scholarly journals Long-term observation of graft thickness and shape in Descemet stripping and automated endothelial keratoplasty

2019 ◽  
Vol 30 (1) ◽  
pp. 155-161
Author(s):  
Yi-Ching Hsieh ◽  
Chun-Chi Chiang ◽  
Yi-Yu Tsai
Keyword(s):  
Optical Coherence Tomography ◽  
Retrospective Study ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Graft Thickness ◽  
Asymmetrical Shape ◽  
Optical Zone ◽  
Long Term Observation ◽  
Common Shape

Purpose: To evaluate the thickness and shape of the posterior lamellar graft in Descemet stripping and automated endothelial keratoplasty after long-term observation. Methods: All patients who underwent Descemet stripping and automated endothelial keratoplasty including simple and triple Descemet stripping and automated endothelial keratoplasty between August 2009 and May 2014 were enrolled in this retrospective study. To assess postoperative thickness and shape of the Descemet stripping and automated endothelial keratoplasty graft, images of the graft taken at the center (C), mid-periphery at 4 mm optical zone (P1), and periphery at 6 mm optical zone (P2) at 1, 2, and 3 years postoperatively were obtained using anterior segment optical coherence tomography. Results: C:P1 was 0.96, 0.96, and 0.95 at 1, 2, and 3 years postoperatively, respectively. C:P2 was 0.85, 0.84, and 0.83 at 1, 2, and 3 years postoperatively, respectively. There was a greater thinning of the central graft thickness compared with the peripheral graft thickness. The shapes of the posterior lamellar graft were variable, such as concave, asymmetrical, planar, irregular, and convex meniscus shapes. The most common shape was asymmetrical shape at 1 year postoperatively and concave at 2 and 3 years postoperatively. The most common shape of the posterior lamellar grafts was asymmetrical shape (38.18%) at 1 year postoperatively, followed by concave (34.54%), planar (20.00%), irregular (5.45%), and convex (1.81%) shapes. The most common shape was concave shape (44.44% and 57.14% for 2 and 3 years postoperatively, respectively), followed by asymmetrical (27.77% and 17.85%, respectively), planar (16.66% and 17.85%, respectively), and irregular (11.11% and 7.14%, respectively) shapes. Conclusion: In our study, concave meniscus was not the only observed shape of the graft. The shape and thickness of the graft did not stabilize even 3 years postoperatively in some patients. These findings should be taken into consideration in a combination of Descemet stripping and automated endothelial keratoplasty and cataract surgery.

scholarly journals Intraoperative optical coherence tomography guided corneal sweeping for removal of remnant Interface fluid during ultra-thin Descemet stripping automated endothelial keratoplasty

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Mimouni ◽  
Martin Kronschläger ◽  
Manuel Ruiss ◽  
Oliver Findl
Keyword(s):  
Optical Coherence Tomography ◽  
Retrospective Study ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Intraoperative Optical Coherence Tomography ◽  
Graft Thickness

Abstract Background Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK. Methods This retrospective study included all eyes underwent iOCT guided UT-DSAEK from October 2016 to February 2018 at the Hanusch Hospital, Vienna, Austria. Peripheral meticulous corneal sweeping was performed to remove excess fluid. Central graft thickness (CGT) was measured prior to surgery, after graft bubbling and after corneal sweeping. Remnant interface fluid rates were compared between eyes that underwent rebubbling and those that did not. Results Overall, 28 eyes of 28 patients with a mean age of 73.9 ± 10.0 years were included. An iOCT guided meticulous peripheral sweeping was performed in 89.3% (n = 25) of the cases. Following 84% (n = 21) of the peripheral sweeping performed, remnant fluid was no longer identified. Following peripheral sweeping the interface fluid height was reduced from 17.31 ± 15.96 μm to 3.46 ± 9.52 μm (p < 0.001) and CGT was reduced by 7% (p < 0.001). Rebubbling was performed in 17.9% (n = 5) of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%, p = 0.01). Conclusion The iOCT identified subclinical remnant fluid in nearly 90% of UT-DSAEK cases. An iOCT guided peripheral corneal sweeping led to resolution of interface fluid in a majority of cases. Eyes with persistent remnant fluid despite peripheral corneal sweeping are more likely to require subsequent rebubbling.

scholarly journals Posterior Uveal Effusion after Cataract Surgery

2021 ◽  
pp. 62-67
Author(s):  
Annegret Abaza ◽  
Özlem Dikmetas ◽  
Irmingard Neuhann ◽  
Faik Gelisken
Keyword(s):  
Cataract Surgery ◽  
Corticosteroid Therapy ◽  
Anterior Segment ◽  
Subretinal Fluid ◽  
Posterior Pole ◽  
Functional Improvement ◽  
Long Term Observation ◽  
The Right ◽  
Uveal Effusion

We report a case of posterior uveal effusion (UE) with a long-term follow-up that has occurred following cataract surgery. A 64-year-old woman presented with diminished vision of the right eye (RE) 3 weeks after an uneventful phacoemulsification and intraocular lens implantation. Complete ophthalmic examination including fluorescein angiography (FA), indocyanine green angiography (ICGA), echography and optical coherence tomography (OCT) were performed. Best corrected visual acuity (BCVA) of the RE was 20/50. Anterior segment and intraocular pressure were unremarkable. OCT revealed prominent folds of the choroid and retina, subretinal fluid and darkening of the choroid with reduced visibility of the choroidal vessels and the scleral border. The left eye (LE) was unremarkable. BCVA of the LE was: 20/20. After topical anti-inflammatory and systemic corticosteroid therapy for 5 months, no morphological change of the macula was seen. The patient was observed without any treatment. Forty-three months after the cataract surgery and 38 months after cessation of the corticosteroid therapy, OCT revealed a normal macular morphology and the BCVA improved to 20/25. Even though rare, UE at the posterior pole may occur after modern cataract surgery. OCT examination is a reliable tool in monitoring the macular morphology. Since morphological and functional improvement can be seen in long-term, observation may be considered for some cases of posterior UE with resistance to the therapy.

Evaluation of Conjunctival Graft Thickness after Pterygium Surgery by Anterior Segment Optical Coherence Tomography

2011 ◽  
Vol 36 (9) ◽  
pp. 782-786 ◽  
Author(s):  
Ahmad Kheirkhah ◽  
Mohsen Adelpour ◽  
Mojgan Nikdel ◽  
Reza Ghaffari ◽  
Hamed Ghassemi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Segment ◽  
Optical Coherence ◽  
Graft Thickness ◽  
Pterygium Surgery

scholarly journals ‘Acute-angled bevel’ sign to assess donor lenticule orientation in ultra-thin descemet stripping automated endothelial keratoplasty

2019 ◽  
Vol 12 (2) ◽  
pp. e227927 ◽  
Author(s):  
Jeewan S Titiyal ◽  
Manpreet Kaur ◽  
Farin Shaikh ◽  
Aafreen Bari
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Segment ◽  
Acute Angle ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Anterior Segment Oct ◽  
Intraoperative Optical Coherence Tomography ◽  
Congenital Hereditary Endothelial Dystrophy ◽  
Graft Insertion

A 6.5-year-old boy with congenital hereditary endothelial dystrophy underwent clear corneal ultra-thin descemet stripping automated endothelial keratoplasty (DSAEK). After graft insertion, it was difficult to assess graft orientation due to hazy cornea. Intraoperative optical coherence tomography (iOCT) showed a well-attached graft and the bevelled edge of donor lenticule made an acute angle with the overlying stroma. Postoperative anterior segment OCT confirmed the presence of acute-angled bevel sign. A wetlab experiment was performed with experimental corneoscleral tissues to confirm the findings. Donor lenticule was injected in the artificial chamber with stromal-side up as well as stromal side-down. ‘Acute-angled bevel sign’ was observed on iOCT in the experimental cases with stromal-side up. In inverse graft, the acute-angled bevel was not observed, instead the configuration was obtuse angled. Identifying the ‘acute-angled bevel sign’ on iOCT confirms correct graft orientation after unfolding and is extremely useful for hazy corneas and ultrathin DSAEK lenticules.

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