Femto Circular Keratotomy to Halt the Progression of Keratoconus I and II

2016 ◽  
Vol 5 (3) ◽  
pp. 109-113
Author(s):  
Jörg H Krumeich ◽  
Nino Hirnschall ◽  
Detlev Breyer ◽  
Florian Laufer
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Statistical Evaluation ◽  
Optical Axis ◽  
Stage I ◽  
Time Points ◽  
Corrected Visual Acuity ◽  
Deep Incision ◽  
Descemet’S Membrane ◽  
Best Corrected Visual Acuity

ABSTRACT Aim To simplify and enhance safety in the generation of a stabilizing intracorneal scar by circular keratotomy (CKT). A femtosecond laser was used to perform individually sized intraparenchymal cuts. Materials and methods As equipped, the Ziemer Z6 femto-second laser cuts a 400-µm-deep incision with a diameter of 7.0 mm around the optical axis. The epithelium, Bowmann's membrane, the internal borders of Descemet's membrane, and the endothelium are not affected. The 3-, 6-, and 12-month postoperative values were compared with the 1-month postoperative keratometric readings and astigmatism. The preoperative best corrected visual acuity (BCVA) with glasses was compared with the values found at the same time points as noted above. Results Statistical evaluation indicated that keratometry within ±1.5D remained in 96.6, 93.1, and 96.6% of cases at the 3-, 6-, and 12-month time points respectively. Astigmatism was stable at the same time points in 100, 95.8, and 92.3%. The BCVA improved in 12 cases throughout the first post-operative year (48%, n = 25); however, 11 cases did not change (44%) and 2 cases lost at least one line (8.0%). Conclusion Femto CKT halts the progression of keratoconus for at least 1 year in 96.6% of cases. This treatment provides keratometric and refractive stability for over 1 year. This result, in conjunction with the significant improvement in BCVA, demonstrates the potential of this method for patients with stage I and II keratoconus. How to cite this article Krumeich JH, Hirnschall N, Breyer D, Laufer F. Femto Circular Keratotomy to Halt the Progression of Keratoconus I and II. Int J Kerat Ect Cor Dis 2016;5(3):109-113.

Effect of Circular Keratotomy on Progression of Keratoconus

2016 ◽  
Vol 5 (2) ◽  
pp. 57-62
Author(s):  
Jörg H Krumeich ◽  
Nino Hirnschall
Keyword(s):  
Visual Acuity ◽  
Clinical Study ◽  
Patient Outcomes ◽  
Early Stage ◽  
Statistical Analyses ◽  
Stage I ◽  
Time Points ◽  
Corrected Visual Acuity ◽  
Retrospective Clinical Study ◽  
Best Corrected Visual Acuity

ABSTRACT Purpose Studies on keratoconus treatment with regard to the stage of the disease have not been published. We evaluated patient outcomes over a 5-year period after circular keratotomy (CKT) to treat stage I and II progressive keratoconus. Setting Clinic Krumeich, Bochum, Germany. Design Retrospective clinical study. Materials and methods We retrospectively evaluated the outcomes of 185 consecutive CKT procedures to treat early, progressing keratoconus. A 7-mm trephine incision, with a depth that was 90% of the thinnest pachymetry value but not less than 400 µm, was made with the guided trephine system concentric to the pupil and sutured with a double running anti-torque suture. Keratometry readings and astigmatism measurements at 1-year postsurgery were compared with values obtained at 3 and 5 years postsurgery. Preoperative values of best-corrected visual acuity with glasses were compared with values obtained at 3 and 5 years postsurgery. Statistical analyses for significance were performed. Results Keratometric readings revealed stability at 5 years postsurgery in 84.3% (n= 51) of those eyes for which all values at all time points were available. Likewise, astigmatism values revealed stability in 92.2% of eyes. Best-corrected visual acuity improved significantly from preoperative to 5 years in 73.68% (n = 38). Best-corrected visual acuity did not change in 18.42% (n = 36). Conclusion Circular keratotomy halted the progression of early-stage keratoconus for at least 5 years in 84.3% of the eyes studied. The stable keratometric results suggest that CKT treatment should be considered for patients diagnosed early in the progression of this disease. How to cite this article Krumeich JH, Hirnschall N. Effect of Circular Keratotomy on Progression of Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):57-62.

scholarly journals Efficacy of Burst Mode Torsional Phacoemulsification in Age-Related Cataract

2020 ◽  
Vol 15 (1) ◽  
pp. 94-97
Author(s):  
Md Abdullah Al Masum ◽  
Md Kamrul Hasan Khan ◽  
Zulfikar Hasan ◽  
Natasha Kajmina
Keyword(s):  
Visual Acuity ◽  
Visual Outcome ◽  
Posterior Capsule ◽  
Burst Mode ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Corneal Wound ◽  
Descemet's Membrane ◽  
Descemet’S Membrane ◽  
Best Corrected Visual Acuity

Introduction: Torsional ultrasound energy and burst mode interrupted energy delivery system are recent advancementsin the technique of phacoemulsification surgery. It has been reported that both these advancementshelpto reduce corneal wound burn and thermal induced endothelial cell loss and thereby helps to achieve excellent early postoperative visual outcome Objectives: To evaluate the efficacy of burst mode torsional phacoemulsification surgery in age-related cataract. Materials and Methods: Prospective observational study of 120 cases that underwent phacoemulsificationcataract surgery in which torsional energy was used in burst mode. Phacoemulsification was performed by “vertical –chop” technique. Intraoperatively corneal wound burn, Descemet’s membrane detachment, posterior capsule ruptureetc.were evaluated. Postoperatively corneal oedema, best corrected visual acuity, cystoid macular oedema were evaluated. Postoperatively eyes were examined at day 1, 1 week, 6 weeks and 3 months. Results: Mean age of the patients was 57.28± 8.20 years. Most of the patients 81(67.5%) had nuclear sclerosis grade-II cataract.Intraoperatively, moderate wound burn occurred in 02(1.6%) eyes, localized Descemet’s membrane detachmentin 03(2.5%) eyes and posterior capsule rupture occurred in 03(2.5%) cases. Postoperatively, moderate and severe corneal edema was found in 06(5.0%) and 04(3.3%) eyes respectively at day 1. At the end of 3 months follow-up, 114(95%) eyes maintained a best corrected visual acuity of ≥ 6/18, of which 109(90.8%) eyes achieved ≥ 6/9. Conclusion: Burst mode torsional phacoemulsfication is a very effective and advanced technique of cataract surgery. Intraoperative complications are very less and visual outcome is excellent. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 94-97

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

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.

scholarly journals Correction of postkeratoplastic astigmatism by intrastromal corneal segments implantation using a femtosecond laser

2021 ◽  
Vol 6 (6-1) ◽  
pp. 48-55
Author(s):  
N. A. Pozdeyeva ◽  
M. V. Sinitsyn ◽  
A. E. Terentieva ◽  
O. V. Shlenskaya
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Penetrating Keratoplasty ◽  
Biomechanical Properties ◽  
Corneal Graft ◽  
Corneal Resistance Factor ◽  
Astigmatism Correction ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Best Corrected Visual Acuity

Background. After penetrating keratoplasty, mild to high induced corneal astigmatism was observed in each case. The existing choice of correction of postkeratoplastic astigmatism is aimed at fi nding an individual approach in order to compensate for it and not weaken the biomechanical properties of the corneal graft.The aim: to analyze the clinical, functional, and morphological results of postkeratoplastic astigmatism correction by implantation of intrastromal corneal segments using a femtosecond laser.Methods. 22 patients were examined before and 1 year after surgery. The operation was performed under local anesthesia: stage I – an intrastromal tunnel was formed using a femtosecond laser “Femto Visum” 1 MHz (Optosystems, Russia); stage II – the intrastromal corneal segments were implanted. The results were assessed using standard and special research methods using optical coherence tomography Visante OCT (Zeiss, Germany), keratotopography (Tomey-5, Japan), optical corneal analyzer ORA (Reichert, USA), laser tindalemetry FC-2000 (Kowa, Japan) and confocal microscope Confoscan-4 (Nidek, Japan).Results. Before the operation, uncorrected visual acuity averaged 0.09 ± 0.05, after a year – 0.50 ± 0.16; best corrected visual acuity – 0.30 ± 0.12 and 0.60 ± 0.05 respectively; cylindrical component of refraction – –10.29 ± 3.12 and –2.20 ± 0.64 D respectively; mean keratometry value – 43.59 ± 2.14 and 38.56 ± 1.75 D respectively; corneal hysteresis – 7.92 ± 1.22 and 8.95 ± 1.05 mm Hg respectively; corneal resistance factor – 7.01 ± 1.81 and 8.44 ± 1.44 mm Hg respectively; protein fl ux in the moisture of the anterior chamber – 2.97 ± 0.28 and 3.04 ± 0.24 f/ms respectively; endothelial cell density – 1521 ± 327 and 1475 ± 419 cells/mm2 respectively.Conclusion. Intrastromal corneal segments implantation into a corneal graft using a femtosecond laser has efficiency and safety method in correcting postkeratoplastic astigmatism.

Comparison of outcomes between Aurolab aqueous drainage implant placed in the superotemporal versus inferonasal quadrant

2020 ◽  
pp. bjophthalmol-2019-315558
Author(s):  
George Varghese Puthuran ◽  
Paul Frederic Palmberg ◽  
Hiruni Kaushalya Wijesinghe ◽  
Thandra Sai Shreya ◽  
S R Krishnadas ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Light Perception ◽  
Refractory Glaucoma ◽  
Significant Drop ◽  
Time Points ◽  
Corrected Visual Acuity ◽  
Surgical Option ◽  
Best Corrected Visual Acuity

AimTo determine the outcomes of Aurolab aqueous drainage implant (AADI) placed in the superotemporal versus the inferonasal quadrant in adult eyes with refractory glaucoma.MethodsThis was a retrospective study of eyes that had AADI placement and completed a minimum of 2-year follow-up. The choice of the quadrant was at the surgeon’s discretion and mainly depended on the amount of scarring and conjunctival mobility. The cumulative failure rate of the AADI was defined as intraocular pressure (IOP) >21 mm Hg or not reduced by 20% below baseline on two consecutive follow-up visits after 3 months, IOP ≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision.ResultsWe included 84 eyes with AADI in the inferonasal quadrant versus 69 eyes in the superotemporal quadrant. A significant drop in IOP was seen in both groups (18.4±10.4 mm Hg in the inferonasal group vs 17.7±11.1 mm Hg in the superotemporal group; p=0.63) at 3-month follow-up and this was maintained until last follow-up. Best-corrected visual acuity, IOP, number of IOP-lowering medications and complications were similar between the two groups at all time points. The cumulative success rate at 2-year follow-up without IOP-lowering medications was 57.1% (47.1%–68.1%) in the inferonasal group and 50.7% (39.8%–63.1%) in the superotemporal group (p=0.47).ConclusionsInferonasal AADI placement appears to be an equally safe and effective surgical option compared with superotemporal AADI placement and may be helpful in certain clinical situations.

Comparison of the Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema in Vitrectomized and Nonvitrectomized Eyes

2016 ◽  
Vol 236 (2) ◽  
pp. 67-73 ◽  
Author(s):  
Yoshito Koyanagi ◽  
Shigeo Yoshida ◽  
Yoshiyuki Kobayashi ◽  
Yuki Kubo ◽  
Muneo Yamaguchi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Option ◽  
Central Macular Thickness ◽  
Intravitreal Ranibizumab ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
The Difference ◽  
Best Corrected Visual Acuity

Purpose: To compare the effectiveness of intravitreal ranibizumab (IVR) for diabetic macular edema (DME) between eyes with and without previous vitrectomy. Procedures: We prospectively assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) after IVR for 6 months. Results: There were no significant differences in the baseline BCVA and CMT between both groups. In the nonvitrectomized group (n = 15), the mean changes of BCVA and CMT from baseline to month 6 were significant (p < 0.01). In the vitrectomized group (n = 10), the improvement appeared to be slower, and the mean BCVA improvement was not significant (p = 0.5), although the mean CMT decrease was significant (p < 0.05). There were no significant differences in the mean changes of BCVA and CMT between both groups at 6 months. Conclusions: The difference in the effectiveness of IVR between both groups was not significant. IVR can be a treatment option even for vitrectomized DME eyes.

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 Intraoperative choroidal detachment during small-gauge vitrectomy: analysis of causes, anatomic, and visual outcomes

Eye ◽  
2021 ◽  
Author(s):  
Ting Zhang ◽  
Yantao Wei ◽  
Zhaotian Zhang ◽  
Wei Chi ◽  
Lujia Feng ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Medical Records ◽  
Demographic Characteristics ◽  
Choroidal Detachment ◽  
Fluid Exchange ◽  
Visual Outcomes ◽  
Corrected Visual Acuity ◽  
Ocular Hypotony ◽  
Small Gauge ◽  
Best Corrected Visual Acuity

Abstract Introduction To investigate the incidence and causes of intraoperative choroidal detachment (CD) during small-gauge vitrectomy, as well as the anatomic and visual outcomes. Methods We retrospectively reviewed the medical records of 1026 consecutive patients who underwent small-gauge vitrectomy from June 2017 to December 2018 at Zhongshan Ophthalmic Centre, Guangzhou, China. Data on the presence, location, and extent of intraoperative CD and its relationship to the infusion cannula were collected. Patient demographic characteristics and postoperative anatomic and visual outcomes were also assessed. Results A total of six cases were found to have intraoperative CD, including two with serous CD, three with limited haemorrhagic CD, and one with CD caused by inadvertent perfusion of gas during air/fluid exchange. Retraction of the infusion cannula and acute ocular hypotony were found to be the main causes of intraoperative CD in five out of the six cases. The best-corrected visual acuity of all cases significantly improved after the surgery. Conclusion The incidence of intraoperative CD during small-gauge vitrectomy is low; the predominant causes are retraction of the infusion cannula and acute ocular hypotony. Immediate awareness and timely closure of the incision may contribute to a better surgical prognosis.

scholarly journals Pseudoamblyopia in Congenital Cyclotropia

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Antonio Frattolillo ◽  
Filippo Tassi ◽  
Valentina Di Croce ◽  
Costantino Schiavi
Keyword(s):  
Visual Acuity ◽  
Surgical Correction ◽  
Visual Performance ◽  
Time Study ◽  
Superior Oblique Palsy ◽  
Fixation Pattern ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity ◽  
Superior Oblique

Purpose. To study the effect of surgery on amblyopia and suppression associated with congenital cyclovertical strabismus. Methods. The fixation pattern was investigated with microperimetry before and soon after surgery in ten consecutive children operated for congenital superior oblique palsy at the S. Martino Hospital, Belluno, Italy, between September 2014 and December 2015. Changes in visual performance in terms of best-corrected visual acuity (BCVA) and stereopsis between the day before and one week after surgery were also evaluated. No other amblyopia treatment has been administered during the time study. Results. Surgical correction of the excyclodeviation in congenital SO palsy determined monocular and binocular sensory consequences: monocularly, in the cyclodeviated amblyopic eye, BCVA (0.46–0.03 LogMAR; p<0.0001) and the fixation pattern improved, as demonstrated by microperimetry examination. Binocularly, stereopsis improved or emerged while suppression at the Worth four-dot test disappeared. Conclusions. In the absence of further amblyopic factors such as coexisting constant vertical and/or horizontal deviation and anisometropia, the amblyopia encountered in congenital SO palsy may resolve soon after the surgical alignment. Therefore, it may be considered and defined “pseudoamblyopia.”

scholarly journals Foveal Exudative Macroaneurysm Treated with Intravitreal Ranibizumab

2015 ◽  
Vol 6 (2) ◽  
pp. 170-175 ◽  
Author(s):  
Carlos Menezes ◽  
Rui Carvalho ◽  
Carla Teixeira ◽  
José Alberto Lemos ◽  
Rita Gonçalves ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Edema ◽  
Morphological Data ◽  
Foveal Avascular Zone ◽  
Optical Coherence ◽  
Intravitreal Ranibizumab ◽  
Corrected Visual Acuity ◽  
Retinal Macroaneurysm ◽  
Best Corrected Visual Acuity

Purpose: We report a case of a foveal macroaneurysm with long-standing macular edema in a rare location, successfully treated with intravitreal ranibizumab. Methods: We report the case of a 52-year-old man with left eye long-term visual loss due to macular edema caused by a retinal macroaneurysm, localized about 400 μm from the center of the fovea, and its response to 6 monthly ranibizumab intravitreal injections. His best-corrected visual acuity and morphological data evaluated by optical coherence tomography and fluorescein angiography are presented. Results: His best-corrected visual acuity improved from 1/10 to 3/10 after the 3rd injection, and from 1/10 to 4/10 after the 6th one. The central retinal thickness was evaluated by optical coherence tomography and improved from 310 to 233 μm, with the resolution of both the associated serous detachments and the cystoid macular edema; an almost complete reabsorption of the hard exudates at the end of the treatment was also observed. The macroaneurysm lumen almost obliterated after the 3rd injection and completely collapsed at the end of treatment. Conclusions: Intravitreal ranibizumab may be effective in the treatment of long-standing macular edema associated with foveal macroaneurysms. To the best of our knowledge, this is the first report of a retinal macroaneurysm located so close to the foveal avascular zone.

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