal refractive surgery. Clinical data also indicate that it is effective in the treatment of bacterial corneal infections and bullous keratopathy. Corneal collagen cross-linking was shown to inhibit the progression of corneal ectasia, and the treatment commonly leads to the improvement in visual acuity, decreases the maximum keratometry values, and improves the corneal topography image. In addition, it is possible to avoid or postpone the need for more complex and invasive surgery.

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Effect of the Retention Ring-Assisted Continuous Application of Riboflavin in Pulsed-Light Accelerated Corneal Collagen Cross-Linking on the Progression of Keratoconus

10.21203/rs.2.72/v1 ◽

2018 ◽

Author(s):

Chung Young Kim ◽

MD Mee Kum Kim

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cell Density ◽

Corneal Thickness ◽

Endothelial Cell Density ◽

Cross Linking ◽

Pulsed Light ◽

Continuous Application ◽

Collagen Cross Linking ◽

Corneal Collagen

Abstract Purpose: To investigate the efficacy and safety of the retention ring-assisted continuous application of 0.1% riboflavin in pulsed-light accelerated corneal collagen cross-linking on the progression of keratoconus. Methods: The medical records of 20 eyes of 18 patients with progressive keratoconus who received collagen cross-linking at Seoul National University Hospital were retrospectively reviewed. Isotonic 0.1% riboflavin was continuously applied for 10 minutes using an 8.0-mm retention ring before the irradiation and accelerated cross-linking was applied with 30-mW pulsed-ultraviolet light at a wavelength 365 nm for eight minutes (1 second on/1 second off; 30 mW/cm2, cumulative dose of 7.2J/cm2) without further intermittent application of riboflavin. Visual acuity, refractive error, topographic index, corneal thickness, and endothelial cell density were evaluated before the operation and at 1, 3, 6, and 12 months. Results: The best corrected visual acuity in logMAR improved from preoperative 0.43 to 0.18 in 12 months. Maximum keratometry decreased from 51.8 D to 50.4 D at six months (p = 0.015) and 50.3 D at 12 months (p < 0.0001). Astigmatism decreased from preoperative 5.5 D to 4.2 D at 12 months (p < 0.0001). Thinnest corneal thickness decreased at three and six months but recovered in 12 months (p > 0.05). Endothelial cell density decreased at one month (p = 0.02) but gradually recovered in 12 months (p > 0.05). Conclusions: Continuous application of riboflavin using a retention ring for 10 minutes in an accelerated pulsed-light collagen cross-linking seems to be safe and effective for halting the progression of the keratoconus.

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Visual Outcome of Descemet Membrane Endothelial Keratoplasty during the Learning Curve in Initial Fifty Cases

Journal of Ophthalmology ◽

10.1155/2019/5921846 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Sanjay K. Singh ◽

Sanjeeta Sitaula

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Learning Curve ◽

Cell Count ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Endothelial Cell Count ◽

Corrected Visual Acuity

This study was performed to evaluate the clinical outcomes of the first fifty patients who underwent Descemet membrane endothelial keratoplasty (DMEK) during the 3-month postoperative period and to describe the challenges encountered during the learning curve. In this retrospective study, we reviewed the charts of patients who underwent DMEK. All information regarding patient demographics, indication for surgery, preoperative and postoperative visual acuity at 3 months, donor age, and complications encountered intraoperatively and postoperatively was recorded. Donor endothelial cell count at the time of surgery and during the 3-month follow-up was noted. Data were analyzed using SPSS version 17. Fifty eyes of 49 patients were included in the study with majority being female patients (male : female = 2 : 3). Mean age of patients was 56.8 ± 11.4 years with the age range of 22–78 years. The common indications for DMEK were pseudophakic bullous keratopathy –57.1%, Fuchs endothelial dystrophy-34.7%, failed grafts-6.1% (Descemet stripping endothelial keratoplasty (DSEK) and failed penetrating keratoplasty), and others. Preoperative best spectacle-corrected visual acuity was <20/400 in 88% cases. Postoperative best spectacle-corrected visual acuity at 3 months was >20/63 in 41.8% of the cases, and 93% had visual acuity of 20/200 or better. Donor size was 8 mm, and average donor endothelial cell count (ECC) was 2919 ± 253 cells/mm2. Average ECC at 3 months postoperatively was 1750 ± 664 cells/mm2, which showed a 40% decrease in ECC. The most common encountered complication was graft detachment, which occurred in 16% cases for which rebubbling was done. Regular follow-up and timely identification of graft detachment may prevent the need for retransplantation.

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