scholarly journals Use of Pressurized Air Infusion For Pre Descemet's Endothelial Keratoplasty (PDEK) - The Air Pump Assisted PDEK Technique

2018 ◽  
Vol 12 (1) ◽  
pp. 175-180 ◽  
Author(s):  
Soosan Jacob
Keyword(s):  
Anterior Chamber ◽  
Corneal Neovascularization ◽  
Endothelial Keratoplasty ◽  
Exchange System ◽  
Peripheral Iridectomy ◽  
Air Exchange

Purpose: To assess the advantages offered by the air pump assisted PDEK technique that utilizes pressurized Anterior Chamber (AC) air infusion. Methods: Pressurized air infusion was provided through an anterior chamber maintainer connected to the fluid air exchange system of a posterior vitrectomy machine during surgery. Results: Pressurized air infusion within the AC helped perform Descemetorhexis, prevented bleeding during Peripheral Iridectomy (PI) and synechiolysis, prevented oozing of blood from peripheral corneal neovascularization into the AC and thus helped maintain a non-fibrinous AC environment. In addition, it helped in precise graft manipulation, centration, edge unfolding and unwrinkling after it was floated against the stroma as well as faster graft adhesion. It also prevented AC depth fluctuations during intra-cameral maneuvers and prevented intra-operative as well as post-operative graft detachment. Conclusions: This technique makes several steps of surgery easier and improves graft adhesion.

scholarly journals Effect of peripheral iridectomy on VEGF-A and TGF-β levels in rabbit aqueous humour

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Annabel C. Y. Chew ◽  
Li-Fong Seet ◽  
Stephanie W. L. Chu ◽  
Nyein C. Lwin ◽  
Tina T. Wong
Keyword(s):  
Anterior Chamber ◽  
Aqueous Humour ◽  
Glaucoma Surgery ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Peripheral Iridectomy ◽  
New Zealand White Rabbits ◽  
The Right ◽  
Tgf Β1 ◽  
Time Point

Abstract Background Peripheral iridectomy (PI), routinely performed during glaucoma filtration surgery, may contribute to scarring. This study aims to determine whether PI alters the concentrations of VEGF-A and TGF-β isoforms in the rabbit aqueous humour. Methods Anterior chamber paracentesis (ACP) was performed in both eyes of six New Zealand white rabbits, with additional surgical PI performed in the right eyes. Eyes were examined on postoperative days (PODs) 1, 7, 30 and 60 by means of the tonopen, slit-lamp biomicroscopy, and bead-based cytokine assays for TGF-β and VEGF-A concentrations in the aqueous humor. Results ACP caused a significant reduction in intraocular pressure (IOP) from mean preoperative 11.47 ± 1.01 mmHg to 5.67 ± 1.63 mmHg on POD 1 while PI did not cause further IOP reduction. Limbal conjunctival vasculature appeared slightly increased on POD 1 in both ACP and PI eyes with PI also causing mild bleeding from damaged iris vessels. Two PI eyes developed fibrinous anterior chamber reaction and/ or peripheral anterior synechiae. Aqueous VEGF-A levels were not significantly different between eyes treated with ACP and PI. Aqueous TGF-β concentrations distributed in the ratio of 4:800:1 for TGF-β1:TGF-β2:TGF-β3 respectively. While aqueous TGF-β2 was not significantly induced by either procedure at any time point, TGF-β1 and TGF-β3 were significantly induced above baseline levels by PI on POD 1. Conclusion PI increases the risk of inflammation. The combined induction of aqueous TGF-β1 and TGF-β3 by PI in glaucoma surgery may impact surgery success in glaucoma subtypes sensitive to these isoforms.

scholarly journals Epithelial Downgrowth after Intraocular Surgery Treated with Intracameral 5-Fluorouracil

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Nina Ni ◽  
Marc A. Goldberg ◽  
Ralph C. Eagle ◽  
Christopher J. Rapuano ◽  
Julia A. Haller
Keyword(s):  
Anterior Chamber ◽  
Penetrating Keratoplasty ◽  
Case Reports ◽  
Corneal Edema ◽  
Limited Area ◽  
Endothelial Keratoplasty ◽  
Intraocular Surgery

Purpose. To present the clinical and histopathologic correlation of two cases of epithelial downgrowth (EDG) after prior intraocular surgery.Methods. Observational case reports.Results. We present two cases of EDG occurring after intraocular surgery. In both cases, after two anterior chamber injections of 5-fluorouracil (5FU), the area of EDG initially regressed. In Case 1, a limited area of EDG eventually recurred, and penetrating keratoplasty with cryotherapy was curative. In Case 2, subsequent corneal edema required Descemet-stripping automated endothelial keratoplasty, and the patient remained clinically free of EDG without further treatment.Conclusion. Intracameral 5FU may have a role in the treatment of EDG after intraocular surgery, though its precise utilization and impact remain to be defined.

Endothelial keratoplasty with anterior chamber intraocular lens versus secondary posterior chamber intraocular lens

2020 ◽  
pp. bjophthalmol-2020-316711
Author(s):  
Jyh Haur Woo ◽  
Anshu Arundhati ◽  
Soon-Phaik Chee ◽  
Weihan Tong ◽  
Lim Li ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Graft Survival ◽  
Intraocular Lens ◽  
Posterior Chamber ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Significant Difference ◽  
Iris Claw ◽  
Iol Exchange

AimTo describe the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with an anterior chamber intraocular lens (ACIOL) compared to secondary posterior chamber (PC) IOL.MethodsThis was a retrospective comparative cohort study. The clinical data of 82 eyes from 82 consecutive patients with pseudophakic (PBK) or aphakic bullous keratopathy (ABK) who either underwent DSAEK with retained or secondary ACIOL (n=23) or DSAEK with IOL exchange and/or secondary PCIOL (retropupillary iris-claw IOL, n=25; intrascleral-fixated IOL, n=29; or sulcus IOL, n=5) were analysed. The main outcome measures were graft survival and complications up to 5 years.ResultsThe graft survival in the secondary PCIOL group was superior than the ACIOL group over 5 years (year 1, 100.0% vs 100.0%; year 3, 94.7% vs 75.0%; year 5, 91.1% vs 60.6%, p=0.022). The presence of an ACIOL was a significant risk factor associated with graft failure (HR, 4.801; 95% CI, 1.406 to 16.396, p=0.012) compared to a secondary PCIOL. There was no significant difference in the rate of graft detachment and elevated intraocular pressure between the groups. There were five cases (9.3%) of IOL subluxation or dislocation in the retropupillary iris-claw and intrascleral-fixated IOL groups.ConclusionsEyes that underwent DSAEK with ACIOL in situ had poorer long-term graft survival compared with those with secondary PCIOL. Intraocular lens exchange was not associated with a higher complication rate. In ABK or PBK eyes with ACIOL, we recommend performing IOL exchange and/or secondary PCIOL implantation combined with endothelial keratoplasty.

scholarly journals Clinical Evaluation of the NS Endo-Inserter, a Novel Donor Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

2019 ◽  
Vol 10 (3) ◽  
pp. 357-364
Author(s):  
Akira Kobayashi ◽  
Hideaki Yokogawa ◽  
Natsuko Mori ◽  
Tsubasa Nishino ◽  
Kazuhisa Sugiyama
Keyword(s):  
Anterior Chamber ◽  
Clinical Outcomes ◽  
Intraoperative Complications ◽  
Case Series ◽  
Argon Laser ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Donor Tissue ◽  
Laser Iridotomy ◽  
Cell Densities

Purpose: This study investigated the clinical outcomes achieved with a newly developed donor inserter (NS Endo-Inserter [NSI], HOYA Co., Ltd., Tokyo, Japan) for Descemet’s stripping automated endothelial keratoplasty (DSAEK) in Japanese eyes with bullous keratopathy secondary to argon laser iridotomy (BK-ALI). The NSI device utilizes pressure flow to push the DSAEK donor tissue into the anterior chamber. Methods: Six eyes of 6 patients (1 male, 5 females; mean age, 78.5 years) with BK-ALI were enrolled. Donor tissue was pushed into the anterior chamber using the NSI. Intraoperative complications, graft dislocation, and iatrogenic primary graft failure were recorded for all eyes. Six-month postoperative central donor endothelial cell densities (ECD) were measured prospectively and compared with preoperative values, along with 6-month best corrected visual acuity (BCVA). Results: In all cases, donor loading onto the NSI spatula and donor insertion into the anterior chamber using the NSI was smooth and successful; no intraoperative complications were noted. There were no cases of graft dislocation or IPGF. Postoperative ECD was 2,187.2 cells/mm2 (mean loss, 14.8%) and mean BCVA increased from 0.27 decimal to 0.8 at 6 months. Conclusion: In this small preliminary case series, clinical outcomes for patients with BK-ALI undergoing DSAEK using the NSI were comparable or better than those achieved with conventional DSAEK insertion techniques.

Descemet’s Stripping Endothelial Keratoplasty—Insertion Techniques for Endothelial Keratoplasty

2012 ◽  
Vol 05 (01) ◽  
pp. 40
Author(s):  
Michael W Belin ◽  
Sadeer B Hannush ◽  
◽  
Keyword(s):  
Endothelial Cell ◽  
Anterior Chamber ◽  
Cell Loss ◽  
Endothelial Keratoplasty ◽  
Endothelial Cell Loss ◽  
Descemet’S Stripping Endothelial Keratoplasty ◽  
Insertion Techniques

Descemet’s stripping endothelial keratoplasty has emerged as the treatment of choice for primary and secondary endothelial failure. One of the most crucial portions of the procedure is introducing the donor lenticule into the anterior chamber. Numerous techniques and instruments have been developed in an attempt to simplify the incision and reduce endothelial cell loss.

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