Epidemiology of Corneal Neovascularization and Its Impact on Visual Acuity and Sensitivity: A 14-Year Retrospective Study

Purpose: To quantify the severity and location of corneal neovascularization (cNV) and its impact on the visual acuity and corneal sensitivity in a cohort of the patients referred to a specialist cornea clinic and also to describe the etiology of cNV in the cohort.Methods: We retrospectively evaluated the charts of 13,493 subjects referred to the San Raffaele Cornea Unit between January 2004 and December 2018 to search for cNV diagnosis. The corneal neovascularization severity was measured in the quadrants (range: 1–4) and location was defined as superficial, deep, or both. Best spectacle corrected visual acuity (BSCVA) was measured in logMar. We used the multiple regression analysis to identify the independent predictors of logMAR, after adjusting for age, gender, keratoconus, herpes keratitis, penetrating keratoplasty, trauma, and cataract surgery.Results: Corneal neovascularization was diagnosed in 10.4% of the patients analyzed. The most prevalent etiology of cNV in our population was non-infectious corneal dystrophies/degenerations followed by herpes simplex virus infection. cNV affected OD, OS, or both eyes in 35.6, 40.2, and 24.2 of cases, respectively. Mean BSCVA (SD) was 0.59 (0.76), 0.74 (0.94), and 1.24 (1.08) in cNV one, two, and three or four of the quadrant groups. Superficial, deep, or mixed cNV occurred in 1,029, 348, and 205 eyes. Severe cNV (three or four of the quadrants) was a significant predictor of low visual acuity (p < 0.001) and reduced corneal sensitivity (p < 0.05). cNV location and its severity were associated (p < 0.05). In addition, corneal anesthesia was associated with lower BSCVA (p < 0.001).Conclusion: Severe and deep cNV are associated with the reduced visual acuity and corneal sensitivity. Our data strongly support the relevance of appropriate follow-up as cNV is a major risk factor for graft rejection.

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Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1066 ◽

2013 ◽

Vol 2 (3) ◽

pp. 133-138

Author(s):

Ramez Barbara ◽

David Zadok ◽

Adel Barbara ◽

Shay Gutfreund

Keyword(s):

Visual Acuity ◽

Penetrating Keratoplasty ◽

Corneal Neovascularization ◽

Young Female ◽

Spherical Equivalent ◽

Corrected Visual Acuity ◽

Optical Zone ◽

Positive Results ◽

Oval Shape ◽

Best Corrected Visual Acuity

ABSTRACT Intacs have yielded positive results for the treatment of keratoconus in terms of reducing the keratometry readings astigmatism and spherical equivalent and consequently improving the uncorrected and best corrected visual acuity. Intacs severe keratoconus (SK) are new design of Intacs with a smaller optical zone (6 mm) and oval shape, they are indicated for severe keratocnus. Pannus is one of the complications of Intacs, as it has never been reported after Intacs SK. We report on corneal neovascularization in the corneal periphery which developed few months after Intacs SK implantation in the cornea of a young female who suffered from advanced keratoconus. The uncorrected visual (UCVA) acuity was satisfactory and the Intacs SK where not removed. Four years after the implantation she presented to our clinic complaining about eye irritation and photophobia, lipid keratopathy was observed. We gave here the choice of explanting the Intacs SK or to try to treat the neovascularization by subconjunctival Avastin, she preferred the second option because of a satisfactory UCVA (0.9). Avastin was injected in the subconjunctival, 10 weeks later Avastin and Kenelog were injected in the subconjunctival, few days after the second injection perforation and melting developed in the cornea, the patient underwent a tectonic graft and few months later penetrating keratoplasty with no intraoperative or postoperative complications. How to cite this article Barbara A, Zadok D, Gutfreund S, Barbara R. Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus. J Kerat Ect Cor Dis 2013;2(3):133-138.

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Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211027705 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110277

Author(s):

Zahra Ashena ◽

Thomas Hickman-Casey ◽

Mayank A. Nanavaty

Keyword(s):

Visual Acuity ◽

Penetrating Keratoplasty ◽

Anterior Segment ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Ocular Coherence Tomography ◽

Corrected Visual Acuity ◽

Intracameral Injection ◽

History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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Corneal densitometry in patients with keratoconus undergoing intrastromal Ferrara ring implantation

European Journal of Ophthalmology ◽

10.1177/11206721211020631 ◽

2021 ◽

pp. 112067212110206

Author(s):

Pablo Felipe Rodrigues ◽

Bernardo Kaplan Moscovici ◽

Guilherme Ferrara ◽

Luciano Lamazales ◽

Marcela Mara Silva Freitas ◽

...

Keyword(s):

Visual Acuity ◽

Medical Records ◽

Spherical Equivalent ◽

Interventional Study ◽

Data Comparison ◽

Corneal Densitometry ◽

Corrected Visual Acuity ◽

Ring Segment ◽

The Mean

Objective: Evaluation of central corneal densitometry changes following Ferrara corneal ring segment implantation in patients with keratoconus, especially the correlation between corneal densitometry and keratometry. Methods: Retrospective, non-comparative, interventional study based on the review of medical records of patients diagnosed with keratoconus who underwent Ferrara corneal ring segment implantation. Pre and post-operative corneal densitometry measurements obtained with Pentacam HR (Oculus, Wetzlar, Germany) were analyzed. The follow-up time was 3 months, and data comparison was made, using specific statistical analysis, with the data of 3 months postoperatively. Results: The study sample consisted of 43 eyes of 36 patients. The mean corrected visual acuity improved from 0.82 LogMAR preoperatively (SD ± 0.33) to 0.19 LogMAR (SD ± 0.13) postoperatively. The mean spherical equivalent varied from −4.63 (SD ± 3.94) preoperatively to −2.16 (SD ± 2.63) postoperatively. Asphericity varied from −0.69 (SD ± 0.32) preoperatively to −0.27 (SD ± 0.31) postoperatively. The mean maximum K was 54.01D (SD ± 3.38) preoperatively and 51.50D (SD ± 2.90) postoperatively. The mean anterior densitometric value was 18.26 (SD ± 2.03) preoperatively and 17.66 (SD ± 1.84) postoperatively. Conclusion: Corneal densitometry is an interesting technology that should be studied in keratoconus patients. Our results suggest that the corneal densitometry in the cornea’s anterior layer reduces after ICRS implantation and correlates with corneal keratometry. Further studies should be performed to increase the knowledge in this field.

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

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v13i2.44 ◽

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.

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The effect of amblyopia on clinical outcomes of children with astigmatism

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211040898 ◽

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.

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Cataract Surgery and Uveitis

Annals of King Edward Medical University ◽

10.21649/akemu.v9i3.1332 ◽

2016 ◽

Vol 9 (3) ◽

Author(s):

Mumtaz Hussain ◽

Muhammad Moin ◽

Nazir Ahmad Aasi ◽

Muhammad Waqas ◽

Jawaid Mughal

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

General Hospital ◽

Cataract Extraction ◽

Extracapsular Cataract Extraction ◽

Iol Implantation ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

The study of 30 patients was performed at Lahore General Hospital, and Institute Of Ophthalmology Mayo Hospital, Lahore from June 1989 to June 2003 for 14 years. Total number of eyes were 34 where 2 patients had both eyes. Age ranged from 12-65 years. Males were 11 and females were 19. all the patients had planned extracapsular cataract extraction with IOL implantation. Total follow up period ranged from 1-5 years and best corrected visual acuity in these patients after surgery was 6/12 to 6/6. Post operatively, eyes had vitreous membranes and glaucomatous reaction.

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Femtosecond laser-assisted deep anterior lamellar keratoplasty: A safer option in keratoconus surgery

European Journal of Ophthalmology ◽

10.1177/11206721211059023 ◽

2021 ◽

pp. 112067212110590

Author(s):

Cristina Monterosso ◽

Marco Antonini ◽

Antonio Di Zazzo ◽

Daniele Gaudenzi ◽

Luigi Caretti ◽

...

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Persistent Epithelial Defect ◽

Corrected Visual Acuity ◽

Anterior Lamellar Keratoplasty ◽

Best Corrected Visual Acuity ◽

Persistent Epithelial Defects

Purpose To evaluate postoperative safety of femtosecond laser deep anterior lamellar keratoplasty performed with an innovative anvil profile in keratoconus patients. Methods This is a single-center, retrospective cohort study. We reviewed medical records of 89 keratoconus patients that underwent femtosecond laser deep anterior lamellar keratoplasty surgery (46 eyes) and manual deep anterior lamellar keratoplasty (47 eyes). Inclusion criteria required: age > 18 years old, best-corrected visual acuity < 0.3 LogMAR, continuous suture of the graft, postoperative immunomodulant regimen with dexamethasone 0.1% for 6 months and at least 12 months follow-up. Previous eye surgery, hydrops, and other ocular disease were excluded. The main outcome measures were postoperative events: rejections, persistent epithelial defects, and graft failures. Results During the follow-up (20 ± 6 months) graft rejection was diagnosed in 0 of femtosecond laser deep anterior lamellar keratoplasty versus 6 (17%) of manual deep anterior lamellar keratoplasty [ p 0.027], persistent epithelial defect in 0 of femtosecond laser deep anterior lamellar keratoplasty versus in 4 (11%) of manual deep anterior lamellar keratoplasty [ p 0.048] and graft failure occurred in 4 (11%) of manual deep anterior lamellar keratoplasty. The best-corrected visual acuity, after removal of sutures, was better in the femtosecond laser deep anterior lamellar keratoplasty group 0.09 ± 0.08 LogMAR versus 0.16 ± 0.13 LogMAR in manual deep anterior lamellar keratoplasty [ p 0.035] group although refractive spherical equivalent and cylinder, topographic average keratometry and cylinder were similar. Conclusions Anvil-shaped femtosecond laser deep anterior lamellar keratoplasty in keratoconus surgery increases safety and readiness of recovery, decreasing the incidence of corneal rejection, epithelial defects, graft failures, and producing better best-corrected visual acuity after removal of sutures.

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Correction of refractive disorders in the surgical treatment of keratoconus by MyoRing implantation

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-5-188-191 ◽

2021 ◽

pp. 188-191

Author(s):

S.V. Milova ◽

◽

A. Daxer ◽

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Key Words ◽

Corneal Stroma ◽

Degenerative Disease ◽

Corrected Visual Acuity ◽

Corneal Deformation ◽

Biomechanical Strength ◽

Observation Period

Keratoconus is a progressive degenerative disease in which, due to the weakening of the biomechanical strength of the cornea, its cone-shaped deformation occurs, leading to the development of induced myopia and astigmatism, as well as to a decrease in corrected visual acuity. Treatment of this disease consists in achieving stabilization of the process by strengthening the structure of the cornea, as well as in correcting refractive disorders caused by corneal deformation. Purpose. The purpose is to evaluate the effectiveness of correction of refractive disorders by implanting a closed MyoRing ring in the corneal stroma of patients with keratoconus. Material and methods. The data of 98 MyoRing implantation operations using CISIS technology using the PoketMaker ultraceratom for stage 3-4 keratoconus were analyzed. The observation period is up to 9 years. The initial myopia averaged -9.23 D ±3.82, astigmatism-6.13 ±2.51. Results. Stabilization of the refractive effect occurred usually within 3-6 months after surgery. On average, the following correction of refractive disorders was achieved: myopia-8.14 D ± 2.67 and astigmatism-4.28 D ± 2.12. Keratometry indicators also in most cases stabilized within 3-6 months after surgery and remained unchanged throughout the entire follow-up period. Conclusions. Implantation of a closed MyoRing ring in keratoconus makes it possible to significantly correct refractive disorders and prevents further progression of the disease. Key words: keratoconus, MyoRing, SISI, ring implantation in keratoconus.

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Comparison of aflibercept and ranibizumab in diabetic macular edema associated with subretinal detachment

European Journal of Ophthalmology ◽

10.1177/1120672119827855 ◽

2019 ◽

Vol 30 (2) ◽

pp. 363-369 ◽

Cited By ~ 1

Author(s):

Abdullah Ozkaya ◽

Gokhan Demir ◽

Asli Kirmaci

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Secondary Outcome ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

Intravitreal Aflibercept ◽

Best Corrected Visual Acuity

Purpose: To compare the efficacy of ranibizumab and aflibercept in the treatment of diabetic macular edema associated with subfoveal retinal detachment. Methods: This is a retrospective, comparative study. The treatment-naïve diabetic macular edema patients who had diabetic macular edema associated with subfoveal retinal detachment and underwent intravitreal aflibercept or intravitreal ranibizumab treatment were included. The patients were treated on a pro re nata treatment regimen after a loading dose of 3-monthly injections and the follow-up time was 12 months. The primary outcome measure of this study was the presence of subfoveal retinal detachment after treatment at different time points. The secondary outcome measures were the change in best corrected visual acuity and central retinal thickness. Results: A total of 46 eyes of 46 patients were included. The aflibercept group consisted of 20 and the ranibizumab group consisted of 26 eyes. During the follow-up period of 12 months, subfoveal retinal detachment was completely resolved in 75% versus 57.7% of the eyes at month 3 (p = 0.2), 90% versus 76.9% at month 6 (p = 0.2), 90% versus 65.4% at month 9 (p = 0.05), and 100% versus 80.8% at month 12 (p = 0.03) in the intravitreal aflibercept versus intravitreal ranibizumab groups. The change in best corrected visual acuity was not statistically different between the groups at months 3, 6, 9, and 12, respectively (p > 0.05 for all). Conclusion: Both intravitreal aflibercept and intravitreal ranibizumab were effective in regards to anatomical and functional outcomes of diabetic macular edema patients associated with subfoveal retinal detachment. Interestingly, intravitreal aflibercept seemed more effective than intravitreal ranibizumab in the resolution of subfoveal retinal detachment at month 12.

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Factors Influencing Visual Outcome after Penetrating Keratoplasty Combined with Intraocular Lens Implantation

European Journal of Ophthalmology ◽

10.1177/112067210301300203 ◽

2003 ◽

Vol 13 (2) ◽

pp. 134-138 ◽

Cited By ~ 3

Author(s):

J.B. Jonas ◽

R.M. Rank ◽

W.M. Budde ◽

G. Sauder

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Penetrating Keratoplasty ◽

Visual Outcome ◽

Intraocular Lens Implantation ◽

Postoperative Visual Acuity ◽

Factors Influencing ◽

Lens Implantation ◽

Preoperative Visual Acuity

Purpose To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation. Methods This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 ± 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined with an exchange of IOL, and 23 penetrating keratoplasties combined with a secondary implantation of a posterior chamber lens. Mean follow-up was 28.3 ± 18.7 months (range 3.3–112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and gain in visual acuity. Results Mean postoperative visual acuity and mean gain in visual acuity were 0.33 ± 0.21 (median 0.30) and 0.25 ± 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129/135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p<0.005), reason for keratoplasty (p<0.005), and diameter of the graft (p = 0.046). Postoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure. Conclusions The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.

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