scholarly journals Deep Anterior Lamellar Keratoplasty Following Epikeratophakia: A Novel Two-Stage One-Graft Method To Treat Acute Corneal Hydrops

2021 ◽  
Author(s):  
Chunyu Liu ◽  
Xinyu Huang ◽  
Xin Liu ◽  
Yushan Zhang ◽  
Jiaqi Shen ◽  
...  
Keyword(s):  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Case Series ◽  
Corneal Graft ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Clinical Effects ◽  
Anterior Lamellar Keratoplasty ◽  
Corneal Hydrops

Abstract Purpose To evaluate the clinical effects of deep anterior lamellar keratoplasty (DALK) using a single graft after epikeratophakia for the treatment of acute corneal hydrops. Methods This novel surgical procedure was performed on seven eyes of seven patients between 2019 and 2020. The procedure combines a first-stage surgery of epikeratophakia with intracameral sterile air injection and a second-stage surgery of DALK using the same corneal graft for both procedures. Main outcome measures included pre- and postoperative best-corrected visual acuity (BCVA) and anterior segment optical coherence tomography (AS-OCT) parameters. Corneal transparency, neovascularization and epithelization were observed at the 1-year follow-up. Results Corneal edema resolved rapidly in six of the seven cases. The group mean central corneal thickness was significantly reduced from baseline at 1 day, 1 week, 1 month, and 2 months after the first-stage surgery, respectively (P < 0.0001). At a mean of 2.1±0.7 months after the first-stage surgery, DALK was successfully performed in all cases. Six months later, the central corneal thickness was 611±31 µm and the thickness of the recipient’s residual stroma bed was 20±6 µm at the central corneal area. LogMAR BCVA was improved from 1.74±0.34 at baseline to 0.20±0.11 after DALK (P < 0.0001). No postoperative complications appeared in our case series during one years of observation. Conclusion A novel curative effect was found in the treatment of acute corneal hydrops with epikeratophakia followed by DALK using the same corneal graft.

scholarly journals A Deep Learning Approach for Successful Big-bubble Formation Prediction in Deep Anterior Lamellar Keratoplasty

2021 ◽  
Author(s):  
Takahiko Hayashi ◽  
Hiroki Masumoto ◽  
Hitoshi Tabuchi ◽  
Naofumi Ishitobi ◽  
Mao Tanabe ◽  
...  
Keyword(s):  
Deep Learning ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Automated System ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Biometric Data ◽  
Validation Data ◽  
Anterior Lamellar Keratoplasty ◽  
Big Bubble

Abstract The efficacy of deep learning in predicting successful big-bubble (SBB) formation during deep anterior lamellar keratoplasty (DALK) was evaluated. Medical records of patients undergoing DALK at the University of Cologne, Germany between March 2013 and July 2019 were retrospectively analyzed. Patients were divided into two groups: (1) SBB or (2) failed big-bubble (FBB). Preoperative images of anterior segment optical coherence tomography and corneal biometric values (corneal thickness, corneal curvature, and densitometry) were evaluated. A deep neural network model, Visual Geometry Group-16, was selected to test the validation data, evaluate the model, create a heat map image, and calculate the area under the curve (AUC). This pilot study included 55 patients overall (12 women, 43 men). SBBs were more common in keratoconus eyes (KC eyes) than in corneal opacifications of other etiologies (non KC eyes) (p = 0.001). The AUC was 0.746 (95% confidence interval [CI]: 0.603–0.889). The determination success rate was 78.3% (18/23 eyes) (95% CI: 56.3-92.5%) for SBB and 69.6% (16/23 eyes) (95% CI: 47.1–86.8%) for FBB. This automated system demonstrates the potential of SBB prediction in DALK. Although KC eyes had a higher SBB rate, no other specific findings were found in the corneal biometric data.

scholarly journals Deep Anterior Lamellar Keratoplasty and Phototherapeutic Keratectomy for Management of Thiel-Behnke Corneal Dystrophy

2017 ◽  
Vol 1 (1) ◽  
pp. oapoc.0000005
Author(s):  
Gaspare Monaco ◽  
Antonio Scialdone ◽  
Mariangela Gari ◽  
Marco Messina ◽  
Craig Wilde ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Corneal Dystrophy ◽  
Early Recurrence ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Retrospective Case ◽  
Phototherapeutic Keratectomy ◽  
Anterior Lamellar Keratoplasty

Background To evaluate the outcome of surgical options in the management of Thiel-Behnke corneal dystrophy (TBCD). This is a retrospective case report. Methods A 52-year-old female with TBCD with a visual acuity of 0.50 LogMAR in both eyes underwent deep anterior lamellar keratoplasty (DALK) in her left eye (LE) and, 8 months later, phototherapeutic keratectomy (PTK) in her right eye (RE). Postoperatively, the presence of recurrence, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), central corneal thickness (CCT), and spherical equivalent (SE) were assessed. Spectralis domain anterior segment optical coherence tomography was also performed to evaluate corneal morphology and reflectivity. Results At 1 year, the LogMAR UCVA and BCVA were +0.80 and +0.24, respectively, in the LE and +0.70 and +0.24 in the RE, respectively. CCT and SE were 741 microns (μm) and +4.25 diopters (D) in the LE, respectively, and 339 μm and +6.00 D in the RE, respectively. The cornea was clear in the LE. There was early recurrence of the TBCD and corneal haze in the RE. Conclusions The visual outcome of both DALK and PTK were similar for TBCD. No episodes of rejection or recurrence of dystrophy were noted in the eye that underwent DALK. However, postoperative hyperopic shift, persistent haze, and early recurrence were noted after PTK.

scholarly journals A deep learning approach for successful big-bubble formation prediction in deep anterior lamellar keratoplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takahiko Hayashi ◽  
Hiroki Masumoto ◽  
Hitoshi Tabuchi ◽  
Naofumi Ishitobi ◽  
Mao Tanabe ◽  
...  
Keyword(s):  
Deep Learning ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Automated System ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Biometric Data ◽  
Validation Data ◽  
Anterior Lamellar Keratoplasty ◽  
Big Bubble

AbstractThe efficacy of deep learning in predicting successful big-bubble (SBB) formation during deep anterior lamellar keratoplasty (DALK) was evaluated. Medical records of patients undergoing DALK at the University of Cologne, Germany between March 2013 and July 2019 were retrospectively analyzed. Patients were divided into two groups: (1) SBB or (2) failed big-bubble (FBB). Preoperative images of anterior segment optical coherence tomography and corneal biometric values (corneal thickness, corneal curvature, and densitometry) were evaluated. A deep neural network model, Visual Geometry Group-16, was selected to test the validation data, evaluate the model, create a heat map image, and calculate the area under the curve (AUC). This pilot study included 46 patients overall (11 women, 35 men). SBBs were more common in keratoconus eyes (KC eyes) than in corneal opacifications of other etiologies (non KC eyes) (p = 0.006). The AUC was 0.746 (95% confidence interval [CI] 0.603–0.889). The determination success rate was 78.3% (18/23 eyes) (95% CI 56.3–92.5%) for SBB and 69.6% (16/23 eyes) (95% CI 47.1–86.8%) for FBB. This automated system demonstrates the potential of SBB prediction in DALK. Although KC eyes had a higher SBB rate, no other specific findings were found in the corneal biometric data.

scholarly journals Comparison of Long-Term Outcomes of the Lamellar and Penetrating Keratoplasty Approaches in Patients with Keratoconus

2021 ◽  
Vol 10 (11) ◽  
pp. 2421
Author(s):  
Dominika Janiszewska-Bil ◽  
Barbara Czarnota-Nowakowska ◽  
Katarzyna Krysik ◽  
Anita Lyssek-Boroń ◽  
Dariusz Dobrowolski ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Adverse Events ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Cell Loss ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Cell Loss ◽  
Anterior Lamellar Keratoplasty ◽  
Significant Difference

We compared the visual and refractive outcomes, intraocular pressure (IOP), endothelial cell loss (ECL), and adverse events in keratoconus patients after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) with the best corrected visual acuity (BCVA) below 0.3 (logMAR 0.52). This is a prospective, comparative cohort study of 90 eyes (90 patients) with a clinical diagnosis of keratoconus. Patients underwent a complete eye examination before the surgical approach, 6 and 12 months postoperatively that consisted of BCVA, refractive astigmatism (AS), central corneal thickness (CCT), IOP, and ECL. Secondary outcomes were adverse events related to the surgical procedure. With lower ECL and less adverse events, DALK was revealed to be beneficial over PK with similar visual outcomes. Results: There was no significant difference between the BCVA in the DALK and PK groups (at 6 months: 0.49 ± 0.17 vs. 0.48 ± 0.17; p = 0.48; at 12 months: 0.54 ± 0.17 vs. 0.52 ± 0.14; p = 0.41). The mean value of AS was significantly lower after the PK procedure when compared to DALK, after both 6 and 12 months of follow up (p < 0.001). The CCT in the DALK group was significantly lower when compared to the PK group (at 6 months: 452.1 ± 89.1 µm vs. 528.9 ± 69.9 µm, p < 0.0001; at 12 months: 451.6 ± 83.5 µm vs. 525.5 ± 37.1 µm). The endothelial cell loss at 12 months after surgery was significantly lower after DALK when compared to PK (p < 0.0001). DALK transplantation should be considered as an alternative procedure in the surgical treatment of keratoconus.

scholarly journals Intraocular Pressure Changes Following Different Keratoplasty Techniques and Association with Cornea Parameters and anterior Chamber Depth

2021 ◽  
Author(s):  
Gülşah Gümüş ◽  
cigdem altan ◽  
yusuf yildirim ◽  
nilay kandemir besek ◽  
selim genç ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Corneal Thickness ◽  
Anterior Chamber Depth ◽  
Early Postoperative Period ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
The Difference ◽  
Pressure Changes

Abstract Purpose To evaluate early intraocular pressure (IOP) changes following different keratoplasty techniques and to investigate the relationship between corneal thickness (CT), keratometry values, anterior chamber depth (ACD) and IOP changes. Methods We included patients who underwent penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). ACD, CT, and keratometry measurements were repeated postoperatively at hour 24, week 1, and month 1. IOP measurements were repeated at postoperative hours 6 and 24, week 1, and month 1 by Tono-Pen XL. Results Twenty-two patients underwent PK, 12 patients underwent DALK, and 19 patients underwent DMEK. The difference between the IOP preoperatively and 6 hours postoperatively and between the IOP preoperatively and 24 hours postoperatively were statistically significant in the three types of surgery (p < 0.05 for each). The difference between preoperative and postoperative week 1 IOP was statistically significant only in the PK group (p = 0.023). When the IOP was compared between the three types of surgeries, the IOP at postoperative week 1 in the PK group was significantly higher than the DALK and DMEK groups (p = 0.021). There was no correlation between ACD, corneal thickness, K values, and IOP in any group. Conclusion IOP may increase in all types of keratoplasty during the first hours after surgery, but PK has a risk of high IOP longer in the early postoperative period. PK patients should be followed more carefully during postoperative week 1 to check for an increase in IOP.

scholarly journals Urrets-Zavalia syndrome after deep anterior lamellar keratoplasty

2016 ◽  
Vol 73 (10) ◽  
pp. 973-975
Author(s):  
Vesna Jovanovic ◽  
Ljubisa Nikolic
Keyword(s):  
Case Report ◽  
Penetrating Keratoplasty ◽  
Secondary Glaucoma ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Pigment Layer ◽  
Anterior Lamellar Keratoplasty ◽  
Corneal Hydrops ◽  
Iris Atrophy ◽  
Uncommon Complication

Introduction. Urrets-Zavalia syndrome is an uncommon complication of the deep anterior lamellar keratoplasty in keratoconus. The manifestations of this syndrome are an irreversible mydriasis, iris atrophy and secondary glaucoma. Case report. Deep anterior lamellar keratoplasty was done for keratoconus with a presumably healed corneal hydrops in a 21-year-old Caucasian man. The graft remained clear, but the surgery was complicated by a fixed, dilated pupil, patches of iris atrophy, ectropium of the iris pigment layer and glaukomflecken in the lens. Conclusion. Although safer than penetrating keratoplasty, the deep anterior lamellar by not trying to secure an unhealed Descemet?s membrane with air. Instead, a new Descemet?s membrane transplanted within a penetrating graft is a safer choice.

Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus

2016 ◽  
Vol 5 (1) ◽  
pp. 32-34
Author(s):  
José RC Reis ◽  
Alberto Diniz-Filho ◽  
Fábio M Rocha
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Young Patients ◽  
Case Series ◽  
Early Postoperative Period ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Deep Lamellar Keratoplasty ◽  
Anterior Subcapsular Cataract

ABSTRACT Purpose To present a case series of patients that developed Urrets-Zavalia syndrome (UZS) after deep anterior lamellar keratoplasty (DALK) for treating keratoconus and discuss the mechanisms for the syndrome. Materials and methods Retrospective chart analysis of patients who developed UZS after DALK at the Cornea Unit, Hospital São Geraldo, Federal University of Minas Gerais. Results We present a series of 3 patients with features consistent with UZS, after undergoing DALK. Elevated intraocular pressure (IOP) was noted in the early postoperative period in 2 cases, despite the fact that the other case reported eye pain, headache, and nausea at the night after the surgery with undocumented IOP. Although at different extents, the pupil remained atrophic and dilated in all 3 eyes, and 2 of them developed anterior subcapsular cataract. Conclusion Iris ischemia resulting from occlusion of iris root vessels due to elevated IOP higher than diastolic blood pressure causes UZS. Elevated IOP should be monitored, especially in young patients with low diastolic blood pressure, in order to avoid the occurrence of the syndrome. How to cite this article Reis JRC, Diniz-Filho A, Rocha FM, Torquetti L. Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(1):32-34.

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