scholarly journals Surgical Treatment of Bullous Keratopathy: Modern Approaches and Trends

2018 ◽  
Vol 15 (3) ◽  
pp. 242-247
Author(s):  
S. V. Trufanov ◽  
G. A. Osipyan ◽  
E. P. Salovarova ◽  
R. Bagh ◽  
K. N. Semchenko
Keyword(s):  
Surgical Treatment ◽  
Anterior Segment ◽  
Corneal Edema ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Lamellar Keratoplasty ◽  
Bullous Keratopathy ◽  
Main Role ◽  
Endothelial Keratoplasty ◽  
Modern Technologies

According to WHO, corneal pathology is the fourth cause (5.1 %) of blindness among the main causes of significant visual impairment in the world after cataract, glaucoma and macular degeneration. Bullous keratopathy is a serious progressive corneal disease, in which the endothelial lesion plays the main role leading to the chronic corneal edema, reduce of visual acuity, development of pain syndrome, formation of permanent opacities, and various infectious complication, which may result in eye globe loss. Since the second half of 90th XX century various modifications of modern posterior (endothelial) keratoplasty have been introduced in the clinical practice, which were subsequently used widely for the treatment of bullous keratopathy. The introduction of new microkeratomes used in refractive surgery significantly contributed to the development of endothelial keratoplasty microsurgical technique, which enables the high quality, selective replacement of the affected corneal layers in comparison to the manual lamellar keratoplasty techniques. One of the contraindications for endothelial keratoplasty is an irreversible central stromal opacity. In that case, modern technologies and new equipment (particularly femtosecond laser) provide an opportunity to perform the penetrating keratoplasty with a complex-shaped profile and corresponding edges of the graft and its bed. In bullous keratopathy, top-hat keratoplasty represents the pathogenically targeted treatment method that allows transplanting of more endothelial cells with a relatively smaller diameter of graft’s anterior segment. This article reviews the literature on modern surgical treatment of bullous keratopathy.

scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

2007 ◽  
Vol 6 (3) ◽  
pp. 43-50
Author(s):  
V. A. Koubyshkin ◽  
I. A. Kozlov ◽  
N. I. Yashina ◽  
T. V. Shevchenko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Gastric Resection ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Pancreas Head ◽  
Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

Epithelial downgrowth after Descemet membrane endothelial keratoplasty

2020 ◽  
pp. 112067212091241
Author(s):  
Viet Nhat Hung Le ◽  
Florian Wabnig ◽  
Bjoern Bachmann ◽  
Claus Cursiefen
Keyword(s):  
Anterior Segment ◽  
Corneal Edema ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Visual Axis ◽  
Corneal Incision ◽  
Descemet Membrane ◽  
Clear Corneal Incision ◽  
Close Observation ◽  
Histopathologic Evaluation

Purpose: To describe a patient with epithelial downgrowth after Descemet membrane endothelial keratoplasty. Methods: Case report. Results: A 73-year-old woman underwent triple Descemet stripping automated endothelial keratoplasty for cataract and corneal edema secondary to Fuchs endothelial dystrophy in the left eye elsewhere. Three years later, Descemet membrane endothelial keratoplasty was performed at our department due to graft failure. One month after the operation, her vision improved to 20/32 and maintained stable. At the 14-month visit, her visual acuity decreased, and a routine examination revealed epithelial downgrowth at the posterior surface of the cornea and partly beneath the graft, accompanied by presumed graft rejection. Therefore, repeat Descemet membrane endothelial keratoplasty with epithelial scraping and intracameral injection of 5-fluorouracil was indicated. She recovered 20/25 vision by 1 month after the surgery. However, small sheet-like epithelial downgrowth recurred 1 month later. The epithelial downgrowth was limited to the peripheral margin of the Descemet membrane endothelial keratoplasty graft and did not affect the visual axis. Epithelial downgrowth showed “islands” with connection between epithelial downgrowth and clear corneal incision on anterior segment optical coherence tomography images. Histopathologic evaluation of the removed Descemet membrane endothelial keratoplasty graft confirmed conjunctival epithelium as the source. Under close observation at the current 4-year follow-up, the epithelial downgrowth remained stable and localized and her vision increased to 20/20. Conclusion: Epithelial downgrowth can occur after Descemet membrane endothelial keratoplasty. The limited progression of epithelial downgrowth in this patient suggests that this condition after Descemet membrane endothelial keratoplasty even in the recurrence stage may cause less damage than expected and may only need to be observed closely if no progression occurs.

scholarly journals Experience in personalized cell therapy clinical implementation for treatment of patients with primary endothelial dystrophy after phacoemulsification

2017 ◽  
Vol 10 (4) ◽  
pp. 6-12
Author(s):  
Sergey Yu Astakhov ◽  
Inna A Riks ◽  
Sanasar S Papanyan ◽  
Arkadiy A Kasparov ◽  
Evgeniya A Kasparova ◽  
...  
Keyword(s):  
Cell Therapy ◽  
Therapeutic Effect ◽  
Corneal Edema ◽  
Treatment Method ◽  
Bullous Keratopathy ◽  
Clinical Implementation ◽  
Treatment Results ◽  
Good Therapeutic Effect ◽  
Observation Period

The article presents treatment results of the personalized cell therapy (PCT) method in patients with early post-operative bullous keratopathy which developed in eyes with pre-existing primary Fuchs’ corneal endothelial dystrophy (ED). The patented PCT consists in incubating in vitro the patient’s blood with the stimulator (polyA:polyU), collecting serum with activated leukocytes weighted in it, and introducing the obtained cell preparation in the anterior chamber of the patient’s eye. The study included 12 patients with ED and pseudophakia. The observation period ranged from 8 to 12 months. The therapeutic effect of PCT was obtained in 58.3% of cases, allowing to avoid further surgical procedures. To achieve a good therapeutic effect, several PCT sessions are recommended. To date, PCT is the only effective therapeutic treatment method for early corneal edema after phacoemulsification. (For citation: Astakhov SYu, Riks IA, Papanyan SS, et al. Experience in personalized cell therapy clinical implementation for treatment of patients with primary endothelial dystrophy after phacoemulsification. Ophthalmology Journal. 2017;10(4):6-12. doi: 10.17816/OV1046-12).

scholarly journals Exophiala Keratitis following Descemet Stripping Automated Endothelial Keratoplasty

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Ana Marta ◽  
Paula Costa ◽  
Virgínia Lopes ◽  
Miguel Mesquita Neves ◽  
Miguel Gomes ◽  
...  
Keyword(s):  
Anterior Segment ◽  
Fungal Keratitis ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Slit Lamp ◽  
Direct Examination ◽  
First Case ◽  
Pseudophakic Bullous Keratopathy ◽  
Positive Direct ◽  
Corneal Button

Purpose. To report a case with Exophiala spp. keratitis in a Portuguese patient. Methods. A case report with deep corneal brown-pigmented infiltrates that developed 2 months after a Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy. Results. Diagnosis was established by positive direct examination and cultures from the surgically obtained corneal button. Slit-lamp images and anterior segment optical coherence tomography (AS-OCT) scans were obtained. Conclusion. This is the first described case of fungal keratitis caused by Exophiala spp. in Portugal and, to our knowledge, the first case following DSAEK in the literature.

scholarly journals Еfficacy of Combined Treatment of Epithelial and Endothelial Corneal Dystrophy Using Corneal Crosslinking and Automated Posterior Lamellar Keratoplasty

2019 ◽  
Vol 16 (1S) ◽  
pp. 102-107
Author(s):  
L. R. Marvanova
Keyword(s):  
Surgical Treatment ◽  
Combined Treatment ◽  
Corneal Thickness ◽  
Corneal Edema ◽  
Corneal Dystrophy ◽  
Main Group ◽  
Stage I ◽  
Lamellar Keratoplasty ◽  
Control Group ◽  
Posterior Lamellar Keratoplasty

The purpose: to establish a combined approach to the treatment of patients with epithelial and endothelial cornea dystrophy (EED) based on a comparative study of the results of one-step and two-step methods. Patients and methods. The study included 75 patients (81 eyes) with corneal EED, who underwent surgical treatment at the Ufa Eye Research Institute from 2011 to 2016. The patients were divided into two groups — the main group consisted of 43 (46 eyes, 57 %) patients, who underwent the first stage of the CC before surgical treatment of EED, the second stage after 1–12 months — automated posterior lamellar keratoplasty (APLK). In the control group, isolated APLK was performed in 32 (35 eyes, 43 %) patients. Results. After CC (1–10 days) in the main group an increase in corneal thickness due to edema enhancement in the cornea stroma was observed in patients with stage I–III of the corneal EED. After 3 months, a decrease in corneal thickness was recorded in patients of the main group with I-II stages of the disease (p < 0.05), after 6 months — in all stages of the corneal EED compared with the control group (p < 0.05). According to optical coherence tomography (OCT), a decrease in the total cornea thickness in both зфешутеы groups was noted within 12 months after APLK: in the main group from 667 ± 65 μm initially to 594 ± 31 μm, in the control group, where there was a pronounced corneal edema from 787 ± 56 to 612 ± 67 μm. Conclusion. Corneal cross-linking in patients with I–III stages of corneal EED provides improvement of the cornea, manifested in reducing edema and its thickness. It allows to delay the implementation of the automated posterior lamellar keratoplasty without corneal deterioration in patients with stage I up to 6–12 months, in patients with stage II–III up to 3–6 months.

scholarly journals Outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) Using Surgeon’s Prepared Donor DM-Roll in Consecutive 100 Indian Eyes

2018 ◽  
Vol 12 (1) ◽  
pp. 134-142 ◽  
Author(s):  
Samar K Basak ◽  
Soham Basak ◽  
Viraj R Pradhan
Keyword(s):  
Endothelial Cell ◽  
Corneal Edema ◽  
Cell Loss ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Corneal Surgery ◽  
Descemet Membrane ◽  
Visual Outcomes

Background:Descemet Membrane Endothelial Keratoplasty (DMEK) is now becoming the popular form of endothelial keratoplasty using only donor DM with healthy endothelium as true component lamellar corneal surgery.Objective:To analyze the results of visual outcomes, endothelial cell loss and complications of Descemet membrane endothelial keratoplasty in first consecutive 100 Indian eyes.Methods:100 eyes of 95 consecutive patients with endothelial dysfunctions of different etiologies scheduled for DMEK, were included in this study. In each case, surgeon prepared tissue using McCarey Kaufman medium- or Cornisol-preserved donor cornea with a cell count of ≥2500 cells/mm2. Surgical complications, Best Spectacle Corrected Visual Acuity (BSCVA); Endothelial Cell Density (ECD) and Endothelial Cell Loss (ECL) were analyzed for each patient after a minimum follow-up of three months.Results:The Main indication was pseudophakic corneal edema or bullous keratopathy in 52 (52%) eyes. 38 (38%) eyes had Fuchs′ dystrophy with various grades of cataract. In 43 phakic eyes, DMEK was combined with cataract surgery and intraocular lens implantation. Mean DM-roll preparation time was 7.5 ± 2.8 min and in 3 eyes, DM-graft were damaged. After 3-months, BSCVA was ≥20/25 in 57 (57.6%) cases. Mean ECD was 2123 ± 438/mm2(range: 976 - 3208/ mm2) and the mean endothelial cell loss after 3-months was 26.92 ± 13.40 (range: 4.90 - 66.6%). Partial DM detachment occurred in 8 (8.0%) eyes and rebubbling required in 4 eyes. Iatrogenic primary graft failure occurred in one eye.Conclusion:Descemet membrane endothelial keratoplasty is a safe and effective procedure in several types of endothelial diseases among Indian patients with encouraging surgical and visual outcomes. Complications are less and endothelial cell loss percentage is acceptable.

scholarly journals Indications and Surgical Techniques for Repeat Corneal Transplantation in Eastern China: A Twelve-Year Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xichen Wan ◽  
Wang Yao ◽  
Songjiao Zhao ◽  
Jianjiang Xu ◽  
Qihua Le
Keyword(s):  
Eastern China ◽  
Corneal Transplantation ◽  
Surgical Techniques ◽  
Good Prognosis ◽  
Lamellar Keratoplasty ◽  
Bullous Keratopathy ◽  
Infectious Keratitis ◽  
Endothelial Keratoplasty ◽  
Primary Indication ◽  
Multiple Repeat

Purpose. To analyze the indications and surgical procedures for repeat keratoplasty in eastern China from 2008 to 2019. Methods. This retrospective descriptive study included 418 eyes of 411 patients who underwent no less than 2 keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2019. Medical charts were reviewed. The primary indications for repeat keratoplasty, the reasons for regrafting, and the surgical techniques used in the treatment were collected and analyzed. Results. Among 418 eyes, 337 eyes (80.6%) had one repeat keratoplasty, and 81 eyes (19.4%) had multiple repeat keratoplasties (≥2 repeat keratoplasties). The median interval between the initial keratoplasty and the first repeat keratoplasty was 25 months, and that between two keratoplasties after the first repeat keratoplasty was 27.5 months. Infectious keratitis was the leading primary indication for single repeat keratoplasty (80 cases, 23.7%) and multiple repeat keratoplasties (19 cases, 23.5%). The second most common primary indication was bullous keratopathy for single repeat keratoplasty (49 eyes, 14.5%) and chemical injury for multiple repeat keratoplasties (14 eyes, 17.3%). The main reason for regrafting was allograft rejection (262 cases, 49.3%), followed by endothelial dysfunction (92 cases, 17.3%), and for vision improvement after tectonic keratoplasty (60 cases, 11.3%). Penetrating keratoplasty (PKP) was the major technique used in repeat keratoplasty (447 cases, 84.2%). However, Descemet stripping endothelial keratoplasty was more frequently used than PKP (72.4% vs. 27.6%, P < 0.001 ) in the treatment of failed endothelial keratoplasty. Conclusion. Infectious keratitis was still the leading cause of repeat keratoplasty in eastern China. Although PKP remains the major technique of repeat keratoplasty, the application of customized lamellar keratoplasty has greatly expanded in the last decade. Cautious selection of indications, surgical techniques, and timing for surgery is crucial for a good prognosis after repeat keratoplasty.

scholarly journals CHANGES AND DYNAMICS OF INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS AFTER APPLYING VARIOUS TECHNIQUES OF SURGICAL TREATMENT OF CATARACT

2019 ◽  
Vol 19 (2) ◽  
pp. 74-77
Author(s):  
I. S. Steblovskaya ◽  
I. M. Bezkorovayna
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Negative Impact ◽  
Anterior Segment ◽  
Corneal Edema ◽  
Age Related ◽  
Operative Complications ◽  
The Uk ◽  
Iol Dislocation ◽  
Post Operative Complications

Transition to the small incision surgery and the practice of cataract phacoemulsification and femtosecond-guided cataract phacoemulsification have contributed to the reduction of postoperative complications, however, despite this, there are some potentially dangerous sight problems that include infective endophthalmitis, toxic syndrome of the eye anterior segment, intraoperative suprachoroidoid hemorrhage, cystic macular edema, retinal detachment, persistent corneal edema and IOL dislocation. According to the study conducted in the UK, the overall frequency of complications following phacoemulsification was 8.7%. Complications that arise at any stage of the surgical intervention and after it have a negative impact on the immediate and remote functional outcomes of the treatment. Thus, the improvement of surgical treatment of age-related cataracts by studying the features and mechanisms of the development of postoperative edema in the central retinal zone, as well as the development of new methods for predicting this complication, is an urgent problem of ophthalmology. The aim of this study was to determine and differentiate the frequency and dynamics of intraoperative, early and late post-operative complications in various techniques of surgical treatment of age-related cataracts. Materials and methods. 558 patients (558 eyes) with cataracts participated in the examination and treatment. The first group consisted of 298 patients (298 eyes) who underwent standard phacoemulsification, and the second group involved 260 patients (260 eyes) who were performed on femtosecond-guided cataract phacoemulsification. The examination was carried out on the 1 day, and in 1, 3 6 and 12 months after cataract surgery. The use of femtosecond laser can reduce the rate of intraoperative, as well as early and late post-operative complications after the cataract removal.

scholarly journals Intraoperative Optical Coherence Tomography Imaging in Corneal Surgery: A Literature Review and Proposal of Novel Applications

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Hiroshi Eguchi ◽  
Fumika Hotta ◽  
Shunji Kusaka ◽  
Yoshikazu Shimomura
Keyword(s):  
Optical Coherence Tomography ◽  
Corneal Transplantation ◽  
Anterior Segment ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Corneal Surgery ◽  
Anterior Lamellar Keratoplasty ◽  
Intraoperative Optical Coherence Tomography

Intraoperative optical coherence tomography (iOCT) is widely used in ophthalmic surgeries for cross-sectional imaging of ocular tissues. The greatest advantage of iOCT is its adjunct diagnostic efficacy, which facilitates to decision-making during surgery. Since the development of microscopic-integrated iOCT (MIOCT), it has been widely used mainly for vitreoretinal and anterior segment surgeries. In corneal transplantation, MIOCT allows surgeons to visualise structure underneath the turbid and distorted cornea, which are impossible to visualise with a usual microscope. Real-time visualisation of hard-to-see area reduces the operation time and leads to favorable surgical outcomes. The use of MIOCT is advantageous for a variety of corneal surgical procedures. Here, we have reviewed articles focusing on the utility of iOCT  and MIOCT in penetrating keratoplasty, deep anterior lamellar keratoplasty, Descemet stripping automated endothelial keratoplasty, and Descemet membrane endothelial keratoplasty. The applications of MIOCT to corneal surgery in terms of surgical education for trainees, emergency surgery, and novel surgery are also discussed, with our cases performed using RESCAN® 700.

scholarly journals Optical reconstructive surgery of the anterior segment of the eye in the far eastern federal district – achievements and unsolved problems

2021 ◽  
Vol 13 (3) ◽  
pp. 47-54
Author(s):  
Oleg V. Kolenko ◽  
Yurii N. Dyachenko ◽  
Evgenii L. Sorokin ◽  
Maxim V. Pshenichnov
Keyword(s):  
Reconstructive Surgery ◽  
Anterior Segment ◽  
Federal District ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Federal State ◽  
High Tech ◽  
Anterior Lamellar Keratoplasty ◽  
Far Eastern ◽  
Modern Technologies

The aim was to analyze organizational and technical difficulties in introducing modern technologies of optical reconstructive surgery, and to find the options of their elimination. Materials and methods. Organizational arrangements to develop and to introduce into clinical practice modern technologies of optical reconstructive surgery in treatment of corneal opacities of different origin in the Khabarovsk branch of the S. Fedorov Eye Microsurgery Federal State Institution of the Ministry of Health of the Russian Federation has been analyzed. Results and conclusions. An unified register of patients of the Far Eastern Federal district who need optical keratoplasty (bullous keratopathies, keratoconus stages 34, post-traumatic leukomas, hereditary corneal dystrophies) a waiting list has been created. The necessary equipment and instruments were acquired, 4 surgeons were trained who mastered the technologies of deep anterior lamellar keratoplasty and Descemet membrane transplantation along with penetrating keratoplasty. From 2014 to 2018, 160 optical keratoplasty were performed using donor material; by 2019, the need for this type of high-tech treatment has been reduced by 2 times. To date, more than 30% of optical keratoplasties are performed using lamellar technology. The organizational sequence of ordering biological material, performing surgeries; the postoperative care system is got up and running; the outpatient departmentsophthalmologists of the region are trained to use clear objective criteria for dynamic follow-up of these patients.

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