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PURPOSE: To analyze visual and refractive results after wedge resection to correct high astigmatism after penetrating keratoplasty (PK) for keratoconus. SETTING: Cornea Unit of the Centro de Oftalmología Barraquer Barcelona, Spain. DESIGN: A retrospective quasi-experimental, before and after study. METHODS: Patients who developed high astigmatism or ectasia in the graft-host junction after PK were treated with wedge resection. The following variables were studied before the surgery, 1-year after and at the final visit: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive and topographic astigmatism and spherical equivalent. Vectorial analysis of the astigmatism changes was performed. RESULTS: Fifty-one eyes were included with a mean follow-up of 4.19 ± 3.09 years. Mean refractive astigmatism was 11.47 ± 3.57 diopters (D) pre-operatively and 4.79 ± 3.32 D at the final follow-up (p < 0.001). The mean centroid changed from 2.65 ± 11.82 D at 23 degrees preoperatively to 0.35 ± 5.86 D at 127 degrees postoperatively. Concerning spherical equivalent, the mean preoperative value was -3.10 ± 4.15 D and the mean postoperative value was -1.55 ± 3.41 D (p = 0.002). Mean pre-operative and final follow-up UDVA were 1.25 ± 0.27 and 0.84 ± 0.50 (p < 0.001). Mean Pre-op and final follow-up CDVA were 0.27 ± 0.19 and 0.24 ± 0.24. CONCLUSIONS: Wedge resection is a useful surgical procedure to correct high astigmatism. It is a safe technique with moderate efficacy and may be considered as initial procedure of choice in high astigmatism due to long-term ectasia in the graft-host junction after PK for keratoconus.
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PURPOSE: To evaluate recurrence and visual outcomes of phototherapeutic keratectomy (PTK) in lattice corneal dystrophy. METHODS: Kaplan-Meier survival analyses were retrospectively performed. Recurrence was defined as central biomicroscopic findings of recurrence with decreased visual acuity: loss of at least two lines or visual acuity ≤ 20/40) at any time during the follow-up. RESULTS: Twenty-two virgin eyes and 10 with previous keratoplasty (20 patients; 13 women and 7 men) were studied during a mean of 4.7 ± 3.5 years (range: 11 months to 18 years). One and 5 years after the first PTK (PTK1), 1 of 32 and 12 of 32 eyes, respectively, recurred. The cumulative probabilities of recurrence were 3%, 48%, and 89% in the whole sample at 1, 5, and 10 years, respectively. All cases in the virgin group and 8 eyes in the previous keratoplasty group improved their visual acuity. There were no significant differences in recurrence probability between groups (log-rank test; P = .86). A second PTK (PTK2) was performed in 15 of 32 eyes, with 6 postoperative recurrences recorded. The cumulative probabilities of recurrence in the whole sample were 18%, 30%, and 44% at 1, 3, and 5 years, respectively. Visual acuity improved in 11 of 13 eyes in the virgin group and 2 of 2 eyes in the previous keratoplasty group. Recurrence probability after PTK1 and PTK2 was similar in the whole sample (log-rank test; P = .637). Persistent graft edema after PTK1 in one eye was the only complication found. CONCLUSIONS: PTK can be an effective, safe, and repeatable treatment to delay keratoplasty in symptomatic lattice corneal dystrophy. [J Refract Surg. 2022;38(1):43-49.].
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Distrofias Hereditárias da Córnea , Ceratectomia Fotorrefrativa , Estudos de Coortes , Distrofias Hereditárias da Córnea/cirurgia , Feminino , Seguimentos , Humanos , Ceratectomia , Lasers de Excimer/uso terapêutico , Masculino , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Corneal graft surgery is one of the most successful forms of human solid-tissue transplantation, and nowadays, there is a worldwide expansion of the surgical volume of corneal grafts. This surgery is continuously evolving, with new surgical techniques and postoperative treatments that have considerably increased the chance of survival for the grafts. Despite the high rate of success, corneal transplantation is still complicated by a relevant risk of graft failure. This study investigates the causes that lead to the failure of the different corneal graft surgical techniques and provides an updated synthesis on this topic. A comprehensive review of the main pathological pathways that determine the failure of corneal grafts is provided, analysing the main risk factors and disclosing the survival rates of the principal form of corneal grafts. Our results revealed that penetrating keratoplasty has higher failure rates than lamellar keratoplasty, with immunological rejection being the leading cause of graft failure, followed by late endothelial failure (LEF) and ocular surface disorders. Postoperative glaucoma and dehiscence of the surgical wound represent other important causes of failure. Endothelial keratoplasty showed the lowest rates of failure in the mid-term, with LEF, detachment of the graft and primary graft failure representing the most common pathological reasons for failure.
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Doenças da Córnea/cirurgia , Transplante de Córnea/efeitos adversos , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/fisiopatologia , Sobrevivência de Enxerto , Humanos , Fatores de RiscoRESUMO
PURPOSE: Purpose: To evaluate the long-term stability of scleral-sutured intraocular lenses (IOLs) and analyse the possible causes of suture breakage. SETTING: Barraquer Institute in Barcelona, Spain. DESIGN: Retrospective study of consecutive cases. METHODS: Study of patients with scleral-sutured IOL with aphakia, subluxated or luxated IOL were included. Follow-up was longer than 6 months and patients over 18 years of age. Preoperative data (best-corrected visual acuity testing (BCVA), intraocular pressure (IOP), axial length and slit-lamp examination), intraoperative data (characteristics of the scleral flaps, suture material (Prolene or Mersilene) and scleral-sutured IOL) and postoperative data (BCVA, IOP, slit-lamp examination and complications) through 10 years were collected for analysis. RESULTS: 345 consecutive cases of scleral-sutured IOL were included. 25 eyes underwent a second operation after a prior sutured IOL due to suture breakage (mean 40.2±39.6 months after the first surgery) and three of them needed a third surgery. Younger adults (less than 40-year old), the use of a combination of Prolene and Mersilene sutures to perform the surgery and suturing only one flap were found to have higher risk of suture breakage after a follow-up of 10 years. The probability of surviving of the scleral-sutured IOL at 10 years after surgery was 0.79. CONCLUSIONS: Scleral-sutured posterior chamber IOL in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Further studies with special focus on young adults or myopic eyes are required to demonstrate long-term safety in those special cases.
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Afacia Pós-Catarata/cirurgia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Esclera/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Acuidade Visual , Adolescente , Adulto , Afacia Pós-Catarata/fisiopatologia , Feminino , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To evaluate the anatomical and functional results obtained with pars plana vitrectomy (PPV) plus autologous platelet concentrate (APC) as a treatment for macular detachment associated with optic disc pit (ODP). METHODS: We performed a prospective interventional study of 19 eyes of 19 consecutive patients with posterior macular detachment due to ODP. All patients underwent PPV, posterior hyaloid peeling, fluid-air exchange, injection of 0.05 mL of APC over the ODP and 15% perfluoropropane (C3F8) endotamponade. Postoperative measures included face-up positioning for 2 hours and then avoidance of the face-up position during the ensuing 10 days. All patients underwent complete ophthalmologic examination and optical coherence tomography preoperatively at 1 month, 3 months, 6 months, 9 months, and 12 months postoperatively and then annually. Outcome measures were best corrected visual acuity (BCVA) by logMAR, improvement of quality of vision, macular attachment, and resolution of intraretinal schisis-like separation. RESULTS: Preoperatively, the median BCVA was 0.70 (range: 0.30-1.70) and all patients showed improved visual acuity after surgery; BCVA was 0.22 (range: 0.07-0.52) at 12 months follow-up. All patients showed complete reabsorption of intraretinal fluid (median time: 3.5 months [range: 2-8 months]) and macular attachment at the end of follow-up (median: 60 months [range: 12-144 months]), with stable or improved visual acuity. No reoperations were needed and no major adverse events were recorded. CONCLUSION: For macular detachment associated with ODP, the combination of PPV, posterior hyaloid peeling, APC, and C3F8 tamponade is a highly effective alternative technique with stable anatomical and functional results.
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BACKGROUND/AIMS: The aim of our study was to report a case of progression of cutaneous vitiligo after large posterior choroidal melanoma diagnosis. METHODS: The clinical history, fundus findings and histopathological features suggest the diagnosis of cutaneous vitiligous progression after a diagnosis of large posterior choroidal melanoma. RESULTS: A 30-year-old female, with a personal history of cutaneous vitiligo for 12 years, was diagnosed with choroidal melanoma 18 months previously. The cutaneous vitiligo had progressed over her back, body and arms during the preceding 3 years. She refused treatment because she was in her 28th week of pregnancy. When she came to our clinic her visual symptoms had worsened, and the fundus examination showed a melanocytic choroidal mass. After confirming that there was no extraocular extension, she was treated with enucleation. A histopathological study confirmed the choroidal melanoma diagnosis. CONCLUSION: The association between the progression of vitiligo and the diagnosis of uveal melanoma could be considered a good prognostic factor, as has been described in cases of cutaneous melanoma. A longer follow-up of these patients will allow us to confirm this association.
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PURPOSE: To evaluate the long-term visual prognosis of corneal and ocular surface surgery in patients with congenital aniridia. METHODS: Retrospective comparative interventional case series on 88 eyes of 45 patients with congenital aniridia treated and/or operated on from 1956 to present. Corneal and ocular surface findings were identified and patients were classified into operated (group I) or not operated (group II). Long-term best-ever best-corrected visual acuity (BCVA), final BCVA and long-term delta BCVA (long-term best-ever BCVA - final BCVA) were recorded and compared between the two groups, and between the limbal transplant (LT) (group I-A) and the penetrating keratoplasty (PK) (group I-B) patients. Postoperative results were also compared. RESULTS: Limbal insufficiency was present in 58% of eyes and dense central corneal opacities were present in 27% of eyes. As a primary surgery, limbal allograft was performed in 10 eyes and PK in 13 eyes. The mean long-term follow-up times were 23 years in group I and 16 years in group II. The mean long-term delta BCVA was 0.032 in group I and 0.028 in group II. Comparisons of the VA means were insignificant (long-term best-ever, final BCVA and long-term delta BCVA). When comparing the LT and PK groups, mean long-term delta BCVA was 0.0328 in group I-A and 0.0382 in group I-B. Mean postoperative delta BCVA was 0.028 in group I-A and 0.048 in group I-B. We found no statistical significance between the LT and the PK groups as regards long-term postoperative BCVA results. CONCLUSION: Long-term visual prognosis does not differ whether or not the patient undergoes surgery for aniridic keratopathy. LT and PK have comparable results over 5 years of follow-up because of the eventual failure of transplanted allografts.