AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK)....AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.展开更多
·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case se...·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case series, 10 eyes of 9 patients underwent DALK procedures with a femtosecond laser(Carl Zeiss Meditec AG, Jena,Germany). Of the 9 patients, 7 had keratoconus and 2had post-LASIK keratectasia. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA), corneal thickness,astigmatism, endothelial density count(EDC), and corneal power.·RESULTS: All eyes were successfully treated. Early postoperative evaluation showed a clear graft in all cases. Intraoperative complications included one case of a small Descemet's membrane perforation.Postoperatively, there was one case of stromal rejection,one of loosened sutures, and one of wound dehiscence.A normal corneal pattern topography and transparency were restored, UCVA and BCVA improved significantly,and astigmatism improved slightly. There was no statistically significant decrease in EDC.· CONCLUSION: Our early results indicate that femtosecond laser-assisted deep anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology. This approach shows promise as a safe and effective surgical choice in the treatment of keratoconus and post-LASIK keratectasia.展开更多
AIM:To compare the functional and anatomic results of femtosecond laser(FSL)-assisted deep anterior lamellar keratoplasty(DALK) associated with phototherapeutic keratectomy(PTK) and FSL-assisted DALK performed using t...AIM:To compare the functional and anatomic results of femtosecond laser(FSL)-assisted deep anterior lamellar keratoplasty(DALK) associated with phototherapeutic keratectomy(PTK) and FSL-assisted DALK performed using the big-bubble technique in keratoconus.METHODS:During the first phase of the study,an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups:in FSL group,FSL lamellar cuts were performed on two corneas and in FSL+PTK group,PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made.During the second phase of the study,a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus:group 1(n=14 eyes) underwent FSL-assisted DALK associated with PTK and group 2(n=12 eyes) underwent FSL-assisted DALK associated with the bigbubble technique.The main outcome measures were the postoperative visual acuity(VA) and optical coherence tomography(OCT) measurements,confocal microscopic findings,and contrast sensitivity.RESULTS:In the pilot study,histopathology showed a more regular stromal bed in the FSL+PTK group.In the clinical trial,group 1 had significantly worse best spectaclecorrected VA and contrast sensitivity(P<0.05 for both comparisons).The residual stromal bed measured by OCT was significantly(P<0.05) thicker in group 1.Confocal microscopy detected opacities only at the donor-receptor interface in group 1.CONCLUSION:Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.展开更多
Dear Editor,Keratoconus is a progressive,non-inflammatory disease of the cornea,which is characterized by marked corneal steepening and thinning[1].It induces myopia and irregular astigmatism leading frequently to sev...Dear Editor,Keratoconus is a progressive,non-inflammatory disease of the cornea,which is characterized by marked corneal steepening and thinning[1].It induces myopia and irregular astigmatism leading frequently to severe visual impairment[1].Although several aetiological factors have been implicated in its pathophysiology,the exact mechanisms underlying keratoconus are not fully elucidated yet.Corneal crosslinking is the treatment of choice in order to inhibit the progression展开更多
Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on d...Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.展开更多
Deep anterior lamellar keratoplasty(DALK)is preferred over conventional penetrating keratoplasty(PKP)for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection.However,D...Deep anterior lamellar keratoplasty(DALK)is preferred over conventional penetrating keratoplasty(PKP)for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection.However,DALK remains surgically challenging,largely due to challenges associated with achieving consistent pneumo-dissection of posterior stroma from the underlying pre-Descemet’s or Descemet’s membrane(DM).Air must be injected at sufficient depth in the corneal stroma in order to achieve successful pneumo-dissection,but advancing a needle too deep into the cornea can lead to perforation of DM.We describe here a novel technique using a handheld slit lamp(Eidolon model 510L,Eidolon Optical LLC,Natick,MA,USA)to assist in creation of the big-bubble in DALK surgery.Use of a handheld slit beam intraoperatively is a safe,relatively inexpensive,and effective technique for increasing the success of big-bubble formation in DALK procedures.展开更多
Because of the low incidence of immunological rejection,deep anterior lamellar keratoplasty(DALK)is currently the preferred treatment for macular corneal dystrophy(MCD).However,there were few reports about whether the...Because of the low incidence of immunological rejection,deep anterior lamellar keratoplasty(DALK)is currently the preferred treatment for macular corneal dystrophy(MCD).However,there were few reports about whether the consistent results were obtained when performing DALK in both eyes for MCD,especially when the corneal grafts were taken from different donors.Also,there were few reports about whether the stromal graft rejection occurred typically in both eyes in MCD with DALK.This case may represent the first report of an unusual and misleading manifestation of stromal graft rejection after uneventful DALK with big bubble technique in the fellow eye in MCD.A 32-year-old healthy man with MCD underwent bilateral uneventful DALK with a big bubble technique in the left eye in January and the right eye in July,the corneal grafts were taken from different donors.There was an atypical allograft rejection that occurred in the right eye and none in the left eye;although a timely diagnosis of graft rejection revealed following aqueous determination,it could not be reversed and underwent PK finally.The purpose of this case report is to illustrate the identification of atypical allograft rejection after DALK in the fellow eye,the significance of aqueous detection in the diagnosis of graft rejection,the choosing of grafts,and the timing of bilateral corneal transplantation in patients with MCD.展开更多
Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received fu...Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.展开更多
AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial...AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK.RESULTS:Mean best spectacle corrected visual acuity(BSCVA)at the first postoperative week(P=0.012)and the first postoperative month(P<0.001)was statistically significantly higher in DALK group. The mean BSCVA at12 mo was not significantly different for DALK(0.30±1.99 log MAR)versus PK(0.40±0.33 log MAR)(P=0.104). The76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4%in PK group(P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group(P=0.644). Mean spherical equivalent was-2.94 D in DALK and-3.09 D in PK group.Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31(81.6%)of DALK and 29(76.3%)of PK(P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie,seen in 39.5% in DALK and 23.7% in PK. CONCLUSION:Big bubble DALK provides an earlier visual improvement compare to PK. However,visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However,intraoperativeperforation of the Descemet's membrane is a significant complication.展开更多
Background:To evaluate refractive outcome 24 months after Deep Anterior Lamellar Keratoplasty(DALK)in pediatric patients by comparing results achieved using mechanical trephine and femtosecond laser.Methods:Twenty eye...Background:To evaluate refractive outcome 24 months after Deep Anterior Lamellar Keratoplasty(DALK)in pediatric patients by comparing results achieved using mechanical trephine and femtosecond laser.Methods:Twenty eyes of 20 patients affected by keratoconus were evaluated.To perform big-bubble DALK,10 eyes(Group 1;mean age 11.2±2.2 years)were subjected to the Hessburg-Barron mechanical trephine and the remaining 10 eyes(Group 2;mean age 11.3±3.1 years)to a 150 kHz femtosecond laser that performed mushroom incisions.Preoperative thinnest point in the corneal thickness map and K readings were measured by the Sirius Scheimpflug camera.We also evaluated corrected distance visual acuity(CDVA)as logMAR value using spectacles,spherical equivalent and refractive astigmatism.Results:Mean preoperative thinnest point and pre-and post-operative K readings did not show significant difference(P>0.05)between the two groups.CDVA,spherical equivalent and refractive astigmatism were respectively,0.14±0.08 logMAR and 0.13±0.10 logMAR(P=0.8),−4.2±1.1 D and−2.8±1.2 D(P=0.03),4.4±2.0 D and 3.6±1.2 D(P=0.4)in Groups 1 and 2.All DALK procedures were uneventful.Conclusion:Our findings suggest that femtosecond laser compared to mechanical trephine could significantly reduce the spherical equivalent amount in pediatric big-bubble DALK.展开更多
BACKGROUND Corneal keloid is a rare clinical disease with an unknown etiology,which is easily misdiagnosed.Surgery is the most effective treatment but is rarely reported in the literature.Herein,we report the clinical...BACKGROUND Corneal keloid is a rare clinical disease with an unknown etiology,which is easily misdiagnosed.Surgery is the most effective treatment but is rarely reported in the literature.Herein,we report the clinical features,histopathology,and surgical outcome of a giant corneal keloid with trophoblastic vessels and discuss the genesis of the mass.CASE SUMMARY A 36-year-old young man was admitted to the hospital because of a large mass on the surface of the left cornea.The patient had suffered an injury to his left eye at the age of 6-years-old;however,as the injury did not cause cornea perforation,he did not undergo treatment.Slit lamp exam showed a large,elevated,opaque lesion that covered the entire cornea and protruded from the surface of the eyeball.Anterior segment optical coherence tomography(AS-OCT) revealed a lesion of irregular density involving the anterior stroma.We suspected a secondary corneal fibroproliferative mass based on the clinical history,and slit lamp and AS-OCT findings.The patient subsequently underwent a superficial keratectomy and keratoplasty,and the final diagnosis of corneal keloid was confirmed by intraoperative histopathological examination.CONCLUSION Non-penetrating corneal trauma damages corneal epithelium basement membrane,initiating stromal fibrosis and causing corneal keloids.AS-OCT and biopsy confirm diagnosis.展开更多
The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery.With accuracy,safety,and repeatability,eye surgeons can utilize the femtosecond laser in almost all anterior refractive p...The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery.With accuracy,safety,and repeatability,eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures;laser in situ keratomileusis(LASIK),small incision lenticule extraction(SMILE),penetrating keratoplasty(PKP),insertion of intracorneal ring segments,anterior and posterior lamellar keratoplasty(Deep anterior lamellar keratoplasty(DALK)and Descemet's stripping endothelial keratoplasty(DSEK)),insertion of corneal inlays and cataract surgery.As the technology matures,it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored.As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay.This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.展开更多
Keratoconus is a disease characterized by progressive thinning,bulging,and distortion of the cornea.Advanced cases usually present with loss of vision due to high irregular astigmatism.A majority of these cases requir...Keratoconus is a disease characterized by progressive thinning,bulging,and distortion of the cornea.Advanced cases usually present with loss of vision due to high irregular astigmatism.A majority of these cases require surgical intervention.This review provides an update on the current treatment modalities of corneal surgery available for the management of advanced corneal ectasias.展开更多
Several treatment options corresponding to the grade of keratoconus have been established.These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating ker...Several treatment options corresponding to the grade of keratoconus have been established.These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of keratoconus.Bowman layer transplantation was developed as a procedure for patients with advanced,progressive keratoconus.The technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ectasia.Thus,it aims at corneal stabilization in eyes with advanced keratoconus,and enabling continued contact lens wear for normal visual functionality.By being a sutureless procedure and using an acellular graft,it potentially avoids commonly known suture and graftrelated complications of penetrating or deep anterior lamellar keratoplasty.The treatment seems to be a promising option in the management of advanced keratoconus in order to postpone or prevent a more invasive corneal surgery,while minimizing the risk of complications and allowing less stringent surveillance and less intensive medical therapy.展开更多
基金Supported by the National Natural Science Foundation of China(No.82171025No.82070934)+2 种基金the Fundamental Research Funds for the Central Universities(No.HUST:2019kfy XMBZ065)the Key Research and Development Program of Hubei Province(No.2021BCA146)the Clinical Research Foundation of Wuhan Union Hospital(No.2021xhlcyj03)。
文摘AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.
基金National Natural Science Foundation of China (No. 81270979)Natural Science Foundation of Jiangsu Province, China (No.BK2012777)
文摘·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case series, 10 eyes of 9 patients underwent DALK procedures with a femtosecond laser(Carl Zeiss Meditec AG, Jena,Germany). Of the 9 patients, 7 had keratoconus and 2had post-LASIK keratectasia. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA), corneal thickness,astigmatism, endothelial density count(EDC), and corneal power.·RESULTS: All eyes were successfully treated. Early postoperative evaluation showed a clear graft in all cases. Intraoperative complications included one case of a small Descemet's membrane perforation.Postoperatively, there was one case of stromal rejection,one of loosened sutures, and one of wound dehiscence.A normal corneal pattern topography and transparency were restored, UCVA and BCVA improved significantly,and astigmatism improved slightly. There was no statistically significant decrease in EDC.· CONCLUSION: Our early results indicate that femtosecond laser-assisted deep anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology. This approach shows promise as a safe and effective surgical choice in the treatment of keratoconus and post-LASIK keratectasia.
文摘AIM:To compare the functional and anatomic results of femtosecond laser(FSL)-assisted deep anterior lamellar keratoplasty(DALK) associated with phototherapeutic keratectomy(PTK) and FSL-assisted DALK performed using the big-bubble technique in keratoconus.METHODS:During the first phase of the study,an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups:in FSL group,FSL lamellar cuts were performed on two corneas and in FSL+PTK group,PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made.During the second phase of the study,a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus:group 1(n=14 eyes) underwent FSL-assisted DALK associated with PTK and group 2(n=12 eyes) underwent FSL-assisted DALK associated with the bigbubble technique.The main outcome measures were the postoperative visual acuity(VA) and optical coherence tomography(OCT) measurements,confocal microscopic findings,and contrast sensitivity.RESULTS:In the pilot study,histopathology showed a more regular stromal bed in the FSL+PTK group.In the clinical trial,group 1 had significantly worse best spectaclecorrected VA and contrast sensitivity(P<0.05 for both comparisons).The residual stromal bed measured by OCT was significantly(P<0.05) thicker in group 1.Confocal microscopy detected opacities only at the donor-receptor interface in group 1.CONCLUSION:Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.
文摘Dear Editor,Keratoconus is a progressive,non-inflammatory disease of the cornea,which is characterized by marked corneal steepening and thinning[1].It induces myopia and irregular astigmatism leading frequently to severe visual impairment[1].Although several aetiological factors have been implicated in its pathophysiology,the exact mechanisms underlying keratoconus are not fully elucidated yet.Corneal crosslinking is the treatment of choice in order to inhibit the progression
基金Supported by The Ophthalmic Research Center,Shahid Beheshti University of Medical Sciences,Tehran,Iran
文摘Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.
文摘Deep anterior lamellar keratoplasty(DALK)is preferred over conventional penetrating keratoplasty(PKP)for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection.However,DALK remains surgically challenging,largely due to challenges associated with achieving consistent pneumo-dissection of posterior stroma from the underlying pre-Descemet’s or Descemet’s membrane(DM).Air must be injected at sufficient depth in the corneal stroma in order to achieve successful pneumo-dissection,but advancing a needle too deep into the cornea can lead to perforation of DM.We describe here a novel technique using a handheld slit lamp(Eidolon model 510L,Eidolon Optical LLC,Natick,MA,USA)to assist in creation of the big-bubble in DALK surgery.Use of a handheld slit beam intraoperatively is a safe,relatively inexpensive,and effective technique for increasing the success of big-bubble formation in DALK procedures.
文摘Because of the low incidence of immunological rejection,deep anterior lamellar keratoplasty(DALK)is currently the preferred treatment for macular corneal dystrophy(MCD).However,there were few reports about whether the consistent results were obtained when performing DALK in both eyes for MCD,especially when the corneal grafts were taken from different donors.Also,there were few reports about whether the stromal graft rejection occurred typically in both eyes in MCD with DALK.This case may represent the first report of an unusual and misleading manifestation of stromal graft rejection after uneventful DALK with big bubble technique in the fellow eye in MCD.A 32-year-old healthy man with MCD underwent bilateral uneventful DALK with a big bubble technique in the left eye in January and the right eye in July,the corneal grafts were taken from different donors.There was an atypical allograft rejection that occurred in the right eye and none in the left eye;although a timely diagnosis of graft rejection revealed following aqueous determination,it could not be reversed and underwent PK finally.The purpose of this case report is to illustrate the identification of atypical allograft rejection after DALK in the fellow eye,the significance of aqueous detection in the diagnosis of graft rejection,the choosing of grafts,and the timing of bilateral corneal transplantation in patients with MCD.
基金Project (No. 2011C13029-2) supported by the Major Program for Science and Technology Research of Zhejiang Province, China
文摘Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.
文摘AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK.RESULTS:Mean best spectacle corrected visual acuity(BSCVA)at the first postoperative week(P=0.012)and the first postoperative month(P<0.001)was statistically significantly higher in DALK group. The mean BSCVA at12 mo was not significantly different for DALK(0.30±1.99 log MAR)versus PK(0.40±0.33 log MAR)(P=0.104). The76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4%in PK group(P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group(P=0.644). Mean spherical equivalent was-2.94 D in DALK and-3.09 D in PK group.Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31(81.6%)of DALK and 29(76.3%)of PK(P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie,seen in 39.5% in DALK and 23.7% in PK. CONCLUSION:Big bubble DALK provides an earlier visual improvement compare to PK. However,visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However,intraoperativeperforation of the Descemet's membrane is a significant complication.
文摘Background:To evaluate refractive outcome 24 months after Deep Anterior Lamellar Keratoplasty(DALK)in pediatric patients by comparing results achieved using mechanical trephine and femtosecond laser.Methods:Twenty eyes of 20 patients affected by keratoconus were evaluated.To perform big-bubble DALK,10 eyes(Group 1;mean age 11.2±2.2 years)were subjected to the Hessburg-Barron mechanical trephine and the remaining 10 eyes(Group 2;mean age 11.3±3.1 years)to a 150 kHz femtosecond laser that performed mushroom incisions.Preoperative thinnest point in the corneal thickness map and K readings were measured by the Sirius Scheimpflug camera.We also evaluated corrected distance visual acuity(CDVA)as logMAR value using spectacles,spherical equivalent and refractive astigmatism.Results:Mean preoperative thinnest point and pre-and post-operative K readings did not show significant difference(P>0.05)between the two groups.CDVA,spherical equivalent and refractive astigmatism were respectively,0.14±0.08 logMAR and 0.13±0.10 logMAR(P=0.8),−4.2±1.1 D and−2.8±1.2 D(P=0.03),4.4±2.0 D and 3.6±1.2 D(P=0.4)in Groups 1 and 2.All DALK procedures were uneventful.Conclusion:Our findings suggest that femtosecond laser compared to mechanical trephine could significantly reduce the spherical equivalent amount in pediatric big-bubble DALK.
文摘BACKGROUND Corneal keloid is a rare clinical disease with an unknown etiology,which is easily misdiagnosed.Surgery is the most effective treatment but is rarely reported in the literature.Herein,we report the clinical features,histopathology,and surgical outcome of a giant corneal keloid with trophoblastic vessels and discuss the genesis of the mass.CASE SUMMARY A 36-year-old young man was admitted to the hospital because of a large mass on the surface of the left cornea.The patient had suffered an injury to his left eye at the age of 6-years-old;however,as the injury did not cause cornea perforation,he did not undergo treatment.Slit lamp exam showed a large,elevated,opaque lesion that covered the entire cornea and protruded from the surface of the eyeball.Anterior segment optical coherence tomography(AS-OCT) revealed a lesion of irregular density involving the anterior stroma.We suspected a secondary corneal fibroproliferative mass based on the clinical history,and slit lamp and AS-OCT findings.The patient subsequently underwent a superficial keratectomy and keratoplasty,and the final diagnosis of corneal keloid was confirmed by intraoperative histopathological examination.CONCLUSION Non-penetrating corneal trauma damages corneal epithelium basement membrane,initiating stromal fibrosis and causing corneal keloids.AS-OCT and biopsy confirm diagnosis.
文摘The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery.With accuracy,safety,and repeatability,eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures;laser in situ keratomileusis(LASIK),small incision lenticule extraction(SMILE),penetrating keratoplasty(PKP),insertion of intracorneal ring segments,anterior and posterior lamellar keratoplasty(Deep anterior lamellar keratoplasty(DALK)and Descemet's stripping endothelial keratoplasty(DSEK)),insertion of corneal inlays and cataract surgery.As the technology matures,it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored.As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay.This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.
文摘Keratoconus is a disease characterized by progressive thinning,bulging,and distortion of the cornea.Advanced cases usually present with loss of vision due to high irregular astigmatism.A majority of these cases require surgical intervention.This review provides an update on the current treatment modalities of corneal surgery available for the management of advanced corneal ectasias.
文摘Several treatment options corresponding to the grade of keratoconus have been established.These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of keratoconus.Bowman layer transplantation was developed as a procedure for patients with advanced,progressive keratoconus.The technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ectasia.Thus,it aims at corneal stabilization in eyes with advanced keratoconus,and enabling continued contact lens wear for normal visual functionality.By being a sutureless procedure and using an acellular graft,it potentially avoids commonly known suture and graftrelated complications of penetrating or deep anterior lamellar keratoplasty.The treatment seems to be a promising option in the management of advanced keratoconus in order to postpone or prevent a more invasive corneal surgery,while minimizing the risk of complications and allowing less stringent surveillance and less intensive medical therapy.
