scholarly journals Evaluation of Donor and Recipient Characteristics Involved in Descemet Stripping Automated Endothelial Keratoplasty Outcomes

2021 ◽  
Vol 8 ◽  
Author(s):  
Michele Lanza ◽  
Rosa Boccia ◽  
Adriano Ruggiero ◽  
Paolo Melillo ◽  
Mario Bifani Sconocchia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Eye Bank ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Aims: To evaluate both donor and recipient features involved in visual acuity restoring and complication insurgence in eyes that have undergone Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: In this retrospective study, charts of 111 eyes of 96 patients (mean age 70.25 ± 8.58 years) that underwent DSAEK were evaluated. Only Fuch's Distrophy (FD) or Bullous Keratopathy (BK) due to cataract surgery eyes were included. A complete ophthalmic check with endothelial cell density (ECD) and central corneal thickness (CCT) measurement was performed before surgery and at 1, 3, 6, and 12 months follow-up. Each DSAEK was performed by the same well-trained surgeon; only pre-cut lenticules, provided by same Eye Bank, were implanted.Results: A total of 48 (43%) complications have been observed (most of them were 22 partial graft detachments and 17 IOP spikes). At the last follow-up (mean: 8.58 ± 4.09 months), a significant increase (p < 0.05) of best corrected visual acuity (BCVA) was detected. Overall mean BCVA of the eyes evaluated was 0.40 ± 0.43 LogMAR with BK eyes showing a significantly higher improvement (p < 0.05) compared to FD eyes. The only factor showing a significant correlation (p < 0.05) with visual acuity enhancement was the implant of a lenticule thinner than 100 μm. Recipient features significantly (p < 0.05) associated with complications observed after surgery were glaucoma and diabetes mellitus.Conclusion: The use of a graft thinner than 100 μm can provide better visual acuity recovery while recipients affected by glaucoma or diabetes mellitus are more prone to develop complications after surgery.

Comparative study on corneal cross-linking with isotonic and hypotonic riboflavin: can hypotonic riboflavin be applied in thinner corneas?

2021 ◽  
Vol 2 (1) ◽  
pp. 14-19
Author(s):  
Ana Sofia Lopes ◽  
◽  
Susana Henriques ◽  
Peter Pêgo ◽  
Cristina Vendrell ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retrospective Study ◽  
Comparative Study ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Corrected Visual Acuity ◽  
The Difference ◽  
Best Corrected Visual Acuity

AIM: To compare the results of corneal cross-linking (CXL) with isotonic (IR) and hypotonic riboflavin (HR) in patients with keratoconus and to verify the efficacy of keratoconus in thinner corneas. METHODS: Retrospective study of 29 eyes/keratoconus patients submitted to CXL, 15 eyes with application of IR (IR group) and 14 eyes with application of HR (HR group). The parameters analysed included (1-year follow-up): best corrected visual acuity (BCVA), sphere and cylinder, central and finer pachymetry, mean and maximum keratometry (Km and Kmax respectively), complications and progression. RESULTS: An increase on the BCVA scale (logMAR, logarithm of the minimal angle of resolution) was observed in the two groups: 0.26±0.57 (IR) and 0.47±0.72 (HR) before treatment, and 0.13±0.79 (IR) and 0.29±1.52 (HR) at the 1y. Only at 1y, the difference was statistically significant (P=0.018, group IR with higher BCVA). The central pachymetry (μm) decreased at 1mo in both groups, and increased in the following months: 497±28 μm (IR) and 432±14 μm (HR) before treatment, and 480±31 μm (IR) and 424±15 μm (HR) to the 1y. The thinner pachymetry (μm) presented the same evolution: 487±29 μm (IR) and 410±20 μm (HR) before treatment, and 468±33 μm (IR) and 413±13μm (HR) at 1y. Km and Kmax decreased in both groups (P>0.05). Six eyes from each group presented transitory haze. No eye progressed to the 1y. CONCLUSION: The use of hypotonic riboflavin seems to be a valid alternative for performing the traditional corneal cross-linking technique in eyes with a central corneal thickness of <400 μm.

Detecting subclinical keratoconus by biomechanical analysis in tomographically regular keratoconus fellow eyes

2021 ◽  
pp. 112067212110637
Author(s):  
Victor A Augustin ◽  
Hyeck-Soo Son ◽  
Isabella Baur ◽  
Ling Zhao ◽  
Gerd U Auffarth ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Case Series ◽  
Biomechanical Analysis ◽  
Corvis St ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Best Corrected Visual Acuity ◽  
Fellow Eyes

Purpose To analyze the tomographically non-affected second eyes of keratoconus patients using the Corvis ST to detect any biomechanical abnormalities or subclinical keratoconus. Methods In this retrospective, single-center, consecutive case series 244 eyes of 122 keratoconus patients were analyzed between November 2020 and February 2021. Fourteen fellow eyes fulfilled the inclusion criteria and showed no clinical or tomographic signs of keratoconus. Main outcome measures included best-corrected visual acuity, tomographic and biomechanical analyses using Scheimpflug imaging: Pentacam and Corvis ST (Oculus, Wetzlar, Germany). Tomographic analyses included anterior and posterior simulated keratometry, K-Max, central corneal thickness, thinnest corneal thickness, Belin/Ambrosio Ectasia Display, and the ABCD grading system. For biomechanical analyses, the corneal biomechanical index (CBI) and tomographic biomechanical index were used. Results The mean best-corrected visual acuity was 0.01 ± 0.10 logMAR. Mean K-Max was 43.79 ± 1.12 D, mean central corneal thickness 529 ± 25 µm, mean thinnest corneal thickness 524 ± 23 µm, and mean Belin/Ambrosio Ectasia Display 1.0 ± 0.32. The mean CBI was 0.30 ± 0.21. Regular CBI values were found in six of 14 patients. The mean tomographic biomechanical index was 0.47 ± 0.22 with regular values observed in only two of 14 patients. No signs of tomographic or biomechanical abnormalities were shown in only one of 14 keratoconus fellow eyes, with regular ABCD, Belin/Ambrosio Ectasia Display, CBI and tomographic biomechanical index values. Conclusions Tomographically normal fellow eyes of keratoconus patients are rare. In these cases, a biomechanical analysis of the cornea may help detect a subclinical keratoconus. The tomographic biomechanical index was the most sensitive index to verify a mild ectasia.

scholarly journals Comparative study of anatomic and functional changes of the corneal endothelium in cataract patients undergoing phacoemulsification and MSICS

2021 ◽  
Vol 7 (2) ◽  
pp. 358-362
Author(s):  
Gurvinder Khosa ◽  
Karanijit Singh ◽  
Prempal Kaur ◽  
Rajesh Kumar ◽  
Upasna Ajmani
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Cell Loss ◽  
P Value ◽  
Corrected Visual Acuity ◽  
Group 2 ◽  
Best Corrected Visual Acuity ◽  
Group 1

The purpose of this study was to compare the effect of Phacoemulsification and Manual small incision cataract surgery (MSICS) on the corneal endothelium and to assess its impact on visual acuity and induced astigmatism. In this prospective randomized study, 100 cases were randomly selected with the help of lottery system. 50 cases underwent phacoemulsification (group 1) and 50 underwent MSICS (group 2) by a single surgeon. The endothelial cell count, central corneal thickness, best corrected visual acuity and induced astigmatism was measured preoperatively and postoperatively on day 1, 7, 28 and on day 42. Mean endothelial cell loss (cells/mm2) in group 1 at the end of six weeks was 538.64 (20.59%) and in group 2 was 485.66 (19.20%) which was statistically insignificant (p &#62;0.05). The mean central corneal thickness was reduced in both the groups with a mean of 0.51±0.04 mm in group 1 and 0.50±0.03 mm in group 2 which was statistically insignificant. Postoperative best corrected visual acuity of more than 6/18 was found in 49 (98%) cases in each group at six weeks, and was statistically insignificant (p value &#62; 0.05). Phacoemulsification group had statistically significant less mean postoperative astigmatism than MSICS group (p value &#60; 0.05). Both groups gave similar statistically insignificant results in relation to endothelial cell loss, central corneal thickness and best corrected visual acuity at the end of six weeks, although the mean astigmatism was more in group 2 in comparison to group 1 with a statistically significant difference.

scholarly journals Estimation of the Level of Glycosylated Hemoglobin as a Predictor Factor to Bevacizumab Injection in Diabetic Macular Edema in a Sample of Iraqi Patients

2021 ◽  
Vol 9 (B) ◽  
pp. 1480-1483
Author(s):  
Hasanain Hasan Attar ◽  
Farooq Mohammed Abbas ◽  
Haider Layikh
Keyword(s):  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Intraocular Pressure ◽  
Macular Edema ◽  
Glycosylated Hemoglobin ◽  
Study Groups ◽  
Corrected Visual Acuity ◽  
Significant Difference ◽  
Best Corrected Visual Acuity

Abstract Background: clinically significant macular edema ( CSME) consider as one of the most critical complications of poorly controlled diabetes and it’s the main reason for decreased vision in that kind of patients, we try in this article to find the relation between glycosylated hemoglobin level and the response to bevacizumab injections in people with macular edema   Materials and methods: Ninety-five patients (55 male:40 female) were recruited in this study, all of them had diabetes type2, age of the participants ranging from 42 to 70 years old, Complete ophthalmic examination was done for all the participants including (best-corrected visual acuity), (intraocular pressure) checking, fundus evaluation, and central macular thickness measurement, serum glycosylated hemoglobin (HbA1C) was also measured, Patients were given 0.05ml(1.25mg) of bevacizumab (Avastin)  intravitreally for three successive months, Follow up visit was at 4,8,12 week post-injection. On each follow up detailed examination was done including the( best-corrected visual acuity) examination, (Intraocular pressure), both fundus examination, and OCT of the macula. Results: This study included 111 patients who had type 2 diabetes mellitus who were classified according to HbA1c into two sub-groups, HbA1c ≤ 7 % (n = 45) and HbA1c > 7 % (n = 66) we found no significant difference in mean age and frequency distribution according to gender between study groups (p > 0.05), but, there was a highly significant difference in mean HbA1c % (p < 0.001). when we compare mean OCT and mean VA before and after the intervention in patients who had diabetes mellitus classified according to HbA1c into (HbA1c ≤ 7 % and HbA1c > 7 %) we found that before the intervention, there was no significant difference in mean OCT between study groups (p > 0.05), but after the intervention, there was a reduction in mean OCT and the reduction was more pronounced in the group of HbA1c of less than 7 % (p < 0.001). About visual acuity, we found no significant difference before the intervention and after the intervention, the changes were comparable between both study groups (p > 0.05). Conclusion: intra-vitreal injections of bevacizumab result in anatomical (macular thickness) and functional (vision ) improvement in those patients who had diabetic macular edema and strict glycemic control affecting the outcome of the treatment where strict regulation of glucose level have yield maximum benefit from the given therapy   

scholarly journals Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK

2020 ◽  
Vol 5 (1) ◽  
pp. e000546
Author(s):  
Vito Romano ◽  
Luca Pagano ◽  
Kunal A Gadhvi ◽  
Giulia Coco ◽  
Mitchell Titley ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Clinical Outcomes ◽  
Corneal Dystrophy ◽  
University Hospital ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Corrected Visual Acuity ◽  
Pseudophakic Bullous Keratopathy ◽  
Best Corrected Visual Acuity

ObjectiveTo compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK).Methods and analysisComparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures.Results56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01.ConclusionPl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern.

Rebubbling rate in preloaded versus surgeon prepared DSAEK

2021 ◽  
pp. 112067212110143
Author(s):  
Luca Pagano ◽  
Kunal A Gadhvi ◽  
Giulia Coco ◽  
Matthew Fenech ◽  
Mitchell Titley ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Statistical Difference ◽  
Preparation Method ◽  
Eye Bank ◽  
Eye Banks ◽  
Corrected Visual Acuity ◽  
Detachment Rate ◽  
Pull Through ◽  
Graft Diameter ◽  
Best Corrected Visual Acuity

Purpose: To compare the clinical outcomes of eye bank preloaded Descemet stripping automated endothelial keratoplasty (DSAEK) grafts and surgeon prepared. Methods: In this retrospective study, the data were obtained from two groups (a) surgeon cut DSAEK where tissue was prepared by the surgeon immediately before surgery, and (b) preloaded DSAEK tissue shipped to the surgeon after preparation by the eye bank. Standard DSAEK preparations using Moria microkeratome with single pass method were performed. For the tissues prepared by the eye banks, they were preloaded in an iGlide device and shipped in transport media. Standard DSAEK surgery using bimanual pull-through technique was performed for all the grafts. Air was used as a tamponade. Main outcome measures included best corrected visual acuity (BCVA) and rebubbling rate. Result: Out of 107 eyes of 101 patients that underwent DSAEK surgery, 33 tissues were prepared by the surgeon (sc-DSAEK), while 74 were prepared by the eye bank (pl-DSAEK). sc-DSAEK showed a rebubbling rate of 9.1%, compared to the 16.2% for the preloaded DSAEK ( p = 0.11). There was no statistical difference in postoperative BCVA between the two groups. Logistic regression analysis showed no association between detachment rate and cataract surgery, graft preparation method, graft diameter and reason for graft. Conclusion: Preloaded grafts have similar rebubbling rate and visual acuity achieved compared with surgeon prepared grafts.

scholarly journals Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs’ endothelial dystrophy

2021 ◽  
Author(s):  
Bishr Agha ◽  
Nura Ahmad ◽  
Daniel G. Dawson ◽  
Thomas Kohnen ◽  
Ingo Schmack
Keyword(s):  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Corneal Astigmatism ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Corneal Densitometry ◽  
Scheimpflug Imaging ◽  
Fuchs Endothelial Dystrophy ◽  
Posterior Corneal Astigmatism

Abstract Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

scholarly journals Effect of phacoemulsification with intraocular lens implantation in eyes with cataract and functioning filtering blebs

2013 ◽  
Vol 13 (2) ◽  
pp. 33-41
Author(s):  
Devendra Maheshwari ◽  
Rengappa Ramakrishanan ◽  
Mohideen Abdul Kader ◽  
Neelam Pawar ◽  
Ankit Gupta
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Intraocular Lens Implantation ◽  
Corrected Visual Acuity ◽  
Lens Implantation ◽  
The Mean ◽  
One Year ◽  
Best Corrected Visual Acuity

Aim: To evaluate the effect of phacoemulsification with intraocular lens implantation in eyes with pre-existing trabeculectomy.Methods: This prospective single-center clinical study evaluated intraocular pressure in 60 eyes of 60 patients who underwent phacoemulsification and implantation of a foldable intraocular lens after a previous successful trabeculectomy. Patients who had a trabeculectomy more than one year prior to the study were included. Intraocular pressure, number of antiglaucoma medications, bleb appearance, and visual acuity were recorded preoperatively, and at each follow-up examination and 12 months after phacoemulsification.Results: The mean intraocular pressure before phacoemulsification was 12.42 mmHg (SD, 4.60 mmHg), which increased to 14.98 mmHg (SD, 4.18 mmHg), 14.47 mmHg (SD, 3.58 mmHg), 15.44 mmHg (SD, 3.60 mmHg), and 15.71 mmHg (SD, 3.47 mmHg) after one, three, six, and 12 months, respectively. At each follow-up visit, the mean IOP was significantly higher than the preoperative value (p < 0.001, p = 0.015, p ≤ 0.001, and p = 0.001 at month one, three, six, and 12, respectively). The mean preoperative best-corrected visual acuity was 0.98 logMAR (SD, 0.44 logMAR) and the mean postoperative best-corrected visual acuity at 12 months was 0.20 logMAR (SD, 0.21 logMAR) [p = 0.0001]. The mean preoperative number of antiglaucoma medications used was 0.57 (SD, 0.63), which increased to 0.65 (SD, 0.63 ), 0.70 (SD, 0.72 ) 0.68, (SD, 0.70), and 0.67 (SD, 0.77 ) at one, three, six, and 12 months, respectively, but there were no statistically significant differences. Bleb size decreased clinically after phacoemulsification. Nineteen of 60 eyes (32%) developed fibrosis of bleb with decreased bleb size.Conclusion: Phacoemulsification with intraocular lens implantation significantly increased intraocular pressure and increased the number of antiglaucoma medications in eyes with pre-existing functioning filtering blebs.

scholarly journals Descemet stripping endothelial keratoplasty: One-year follow-up

2010 ◽  
Vol 138 (11-12) ◽  
pp. 690-693
Author(s):  
Ljubisa Nikolic ◽  
Vesna Jovanovic
Keyword(s):  
Corneal Thickness ◽  
Long Term Results ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
Air Bubble ◽  
Primary Graft Failure ◽  
Internal Side ◽  
One Year

Introduction. Sutureless transplantation of endothelium on a thin stromal carrier was introduced under the name of Descemet stripping endothelial keratoplasty (DSEK) in 2004. It has become the treatment of choice of corneal oedema due to endothelial dysfunction. Objective. To investigate posterior lamellar graft attachment, central corneal thickness (CCT), astigmatism, and best corrected visual acuity (BCVA) during one-year follow-up. Methods. Surgery was performed on one eye of 11 patients with pseudophakic bullous keratopathy and Fuchs? dystrophy. The graft thick 150-200 ?m and 8.0 mm in diameter was detached manually. The carrier of the recipient cornea was created by DSEK. The graft was folded in half, introduced into the anterior orbital chamber through a 5.0 mm cut on the limbus and attached by air bubble along the internal side of the recipient cornea. CCT and astigmatism were evaluated by corneal topography, and graft attachment by biomicroscopy. Results. One year after surgery, all grafts remained attached. Primary graft failure occurred in three eyes, probably due to the crushing effect of the forceps. BCVA was 20/30 (2 eyes), and 20/40 (6 eyes), CCT 643-728 ?m, and astigmatism 1.1 D to 2.9 D. The peak values were reached three months after surgery, and did not change much afterwards. Conclusion. This is the first report on the long-term results of DSEK in our literature. The results are similar to those obtained by more experienced DSEK surgeons, and suggest that this procedure is safe and successful.

scholarly journals The effect of amblyopia on clinical outcomes of children with astigmatism

2021 ◽  
Vol 13 ◽  
pp. 251584142110408
Author(s):  
Burçin Çakır ◽  
Nilgün Özkan Aksoy ◽  
Sedat Özmen ◽  
Özlem Bursalı
Keyword(s):  
Visual Acuity ◽  
Clinical Outcomes ◽  
Medical Records ◽  
Convergence Insufficiency ◽  
Corrected Visual Acuity ◽  
Ocular Deviation ◽  
The Mean ◽  
The Difference ◽  
Best Corrected Visual Acuity

Background: Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. Objective: To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. Methods: We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. Results: The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. Conclusion: A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.

Sign in / Sign up

Export Citation Format

Share Document