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.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in the treatment of stromal corneal dystrophies

2021 ◽  
Vol 2 (2) ◽  
pp. 116-122
Author(s):  
Ahmed Reda ◽  
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Visual Outcome ◽  
Corneal Dystrophy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Safety Outcomes

AIM: To compare the efficacy and safety of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in the treatment of stromal corneal dystrophy. METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity [best-corrected visual acuity (BCVA) (LogMAR)] and corneal endothelial cell count (ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference (WMD) and risk ratios (RRs), respectively, along with their respective 95% confidence intervals (CIs). RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy (59.71% males) were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively (WMD=401.62 cell/mm2, 95%CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower (RR=0.30, 95%CI: 0.14-0.64, P=0.002; RR=0.09, 95%CI: 0.02-0.46, P=0.004, respectively) when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet’s membrane perforations and postoperative double anterior chamber (All P<0.001). CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

Microbubble technique in failed deep anterior lamellar keratoplasty: 2-year outcomes

2018 ◽  
Vol 28 (2) ◽  
pp. 243-245 ◽  
Author(s):  
Stefano Lippera ◽  
Giuseppe Pallotta ◽  
Piero Ferroni ◽  
Myrta Lippera ◽  
Leopoldo Spadea ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Corneal Thickness ◽  
Long Term Results ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Best Corrected Visual Acuity ◽  
Big Bubble

Purpose: To compare the long-term results of big-bubble technique and microbubble techniques to complete stroma dissection after failure of achieving a big-bubble. Methods: A total of 35 eyes with keratoconus underwent lamellar keratoplasty with the big-bubble technique (15 eyes) or the microbubble technique (15 eyes). Conversion to penetrating keratoplasty was performed in 3 eyes of the big-bubble group and in 2 eyes of the microbubble group. Best-corrected visual acuity, corneal thickness, corneal astigmatism, and endothelial cell count were assessed preoperatively and at 12 and 24 months after surgery. Results: Mean preoperative visual acuity was 0.29 ± 0.18 in the big-bubble group and 0.25 ± 0.15 in the microbubble group. Postoperatively, all patients showed a regular interface between donor and recipient tissue. At 24 months, mean best-corrected visual acuity was 0.84 ± 0.16 in the big-bubble group and 0.68 ± 0.17 in the microbubble group (p = 0.013), and mean central corneal thickness was 530 ± 39 µm in the big-bubble group and 545 ± 30 µm in the microbubble group. Astigmatism was 2.41 ± 1.29 D and 3.59 ± 1.48 D (p = 0.036), respectively, while endothelial cell density was 1,671 ± 371 in the big-bubble group and 1,567 ± 275 in the microbubble group. Conclusions: The microbubble technique appears to be a valid alternative as it was safe and provided good functional results.

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 Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Vincent M. Borderie ◽  
Sara Touhami ◽  
Cristina Georgeon ◽  
Otman Sandali
Keyword(s):  
Visual Acuity ◽  
Predictive Factors ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
First Choice ◽  
Anterior Lamellar Keratoplasty ◽  
Big Bubble

Objective. Big bubble (BB)-deep anterior lamellar keratoplasty (DALK) has become the reference transplantation technique for corneal stromal disorders. Type 1 BB is the desired aspect but it is not constant. We aimed to determine the predictive factors of type 1 BB success. Methods. Observational cohort study including 77 consecutive eyes of 77 patients undergoing DALK by one surgeon at a single reference center without any selection. Clinical and spectral domain optical coherence tomography data were collected pre- and postoperatively. Results. Stromal scars were found in 91.8% of cases and were located in the anterior (90.9%), mid (67.5%), and posterior (36.4%) stroma. Type 1 BB (49.3% of cases) was significantly associated with the absence of scars in the posterior stroma, stage 1–3 keratoconus, and deep trephination. Among eyes with posterior scars, type 1 BB was associated with higher minimal corneal thickness, maximum-minimum corneal thickness < 220 μm, and diagnosis other than keratoconus. Eyes with type 1 BB featured significantly thinner residual stromal bed (22 ± 8 µm versus 61 ± 28 µm), thinner corneas at 12, 24, and 36 months, and better visual acuity at 12 months compared with eyes with no type 1 BB. Conversely, no significant differences between both groups were observed for graft survival, visual acuity at 24 and 36 months, and endothelial cell density at 12 and 36 months. Conclusion. OCT assessment before DALK is useful for choosing trephination depth that should be as deep as possible and for looking for posterior scars. The BB technique may not be the most appropriate method in keratoconus with posterior scars. Follow-up data do not support the need for conversion to penetrating keratoplasty when type 1 BB cannot be obtained nor does it support the need for performing a penetrating keratoplasty as a first-choice procedure in eyes with posterior stromal scars.

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 Possibilities of Intralamellar Keratoplasty in Rehabilitation of Keratoconus Patients

2019 ◽  
Vol 16 (2) ◽  
pp. 169-173 ◽  
Author(s):  
G. A. Osipyan ◽  
Kh. Khrayst
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Recovery Period ◽  
Corneal Thickness ◽  
Biological Tissues ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Uncorrected Visual Acuity

Keratoconus is one of the topical problems in modern ophthalmology. Among the currently used treatment methods is intralamellar keratoplasty that utilizes allomaterials or homotransplants. The surgery technique has obvious advantages over penetrating and deep anterior lamellar keratoplasty. There is no risk of tissue incompatibility, the recovery period is shorter, and prolonged use of corticosteroids is not necessary. In recent years, technological development has made the application of femtosecond laser a standard procedure for various surgical interventions on the cornea, particularly for creation of intrastromal tunnels and corneal bags. This article presents an analysis of the modern literature data about different intralamellar keratoplasty techniques for treatment of keratoconus. The described techniques show its great clinical possibilities, especially the intrastromal keratoplasty variant with implantation of biological tissues. One of such techniques was developed and tried by a group of specialists at Research Institute of Eye Diseases in 2014. It involves recovery of corneal thickness in the ectatic area by intralamellar transplantation of a layered transplant of adequate size, which acts as a bandage. The surgery simultaneously affects the stabilization action, corrects refractive errors and eliminates the structural changes; it was accordingly named bandage therapeutic-optical keratoplasty (BTOK). The indication for its usage is progressing keratoconus in stage II–III patients. Among the described outcomes are cease of the disease progression in long-term follow-up, improvement of corrected and uncorrected visual acuity. The foreign analogue of the technique is Corneal Allogenic Intrastromal Ring Segments (CAIRS) by Jacob S. et al. His study included 20 patients with stages I to IV keratoconus; all patients undergone corneal cross-linking as the first stage, then they had CAIRS implanted into the intrastromal tunnels prepared with femtosecond laser. In both methods, the authors point at the improvement of corrected and uncorrected visual acuity. None of the patients had implant dislocation or keratoconus progression during the follow-up period.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in corneas showing a high or low graft rejection risk

2018 ◽  
Vol 29 (3) ◽  
pp. 295-303
Author(s):  
Edgar Javier Infantes Molina ◽  
Javier Celis Sánchez ◽  
José Maria Tenias Burilllo ◽  
David Diaz Valle ◽  
José Manuel Benítez-Del-Castillo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
High Risk ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Low Risk ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corrected Visual Acuity ◽  
Anterior Lamellar Keratoplasty ◽  
Best Corrected Visual Acuity

Purpose: To compare visual, topographic and topometric outcomes in patients subjected to deep anterior lamellar keratoplasty or penetrating keratoplasty showing a high or low risk of graft rejection. Setting: Complejo Hospitalario La Mancha Centro, Ciudad Real, Spain. Materials and methods: Data were reviewed for consecutive patients with a corneal stroma disease undergoing deep anterior lamellar keratoplasty or penetrating keratoplasty over the period 2009–2015 at our centre by the same surgeon. The outcome measures examined were 2-year follow-up best-corrected visual acuity, refractive error, topographic astigmatism, intraocular pressure, endothelial cell density and central corneal thickness. Results: Of 115 eyes enrolled, 46 underwent deep anterior lamellar keratoplasty (15 low risk, 31 high risk) and 69 penetrating keratoplasty (23 low risk, 46 high risk). Mean postoperative best-corrected visual acuity (logMAR) in the low- and high-risk groups, respectively, were 0.31 and 0.26 for deep anterior lamellar keratoplasty (p = 0.32) and 0.40 and 0.51 for penetrating keratoplasty (p = 0.28). The values for the high-risk deep anterior lamellar keratoplasty versus high-risk penetrating keratoplasty patients were 0.26 and 0.51, respectively (p = 0.004). Mean postoperative spherical equivalents were −2.60 D for low-risk deep anterior lamellar keratoplasty versus −2.29 D for high-risk deep anterior lamellar keratoplasty (p = 0.19), and −0.41 D for low-risk penetrating keratoplasty versus −0.13 D for high-risk penetrating keratoplasty (p = 0.51). Conclusion: Final best-corrected visual acuity and visual acuity gains were better for deep anterior lamellar keratoplasty, mainly in corneas with a high rejection risk. Despite a better corneal thickness recorded in the deep anterior lamellar keratoplasty group, the other variables examined were comparable. Deep anterior lamellar keratoplasty emerged as an effective alternative to penetrating keratoplasty for patients with a disease affecting the corneal stroma.

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.

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