scholarly journals Changes in post-keratoplasty astigmatism after suture removal: refraction vs tomography vs aberrometry

2021 ◽  
Vol 14 (11) ◽  
pp. 1707-1713
Author(s):  
Suraj Kumar Chaurasiya ◽  
◽  
Pravin K. Vaddavalli ◽  
Christopher J. Rapuano ◽  
◽  
...  
Keyword(s):  
Poor Quality ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Refraction Tomography ◽  
Anterior Lamellar Keratoplasty ◽  
Manifest Refraction ◽  
Corrected Distance Visual Acuity ◽  
Before And After ◽  
The Mean ◽  
Corneal Tomography

AIM: To analyse the changes in magnitude and orientation of astigmatism after suture removal (SR) in keratoplasty eyes as measured by refraction, tomography, and aberrometry. METHODS: Twenty-six eyes of 25 patients after optical keratoplasty requiring SR to reduce the astigmatism during the follow-up period were prospectively included. Eyes with poor quality topography scans or if there were no sutures in the steepest semi meridian were excluded. Corrected distance visual acuity (CDVA), manifest refraction, corneal tomography and aberrometry were performed on all patients before and after SR. RESULTS: The mean age of the patients was 40.8±14.4y. Penetrating keratoplasty was performed in 23 eyes (89%) and deep anterior lamellar keratoplasty was done in 3 eyes (11%). There was a statistically significant reduction in the magnitude of refractive, tomographic and aberrometry astigmatism after SR (P<0.001) at 2h after suture removal. The mean net reduction of the astigmatism was greater as measured by corneal tomography compared to refractive astigmatism (P<0.05). There was no statistically significant change in refractive astigmatism between 2h and 2mo after SR (P=0.55). Vector calculations demonstrated a greater amount of undercorrection in the tomography group and the rotational error was more towards counterclockwise direction. Mean monocular logMAR CDVA improved from 0.57 D to 0.49 D after SR (P=0.002). CONCLUSION: The net reduction in the magnitude of astigmatism after SR is greater in the tomography and aberrometry groups. With one episode of SR, there is no difference in the aberration profile.

scholarly journals A New Pre-descemetic Corneal Ring (Neoring) in Deep Anterior Lamellar Keratoplasty for Moderate-Advanced Keratoconus: A Pilot 2-Year Long-Term Follow-Up Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Belén Alfonso-Bartolozzi ◽  
Carlos Lisa ◽  
Luis Fernández-Vega-Cueto ◽  
David Madrid-Costa ◽  
José F. Alfonso
Keyword(s):  
Spherical Aberration ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
Long Term Follow Up ◽  
The Mean ◽  
Corneal Tomography

Purpose: To assess the outcomes of implanting a new polymethylmethacrylate (PMMA) ring (Neoring; AJL Ophthalmic) in pre-descemet deep anterior lamellar keratoplasty (PD-DALK) procedure for moderate-advanced keratoconus.Methods: This prospective study included 10 eyes of 10 patients with moderate-advanced keratoconus who underwent PD-DALK with Neoring implantation. Neoring was implanted in a pre-descemetic pocket. The post-operative examination included refraction, corrected distance visual acuity (CDVA), corneal tomography, and endothelial cell density (ECD). The root mean squares (RMSs) for coma-like aberrations and spherical aberration were evaluated for a pupil size of 4.5 mm. The junctional graft (Tg) and host (Th) thicknesses were measured. The post-operative follow-up was 24 months.Results: Post-operative CDVA was 0.82 ± 0.14 (decimal scale), 100% of the eyes achieved a CDVA of 0.7 (decimal scale). The refractive cylinder was −2.86 ± 1.65 2-years after surgery. No eyes had a post-operative refractive cylinder ≥5.00 D and in five eyes (50%), it was ≤2.50 D. At the last visit, the mean keratometry was 45.64 ± 1.96 D, the RMS for coma-like aberrations was 0.30 ± 0.15 μm and spherical aberration was 0.22 ± 0.09. The mean ECD remains without changes over the follow-up (P = 0.07). At the last visit, Tg and Th were 679.9 ± 39.0 and 634.8 ± 41.2 μm, respectively. The thickness of the complex (host-Neoring) was 740.6 ± 35.6 μm. In all cases, this thickness was thicker than Tg.Conclusion: The results of this study suggest that PD-DALK along Neoring implantation is a viable, effective, and safe option to optimize the post-operative results for moderate-severe keratoconus.

Avoiding big bubble complications: outcomes of layer-by-layer deep anterior lamellar keratoplasty in children

2018 ◽  
Vol 102 (8) ◽  
pp. 1103-1108 ◽  
Author(s):  
Uri Elbaz ◽  
Caitriona Kirwan ◽  
Carl Shen ◽  
Asim Ali
Keyword(s):  
Paediatric Population ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Lamellar Thickness ◽  
Layer By Layer ◽  
Safe Procedure ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
The Mean

Background/aimsTo describe the visual and clinical outcomes of manual layer-by-layer deep anterior lamellar keratoplasty (DALK) in a paediatric population.MethodsThe charts of all children who underwent DALK surgery between January 2007 and January 2015 were reviewed retrospectively. Data collected included preoperative and postoperative spectacle-corrected distance visual acuity (CDVA), intraoperative and postoperative complications including graft rejection and failure. Residual posterior lamellar thickness (RPLT) and endothelial cell density (ECD) were measured in eyes with follow-up longer than 6 months.ResultsFifty-one eyes of 42 patients were included in the study. The mean patient age at surgery was 11.2±5.2 years and the mean follow-up time was 36.5±23.7 months. The most common indications for surgery were mucopolysaccharidosis (29.4%) and keratoconus (23.5%). Nine eyes (17.6%) had intraoperative microperforation, none of which were converted to penetrating keratoplasty (PKP). Only one eye (2.0%) was converted to PKP. Five eyes (9.8%) had a stromal rejection episode of which one eye failed. Another four eyes (7.8%) experienced graft failure among which three eyes (75%) had infectious keratitis. Three of the five failed grafts had a successful repeat DALK. The average RPLT was 81.9±36.5μm. ECD was significantly lower in the operated eye compared with the normal eye (3096±333 cells/mm2 vs 3376±342 cells/mm2, n=11, P=0.003). The mean postoperative CDVA was 0.5±0.4 logarithm of the minimum angle of resolution (logMAR) reflecting a gain of 0.3 logMAR (P<0.001).ConclusionManual dissection DALK is a safe procedure in children with stromal opacities. Despite successful structural rehabilitation, functional recovery is still suboptimal mostly due to amblyopia.

Comparison between manual trephination versus femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus

2019 ◽  
pp. bjophthalmol-2018-313365 ◽  
Author(s):  
Ramin Salouti ◽  
Mohammad Zamani ◽  
Maryam Ghoreyshi ◽  
Isabel Dapena ◽  
Gerrit R.J. Melles ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Manifest Refraction ◽  
Comparative Clinical Study ◽  
The Mean

Background/aimsTo compare the outcomes of femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) versus manual trephination DALK (M-DALK) in patients with keratoconus.MethodsIn this retrospective, comparative, clinical study, medical charts of 860 patients with keratoconus who underwent F-DALK (n=391) or M-DALK (n=469) with the Melles’s technique, and had at least a 12-month follow-up record were reviewed. The main outcome measures comprised best spectacle-corrected visual acuity (BSCVA), manifest refraction and keratometric indices. The postsurgical measurements were recorded for all patients at 12 months (suture-in condition), and a subset of patients with complete data at 24 months (suture-out condition; 111 F-DALK and 282 M-DALK cases).ResultsBoth procedures had comparable mean (±SD) logMAR BSCVA at 12 months (0.18±0.12 for M-DALK and 0.17±0.12 for F-DALK; p=0.224) and 24 months (0.11±0.10 vs 0.09±0.09, respectively; p=0.166) examinations. M-DALK was associated with a significant more residual myopia at 12 months (−3.85±3.27 vs -1.94±2.86 D; p<0.001), and a milder similar trend at 24 months follow-up (−2.94±2.72 vs −2.38±2.65 D, p=0.064). The mean keratometry (12 months: 46.15±1.88 vs 44.39±1.72, p<0.001; 24 months: 45.33±2.37 vs 44.14±1.68, p<0.001) and apical keratometry values (12 months: 50.92±5.00 vs 47.13±2.38, p<0.001; 24 months: 50.29±4.25 vs 48.12±3.81) were significantly greater for M-DALK than F-DALK, while the keratometric astigmatism was similar (12 months: 2.62±1.58 vs 2.53±1.33, p=0.364; 24 months: 3.21±1.83 vs 3.34±1.88, p=0.529).ConclusionsF-DALK for advanced keratoconus performs as well as M-DALK in terms of BSCVA and keratometric astigmatism in both suture-in (12 months) and suture-out (24 months) conditions. It might have advantages over M-DALK for residual myopia and restoring corneal anatomy.

scholarly journals Intrastromal Corneal Ring Segments for Astigmatism Correction after Deep Anterior Lamellar Keratoplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Júlio C. D. Arantes ◽  
Sandro Coscarelli ◽  
Paulo Ferrara ◽  
Luana P. N. Araújo ◽  
Marcos Ávila ◽  
...  
Keyword(s):  
Contact Lenses ◽  
Corneal Astigmatism ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Spherical Equivalent ◽  
Astigmatism Correction ◽  
Intrastromal Corneal Ring ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
Ring Segment

Background. To evaluate the change in corneal astigmatism after intrastromal corneal ring segment (ICRS) implantation in keratoconus patients with previous deep anterior lamellar keratoplasty (DALK). Design was a longitudinal, retrospective, interventional study. The study included 25 eyes of 24 patients with keratoconus who had DALK performed at least two years prior to ICRS implantation. All patients had a clear corneal graft with up to 8.00 D of corneal astigmatism and intolerance to contact lenses. The studied parameters were age, sex, corrected distance visual acuity (CDVA), maximum keratometry (K1), minimum keratometry (K2), spherical equivalent, and astigmatism. There was a statistically significant decrease in the postintervention analysis as follows: 3.5 D reduction in K1 (p<0.001); 1.53 D in K2 (p=0.005); and 2.52 D (p<0.001) in the average K. The spherical equivalent reduced from −3.67 D (±2.74) to −0.71 D (±2.35) (p<0.001). The topographic astigmatism reduced from 3.87 D preoperatively to 1.90 D postoperatively (p<0.001). The CDVA improved from 0.33 (±0.10) to 0.20 (±0.09, p<0.001). ICRS implantation is a useful option for the correction of astigmatism after DALK as it yields significant visual, topographic, and refractive results.

scholarly journals Customized Toric Intraocular Lens Implantation in Eyes with Cataract and Corneal Astigmatism after Deep Anterior Lamellar Keratoplasty: A Prospective Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Domenico Schiano Lomoriello ◽  
Giacomo Savini ◽  
Kristian Naeser ◽  
Rossella Maria Colabelli-Gisoldi ◽  
Valeria Bono ◽  
...  
Keyword(s):  
Case Series ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
The Mean ◽  
The Difference ◽  
A Prospective Study ◽  
Surgically Induced

Purpose. To investigate the effectiveness of toric intraocular lenses (IOLs) for treating corneal astigmatism in patients with cataract and previous deep anterior lamellar keratoplasty (DALK). Setting. San Giovanni-Addolorata Hospital, Rome, Italy. Design. Prospective interventional case series. Methods. Patients undergoing cataract surgery after DALK for keratoconus were enrolled. Total corneal astigmatism (TCA) was assessed by a rotating Scheimpflug camera combined with Placido-disk corneal topography (Sirius; CSO, Firenze, Italy). A customized toric IOL (FIL 611 T, Soleko, Rome, Italy) was implanted in all eyes. One year postoperatively, refraction was measured, the IOL position was recorded, and vectorial and nonvectorial analyses were performed to evaluate the correction of astigmatism. Results. Ten eyes of 10 patients were analyzed. The mean preoperative TCA magnitude was 4.92 ± 1.99 diopters (D), and the mean cylinder of the IOL was 6.18 ± 2.44. After surgery, the difference between the planned axis of orientation of the IOL and the observed axis was ≤10° in all eyes. The mean surgically induced corneal astigmatism was 0.35 D at 20°. The mean postoperative refractive astigmatism power was 1.13 ± 0.94 D; with respect to preoperative TCA, the reduction was statistically significant (p<0.0001). The mean change in astigmatism power was 3.80 ± 1.60 D, corresponding to a correction of 77% of preoperative TCA power. Nine eyes out of 10 had a postoperative refractive astigmatism power ≤ 2D. Conclusions. Toric IOLs can effectively correct corneal astigmatism in eyes with previous DALK. The predictability of cylinder correction is partially lowered by the variability of the surgically induced changes of TCA. This trial is registered with NCT03398109.

scholarly journals Ferrara Technique of Deep Anterior Lamellar Keratoplasty for Keratoconus Treatment

2013 ◽  
Vol 2 (2) ◽  
pp. 51-55
Author(s):  
Leonardo Torquetti
Keyword(s):  
Visual Acuity ◽  
Visual Outcome ◽  
Clinical Results ◽  
Corneal Topography ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity

Abstract Purpose To report the first clinical results of application Ferrara's technique of deep anterior lamellar keratoplasty (FDALK) in patients with keratoconus. Materials and methods Thirty-four eyes of 34 patients with advanced keratoconus were included in the study. All patients were operated by the FDALK technique. Preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal topography and corneal astigmatism were evaluated. Intra- and postoperative complications are described. Results Uncorrected visual acuity improved in from 20/400 to 20/125; corrected visual acuity improved from 20/300 to 20/48. The mean follow-up was 19.3 months (sd: 7.1). Corneal topography (Pentacam®) showed significant corneal flattening in all cases. Microperforations of the Descemet's membrane, requiring conversion to penetrating keratoplasty, occurred in two cases. Conclusion The FDALK technique is a safe and effective technique to be applied in patients with keratoconus. Visual outcome is comparable to PK, with advantage of preserving recipient endothelium, which lessens the risk of endothelium rejection. How to cite this article Ferrara P, Ferrara G, Torquetti L. Ferrara Technique of Deep Anterior Lamellar Keratoplasty for Keratoconus Treatment. Int J Kerat Ect Cor Dis 2013;2(2):51-55.

scholarly journals Big Bubble Deep Anterior Lamellar Keratoplasty for Management of Deep Fungal Keratitis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Hua Gao ◽  
Peng Song ◽  
Jose J. Echegaray ◽  
Yanni Jia ◽  
Suxia Li ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Corneal Thickness ◽  
Fungal Keratitis ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Infiltration Depth ◽  
Air Bubble ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
Big Bubble

Objective. To evaluate the therapeutic effect of big bubble deep anterior lamellar keratoplasty (DALK) in patients with deep fungal keratitis.Methods. Consecutive patients who had DALK for deep fungal keratitis at Shandong Eye Hospital between July 2011 and December 2012 were included. In all patients, the infiltration depth was more than 4/5ths of the corneal thickness. DALK surgery was performed with bare Descemet membrane (DM) using the big bubble technique. Corrected distance visual acuity (CDVA), graft status, and intraoperative and postoperative complications were monitored.Results. Big bubble DALK was performed in 23 patients (23 eyes). Intraoperative perforation of the DM occurred in two eyes (8.7%) during stromal dissection. The patients received lamellar keratoplasty with an air bubble injected into the anterior chamber. Double anterior chamber formed in 3 eyes (13.0%). Mean CDVA of the patients without cataract, amblyopia, and fungal recurrence was improved from preoperative HM/20 cm−1.0 (LogMAR) to0.23 ± 0.13(LogMAR) at the last followup (P<0.01). Fungal recurrence was found in two patients (8.7%). Corneal stromal graft rejection was noted in one patient (4.3%).Conclusions. DALK using the big bubble technique seems to be effective and safe in the treatment of deep fungal keratitis unresponsive to medication.

Deep anterior lamellar keratoplasty for corneal penetrating wounds

2021 ◽  
pp. 112067212110143
Author(s):  
Enrica Sarnicola ◽  
Caterina Sarnicola ◽  
Albert Y Cheung ◽  
Vincenzo Sarnicola
Keyword(s):  
Endothelial Cell ◽  
Cell Loss ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Cell Loss ◽  
Penetrating Wound ◽  
Anterior Lamellar Keratoplasty ◽  
Bed Thickness ◽  
The Mean

Purpose: To report our surgical experience of deep anterior lamellar keratoplasty (DALK) performed in eyes with scarring resulting from a corneal penetrating wound without tissue loss. Methods: Case series of three eyes of three patients that underwent DALK for poor vision due to a scar resulting from a previous corneal penetrating wound. Surgery was performed at least 1 year after the initial injury. Manual dissection technique was used in all cases. Preoperative and postoperative best correct visual acuity (BCVA), postoperative residual bed thickness, and postoperative endothelial cell count (ECC) were evaluated. Results: Preoperative BCVA ranged from 1.3 to 1.0 LogMAR. Two eyes were pseudophakic and one eye had a traumatic cataract. Manual DALK was successfully accomplished in all three cases. The mean residual recipient bed thickness was 103 µm (range 68–130 µm). The mean endothelial cell loss at the 6th month of follow-up was 6% (range 3%–11%) with a further 1% decrease at 4 years. One of the patients underwent cataract surgery and limbal relaxing incisions 1 year after DALK having a total endothelial cell loss of 4.8% at 2 years of follow-up. BCVA at 2 years of follow-up was 0.1 LogMAR (range 0.22–0.0 LogMAR). No episode of rejection was recorded, and all grafts remained clear at last follow-up (5 years, range 4–6 years). Conclusions: Manual DALK should be considered in cases of corneal scars in optical zone resulting from penetrating wound.

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