scholarly journals Pediatric Keratoplasty: The Success of a Tailor-Made Surgical Management

2020 ◽  
Vol 11 (3) ◽  
pp. 639-646
Author(s):  
Raffaele Nuzzi ◽  
Alessandro Rossi
Keyword(s):  
Surgical Techniques ◽  
Corneal Opacity ◽  
Suture Technique ◽  
Lamellar Keratoplasty ◽  
Postoperative Phase ◽  
Interrupted Suture ◽  
Case Evaluation ◽  
Corneal Opacities ◽  
The Individual ◽  
Surgical Standard

A Romanian 5-month-old girl was referred to our hospital after being diagnosed with congenital corneal opacities. She was sent in order to undergo penetrating keratoplasty (PKP) surgery on her left eye. The patient presented a natural tendency to esotropia. We took into account two different surgical techniques: PKP and lamellar keratoplasty. The latter was technically impossible to carry out because of the full-thickness corneal opacity. We conducted several tests to accurately obtain the patient’s preoperative parameters and specifically decide the details of the surgical technique to be applied. For each step of the surgical procedure we carefully compared the individual results in the literature in order to ensure a stable and lasting result. In addition to this, we used an innovative suture technique: nylon thread, interrupted suture, alternating 11-0/10-0 threads. Six months after the operation, the functional result obtained was 4–5/10, with recovery of the fixation. Pediatric PKP, therefore, cannot follow a surgical standard, but requires careful case-by-case evaluation from the pre- to the postoperative phase, with the aim of maximizing stable visual acuity.

scholarly journals Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joseph J. Noh ◽  
Tae-Hyun Kim ◽  
Chul-Jung Kim ◽  
Tae-Joong Kim
Keyword(s):  
Incisional Hernia ◽  
Single Port ◽  
Surgical Techniques ◽  
Patient Characteristics ◽  
Suture Technique ◽  
Perioperative Outcomes ◽  
Gynecologic Surgery ◽  
Single Port Access ◽  
Interrupted Suture ◽  
Port Access

Abstract The present study was conducted to report the perioperative outcomes of single-port access (SPA) laparoscopic gynecologic surgeries with focus on the incidence of postoperative incisional hernia from our cumulative data of 2498 patients. A retrospective review was performed on the women who had received SPA surgeries from 2008 to 2018. Patient characteristics and perioperative outcomes including the incidence of postoperative incisional hernia were analyzed. There were 2498 Korean patients who received SPA surgeries for various gynecologic diseases. The median age of the patients was 40.3 ± 9.2 years, and the mean body mass index (BMI) was 22.6 ± 3.2 kg/m2. A total of 3 postoperative incisional hernia occurred during the study period. Two patients whose fascial layers were closed in running sutures developed hernias 6 and 8 months after their operations. One patient whose fascial layers were closed in interrupted sutures developed hernia 11 months after her operation. The incidence of postoperative incisional hernia following SPA surgery is low in Asian women whose BMI is relatively lower than other patient populations. Interrupted suture technique may reduce postoperative incisional hernia by providing a distinct visualization of fascial layers during closure. Detailed descriptions of our surgical techniques of closing the port incision are provided.

scholarly journals Clinicopathologic Features and Treatment Characteristics of Congenital Corneal Opacity Infants and Children Aged 3 Years or Less: A Retrospective Single Institution Analysis

2019 ◽  
Vol 29 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Sen Miao ◽  
Qi Lin ◽  
Yang Liu ◽  
Yao-Wen Song ◽  
Ying-Nan Zhang ◽  
...  
Keyword(s):  
Corneal Opacity ◽  
Ultrasound Biomicroscopy ◽  
Pathological Examination ◽  
Lamellar Keratoplasty ◽  
Clinicopathologic Features ◽  
Single Institution ◽  
Treatment Characteristics ◽  
Careful Clinical Examination ◽  
Diagnosis And Classification ◽  
Corneal Opacities

Objective: In this retrospective single institution study, we investigated the clinicopathologic features and treatment characteristics of 90 patients with congenital corneal opacities (CCO) (117 eyes) who were 3 years and younger and treated at our hospital. Subject and Methods: We reviewed the clinical data of patients with CCO who presented for the first time for treatment at our hospital between January 1, 2017, and December 31, 2017. CCO were classified using the “STUMPED” (Sclerocornea, Tears in Descement’s membrane, Metabolic, Peters, Endothelial dystrophy and Dermoid) method and confirmed by pathological examination. ­Results: Seventy percent of the patients had unilateral CCO. Iridocorneal adhesions (61 eyes, 52.1%) and cataracts (22 eyes, 18.8%) were the 2 most common ocular abnormalities. Systemic abnormalities were present in 5 patients (5.6%), including growth retardation (4 patients) and congenital brain defects (1 patient). Eighty-five eyes (72.6%) underwent penetrating keratoplasty (PK), and lamellar keratoplasty (LK) was performed in 30 (25.6%) eyes. Forty-seven (95.9%) eyes with Peters anomaly and all 16 eyes with sclerocornea received PK, and all 24 eyes with dermoids were treated with LK. Conclusion: Our study demonstrates that CCO has varied manifestations in infants and young children in China. A thorough medical history, careful clinical examination, and the use of accessory examinations such as ultrasound biomicroscopy are critical for the accurate diagnosis and classification of CCO and to provide guidance on therapeutic choices.

scholarly journals Indications for keratoplasty in Nepal: 2005 - 2010

2013 ◽  
Vol 5 (2) ◽  
pp. 207-214 ◽  
Author(s):  
Leena Bajracharya ◽  
R Gurung ◽  
EH DeMarchis ◽  
M Oliva ◽  
S Ruit ◽  
...  
Keyword(s):  
Case Series ◽  
Corneal Opacity ◽  
Corneal Dystrophy ◽  
Bullous Keratopathy ◽  
Infectious Keratitis ◽  
Eye Health ◽  
Corneal Scar ◽  
Recipient Age ◽  
Corneal Opacities ◽  
Corneal Blindness

Introduction: Corneal disease, especially infective keratitis, is one of the major causes of visual impairment and blindness in developing countries. Objective: To find out the current indications for keratoplasty, how these indications have changed over time as well as how they are different from those in other parts of the world. Materials and methods: A retrospective study of a case series of 645 keratoplasty surgeries (589 patients) was conducted at the Tilganga Institute of Ophthalmology from January 2005 to December 2010. Outcome measures: The cases were evaluated in terms of demographic parameters, preoperative diagnosis and the type of surgery performed. Results: The most common indication for surgery was active infectious keratitis (264 eyes, 40.9 %), followed by corneal opacity (173 eyes, 26.8 %), regraft (73 eyes, 11.2 %), bullous keratopathy (58 eyes, 9.0 %), keratoconus (45 eyes, 7.0 %) and corneal dystrophy (11 eyes, 1.7 %). The mean recipient age was 41.7 ± 19.9 years with over a half of the patients between 15 to 49 years of age. More men (64.1 %) underwent keratoplasty than women (35.8 %). 59.8 % of the eyes with infectious keratitis had a perforated corneal ulcer. 49.7 % of corneal opacities were due to previous infectious keratitis. 72 % of regrafts were for endothelial failure of various causes. In older patients (> 50 years), bullous keratopathy was an important indication, after infectious keratitis. Keratoconus and corneal scar were major causes of keratoplasty in children of 14 years or less. Four percent of the patients had keratoplasty in both the eyes. 17.1 % of the patients who had one eye operated on had a blind fellow eye with a vision of less than 3/60. Conclusion: Currently, keratitis, either active or healed, is the major indication for keratoplasty, suggesting that improved primary eye health care is necessary to decrease the prevalence of corneal blindness. Nepal J Ophthalmol 2013; 5(10): 207-214 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8730

New Surgical Techniques

Glaucoma ◽  
2012 ◽  
Author(s):  
Anand Mantravadi
Keyword(s):  
Anterior Chamber ◽  
Corneal Endothelium ◽  
Surgical Techniques ◽  
Suture Technique ◽  
Fort Worth ◽  
Scleral Flap ◽  
Conjunctival Flap ◽  
Partial Thickness ◽  
Surgical Options ◽  
Filtering Procedure

The surgical options for glaucoma are expanding with a growing body of evidence of the short- and longer-term results. This chapter will focus on description of newer surgical techniques that hold promise in the treatment of glaucoma. The ExPRESS Mini-shunt (Optonol Ltd., Neve Ilan, Israel/Alcon, Fort Worth, TX) has emerged as a device used to help standardize one part of the trabeculectomy filtering procedure. This biocompatible, stainless-steel device, which measure 400 microns wide by 3 mm long, contains a 50-micron non-valved opening to enable filtration for the treatment of glaucoma (Fig. 14.1) Currently recommended for use underneath a partial-thickness scleral flap • Using a standard fornix- or limbus-based conjunctival flap, and after application of antimetabolites, this device is placed underneath a partial-thickness scleral flap, fashioned identically to a trabeculectomy procedure. • A 26-gauge needle or commercially available Sapphire blade is used to enter the anterior chamber under the scleral flap at the color transition from clear cornea at an angle parallel to iris plane. • Using a preloaded injector, the device is placed into the anterior chamber through the previously fashioned tract so that the plate is flush with the bed of the sclera flap. • The desired position of the device under the sclera flap is into the anterior chamber with distance from the corneal endothelium. • The flap is then sutured as is typical for a trabeculectomy, titrating tightness of sutures to desired amounts of flow. These sutures can, as with a trabeculectomy, be released or lysed with laser subsequently depending on the suture technique. • An iridotomy is not performed with this procedure. Therefore, this procedure represents a modification of a guarded filtration procedure using a device with a standardized ostium size to replace the sclerostomy and iridotomy portions of the trabeculectomy procedure. • By eliminating the sclerostomy, the rate of aqueous egress from the 50-micron opening into the subconjunctival/sub-Tenon’s plane is reportedly more standardized in comparison to trabeculectomy. • Although there are reports suggesting a lower incidence of hypotony with the ExPRESS in the immediate postoperative period as compared to trabeculectomy, the rate of flow in both ExPRESS use and trabeculectomy is critically determined by the tension of the sutures at the scleral flap, which was not standardized among the two groups.

scholarly journals Comparison of clinical, biomechanical, and histopathological effects of various suture techniques on repair of tendon rupture by using autograft

2017 ◽  
Vol 61 (2) ◽  
pp. 231-237
Author(s):  
Celal Şahin Ermutlu ◽  
Vedat Baran
Keyword(s):  
Good Alternative ◽  
Suture Technique ◽  
Suture Techniques ◽  
Tissue Loss ◽  
Group Iii ◽  
Interrupted Suture ◽  
Group I ◽  
Tendon Ruptures ◽  
The Right ◽  
And Control

AbstractIntroduction: The purpose of this study was to compare the effectiveness of four different suture techniques in the treatment of experimentally modelled tendon injuries with tissue loss with autograft and grafting applications in rabbits.Material and Methods: The study was performed on 30 male mature (2-year-old) New Zealand rabbits with mean body weight of 3.1 kg, divided into three equal groups. A graft measuring 1 cm in length was collected from the m. tibialis cranialis of each rabbit under general anaesthesia. The graft collected from the right tendon was transplanted into the left tendon, and the graft from the left tendon was transplanted into the right tendon. In all groups, a simple interrupted suture was placed on the left tendon as control, a Bunnell-Mayer suture was placed on the right tendon in group I, a Locking-Loop suture in group II, and a Horizontal U suture in group III. Both hindlimbs were bandaged for four weeks. The tendons were assessed biomechanically and histopathologically.Results: According to the results of the tensile testing, the maximum durability of the techniques ranked as follows: Bunnell-Mayer, Horizontal U, Locking-Loop, and control groups.Conclusion: The use of autografts was a good alternative for the treatment of tendon ruptures with tissue loss. Furthermore, even though there were no clinical or histopathological differences, the suture technique can be chosen based on the results of the tensile test.

Different Therapeutic Approaches and Outcome in the Treatment of Pterygium

1998 ◽  
Vol 8 (3) ◽  
pp. 148-152 ◽  
Author(s):  
C. H. Karabatsas ◽  
G. W. Marsh ◽  
A. M. Cook ◽  
S. D. Cook
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Lamellar Keratoplasty ◽  
Therapeutic Approaches ◽  
Therapeutic Modalities ◽  
Results Of Treatment ◽  
One Year

Purpose This study was initiated to investigate the role of different therapeutic modalities in the outcome of the surgical treatment of pterygium. Methods The results of treatment of pterygia with a variety of surgical techniques were studied in 56 eyes (49 patients) operated on at Bristol Eye Hospital during a period of five years. The surgical techniques included simple excision; bare sclera; conjunctival autograft; sliding conjunctival flap; lamellar keratoplasty and penetrating keratoplasty. Twelve eyes received additional beta irradiation in a fractionated total dose of 40 Gys. Results The incidence of recurrence was 23.2% for the 43 treated primary pterygia, and 23% for the 13 recurrent pterygia. All recurrences occurred between 2.5 and 11 months postoperatively. None of the 11 cases where additional beta irradiation was used showed any recurrence or other complication within the study period. In the recurrent pterygia group, the cases treated with a combination of surgical excision and beta irradiation, showed significantly lower recurrence rate (p<0.001) compared to those cases treated with surgical excision alone. Conclusions Beta irradiation as a complement to surgical treatment of pterygium, is successful in treating high risk cases such as reoperations, whereas for the majority of primary pterygia surgical excision alone is adequate. Additionally, follow up of one year will reveal any recurrences.

Corneal graft surgery: A monocentric long-term analysis

2020 ◽  
pp. 112067212094759
Author(s):  
Andrea Montesel ◽  
Jorge L Alió del Barrio ◽  
Pilar Yébana Rubio ◽  
Jorge L Alió
Keyword(s):  
Survival Rates ◽  
Surgical Techniques ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corneal Transplant ◽  
Inclusion Criteria ◽  
Visual Outcomes ◽  
Anterior Lamellar Keratoplasty ◽  
Immunological Rejection ◽  
Clinical Records

Purpose: To investigate indications, outcomes and changes in clinical patterns of keratoplasty surgery in a Spanish tertiary eye center. Setting: Vissum Instituto Oftalmológico, Alicante, Spain. Methods: A retrospective review was performed on clinical records of patients that underwent any kind of corneal transplant from 2001 to 2017 in the study center. Inclusion criteria involved the presence of detailed preoperative examination, surgical report and at least 12 months follow-up after the surgery. A statistical analysis was performed on the indications for keratoplasty, survival rates, type of graft failures, and visual outcomes. Results: A total of 907 keratoplasties procedures were identified. About 432 penetrating keratoplasty (PK), 148 deep anterior lamellar keratoplasty (DALK), and 134 endothelial keratoplasty (EK) met the inclusion criteria. Cumulative survival rate ranged from 94% to 69% in a 1-year period and from 85% to 45% in a 5-years period according to the different graft types. The main cause for failure was immunological rejection for PK, surface diseases for DALK and primary graft failure for EK. Postoperative visual function improved for all the surgical techniques. Conclusion: Corneal transplant is a challenging surgery still complicated by a relevant risk of failure. Our study offers a useful opinion of the current trends on keratoplasty in our country, where the outcomes of the grafts differ considerably in relation to the indications and the different surgical techniques, with lamellar procedures that showed higher rates of success and better visual outcomes than full-thickness grafts.

Population-based assessment of visual impairment and pattern of corneal disease: results from the CORE (Corneal Opacity Rural Epidemiological) study

2019 ◽  
Vol 104 (7) ◽  
pp. 994-998
Author(s):  
Ritika Mukhija ◽  
Noopur Gupta ◽  
Praveen Vashist ◽  
Radhika Tandon ◽  
Sanjeev K Gupta
Keyword(s):  
General Population ◽  
Visual Impairment ◽  
Epidemiological Study ◽  
Age Groups ◽  
Corneal Opacity ◽  
Population Based ◽  
Cross Sectional ◽  
Population Based Study ◽  
Corneal Disease ◽  
Corneal Opacities

ObjectiveTo characterise types of corneal diseases and resulting visual impairment (VI) in a rural North Indian population.DesignCross-sectional, population-based study.MethodsThe Corneal Opacity Rural Epidemiological study included 12 899 participants from 25 random clusters of rural Gurgaon, Haryana, India to determine the prevalence of the corneal disease in the general population. Sociodemographic details, presence and type of corneal morbidity, laterality, VI (presenting visual acuity (PVA) <6/18 in the better eye) and characteristics of corneal opacities were noted.ResultsOverall, 12 113 participants of all ages underwent detailed ophthalmic examination and prevalence of corneal opacity was found to be 3.7% (n=452) with bilateral involvement in 140 participants (31%) during the house-to-house visits. Of the total 571 eyes of 435 patients presenting with corneal opacity at the central clinic, PVA was <3/60 in 166 (29.1%), 3/60 to <6/60 in 14 (2.5%), 6/60 to <6/18 in 164 (28.7%), 6/18 to ≤6/12 in 85 (14.9%) and 6/9 to 6/6 in 142 eyes (24.9%), respectively. Further, there were a total of 115 eyes (20.1%) with nebular corneal opacity, 263 (46.1%) with macular, 162 (28.4%) with leucomatous and 31 (5.4%) with an adherent leucoma. The odds of having VI due to corneal disease were greater for the illiterate (OR:4.26; 95% CI: 2.88 to 6.31; p<0.001) and elderly (OR:11.05; 95% CI: 7.76 to 15.74; p<0.001).ConclusionThe data from this study give an insight into the characteristics of various corneal pathologies and resulting VI in the general population. This is a pioneer study involving all age groups on the burden of VI due to corneal diseases.

scholarly journals Management of dislocated nucleus with corneal opacity by combined deep anterior lamellar keratoplasty, pars- plana vitrectomy and phaco-fragmentation

2019 ◽  
Vol 12 (6) ◽  
pp. e229397
Author(s):  
Samendra Karkhur ◽  
Alok Sen ◽  
Gautam Parmar ◽  
Priyavrat Bhatia
Keyword(s):  
Ciliary Body ◽  
Surgical Intervention ◽  
Corneal Opacity ◽  
Ultrasound Biomicroscopy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Ciliary Processes ◽  
Pars Plana ◽  
The Right

A 32-year-old man presented with bilateral diminution of vision for 10 years. Visual acuity was light perception in both eyes with inaccurate projection in the oculus dextrus(OD) and accurate projection in the in oculus sinister (OS). Intraocular pressure was 6 and 12 mm Hg in the OD and OS, respectively. Slit-lamp examination revealed the presence of leucomatous corneal opacification with microcornea in oculus uterque (OU). Both eyes had a dislocated nucleus in the vitreous cavity on ultrasound B-scan with advanced cupping in the right eye. Ultrasound biomicroscopy revealed ciliary body atrophy in the OD and preserved ciliary processes (two quadrants) in the OS. In view of a partially preserved ciliary body function and a potential for gaining useful vision, we planned surgical intervention in the left eye. Deep anterior lamellar keratoplasty with pars planavitrectomy (PPV) and phacofragmentation of the nucleus was done. Donor lamellar graft was sutured after completion of PPV and nucleus fragmentation. The patient regained useful ambulatory vision postoperatively with clear corneal graft.

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