RESUMO
Objectives: To investigate the clinical efficacy and safety of the modified Cretan protocol in patients with post-laser in situ keratomileusis ectasia (PLE). Materials and Methods: In this retrospective study, 26 eyes of 16 patients with PLE were treated with the modified Cretan protocol (combined transepithelial phototherapeutic keratectomy and accelerated corneal collagen cross-linking). Visual, refractive, tomographic, and aberrometric outcomes and point spread function (PSF) were recorded preoperatively and at 6, 12, and 24 months after treatment. Results: Both uncorrected and best corrected visual acuity were stable at 24 months postoperatively compared to baseline (from 0.89±0.36 to 0.79±0.33 logarithm of the minimum angle of resolution [LogMAR] and 0.31±0.25 to 0.24±0.19 LogMAR, respectively, p>0.05 for all values). The mean K1, K2, Kmean, thinnest corneal thickness, and spherical aberration at baseline were 45.76±5.75 diopters (D), 48.62±6.17 D, 47.13±5.89 D, 433.16±56.86 µm, and -0.21±0.63 µm respectively. These values were reduced to 42.86±6.34 D, 45.92±6.74 D, 44.21±6.4 D, 391.07±54.76 µm, and -0.51±0.58 µm at 24 months postoperatively (p<0.001, p=0.002, p<0.001, p=0.001, and p=0.02, respectively). The mean spherical equivalent, manifest cylinder, Kmax, central corneal thickness, other corneal aberrations (root mean square, trefoil, coma, quatrefoil, astigmatism), and PSF remained stable (p>0.05 for all variables), while anterior and posterior elevation were significantly improved at 24 months postoperatively (p<0.001 and p=0.02, respectively). No surgical complications occurred during the 24-month follow-up. Conclusion: The modified Cretan protocol is a safe and effective treatment option for PLE patients that provides visual stabilization and significant improvement in topographic parameters during the 24-month follow-up. Further studies are needed to support our results.
Assuntos
Topografia da Córnea , Reagentes de Ligações Cruzadas , Ceratomileuse Assistida por Excimer Laser In Situ , Fármacos Fotossensibilizantes , Refração Ocular , Acuidade Visual , Humanos , Estudos Retrospectivos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Masculino , Feminino , Adulto , Dilatação Patológica/etiologia , Refração Ocular/fisiologia , Reagentes de Ligações Cruzadas/uso terapêutico , Resultado do Tratamento , Fármacos Fotossensibilizantes/uso terapêutico , Adulto Jovem , Colágeno , Lasers de Excimer/uso terapêutico , Seguimentos , Riboflavina/uso terapêutico , Fotoquimioterapia/métodos , Doenças da Córnea/cirurgia , Doenças da Córnea/etiologia , Doenças da Córnea/diagnóstico , Doenças da Córnea/fisiopatologia , Córnea/patologia , Córnea/cirurgia , Complicações Pós-Operatórias/diagnóstico , Miopia/cirurgia , Miopia/fisiopatologia , Raios UltravioletaRESUMO
PURPOSE: The aim of this study was to identify the risk factors for postkeratorefractive surgery ectasia in unsuspicious tomographies and to report a new index coined diameter of peak locations (DPLs). METHODS: All patients who underwent keratorefractive surgery between 2011 and 2018 at Care-Vision Laser Centers, Israel, and later developed ectasia were included. For each ectasia case, 3 matched controls were selected. Demographic and preoperative, intraoperative, and postoperative data were collected. Multivariate analysis was performed to evaluate the interdependence of the variables. RESULTS: The retrospective study included 19 ectasia and 58 control eyes. There were no significant differences between the groups in ablation depth ( P = 0.73), preoperative spherical equivalent ( P = 0.12), percent tissue altered ( P = 0.71), residual stromal bed ( P = 0.73), and Ectasia Risk Score System ( P = 0.60). The anterior and the posterior symmetry index were significantly higher ( P < 0.001), and DPL was significantly tighter in the ectasia group ( P = 0.01). Binary multiple logistic regression found the symmetry index of the posterior cornea and DPL to be better predictors than age, percent tissue altered, Ectasia Risk Score System, residual stromal bed, and ablation depth. CONCLUSIONS: A higher posterior symmetry index and a tighter DPL are predictors of ectasia in patients with otherwise normal tomographies. A tight DPL implies a weak area in the cornea, which is thin and slightly bulging, increasing the risk of this area becoming ectatic.
Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Humanos , Estudos Retrospectivos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Topografia da Córnea/métodos , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Complicações Pós-Operatórias/cirurgia , Córnea/diagnóstico por imagem , Córnea/cirurgia , TomografiaRESUMO
BACKGROUND/AIMS: Ectasia of the cornea can occur decades after penetrating keratoplasty (PK), especially in keratoconus eyes. The purpose of this study was to characterise ectasia after PK by morphological findings in anterior segment optical coherence tomography (AS-OCT). METHODS: In this retrospective, single-centre case series, 50 eyes of 32 patients with a history of PK at an average of 25±10 years earlier were included. The eyes were classified either as ectatic (n=35) or as non-ectatic (n=15). The main parameters included central corneal thickness (CCT), lowest corneal thickness at the interface (LCTI), anterior chamber depth, graft-host interface angle at the thinnest point and host cornea-iris angle. Furthermore, steep and flat keratometry readings obtained by AS-OCT (CASIA-2, Tomey) and Scheimpflug tomography (Pentacam, Oculus) were assessed. OCT findings were correlated with clinical grading of ectasia. RESULTS: There was a highly significant difference in LCTI, graft-host interface angle and anterior chamber depth (in pseudophakic eyes) between the groups. The ratio calculated by the quotient of LCTI divided by CCT was significantly lower in ectatic than non-ectatic eyes (p<0.001). In eyes with an LCTI/CCT ratio of ≤0.7, the OR for the occurrence of a clinical detectable ectasia was 2.4 (CI 1.5 to 3.7). Steep keratometry values were significantly higher in ectatic eyes. CONCLUSION: AS-OCT is a helpful tool to recognise and quantify ectasia in post-PK eyes objectively.
Assuntos
Ceratocone , Humanos , Ceratocone/diagnóstico , Ceratocone/cirurgia , Ceratoplastia Penetrante/métodos , Tomografia de Coerência Óptica/métodos , Dilatação Patológica/etiologia , Estudos Retrospectivos , Córnea/cirurgia , Topografia da Córnea/métodosRESUMO
INTRODUCTION: To present a case with a history of laser in situ keratomileusis (LASIK) developing central conic protrusion after phacoemulsification cataract surgery, which spontaneously resolved 5 months postoperatively. PATIENT CONCERNS: A 55-year-old female who underwent myopic LASIK surgery 10 years ago presented to the clinic with bilateral cataracts and without ectasia. Following phacoemulsification cataract surgery and intraocular lens implantation in the right eye, the patient experienced a significant increase in spherical equivalent and corneal astigmatism. DIAGNOSES: Based on a central conic protrusion on topography examination, surgically-induced corneal ectasia was diagnosed. INTERVENTIONS: Topical lubricants, corticosteroids, and serial follow-up with corneal topography. OUTCOMES: The corneal protrusion gradually resolved over a period of 5 months. LESSONS: For post-LASIK patient who developed corneal protrusion following uneventful cataract surgery with a clear corneal incision, the clear corneal wound may have disrupted the biomechanical stability of the post-LASIK eye, compromising the peripheral stromal integrity. Additionally, postoperative inflammation could have contributed to corneal ectasia. Smaller clear corneal wounds or scleral tunnel entry during cataract surgery in post-LASIK eyes should be considered. Monitoring wound healing and using topical steroids can aid in achieving satisfactory outcomes and reducing the potential vision-threatening complications associated with corneal ectasia.
Assuntos
Catarata , Doenças da Córnea , Ceratomileuse Assistida por Excimer Laser In Situ , Feminino , Humanos , Pessoa de Meia-Idade , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Dilatação Patológica/etiologia , Acuidade Visual , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Doenças da Córnea/cirurgia , Córnea/cirurgia , Topografia da Córnea , Catarata/complicações , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
The occurrence of corneal ectasia after photorefractive keratectomy is a rare but serious complication of refractive surgery. Possible risk factors are not well assessed, but a probable reason is the failure to detect keratoconus preoperatively. In this report, we describe a case of corneal ectasia after photorefractive keratectomy in a patient who presented a suspicious tomography pattern preoperatively but had no degenerative alterations associated with pathologic keratoconus, as revealed by in vivo corneal confocal microscopy. We also review eligible case reports of post-photorefractive keratectomy ectasia to find similar characteristics.
Assuntos
Ceratocone , Ceratectomia Fotorrefrativa , Humanos , Ceratectomia Fotorrefrativa/efeitos adversos , Ceratocone/cirurgia , Ceratocone/complicações , Dilatação Patológica/etiologia , Dilatação Patológica/diagnóstico , Dilatação Patológica/cirurgia , Lasers de Excimer/efeitos adversos , Topografia da Córnea , Acuidade Visual , Microscopia Confocal , Substância Própria/cirurgiaRESUMO
Iatrogenic keratectasia is induced thinning and protrusion of the cornea after laser refractive surgery. Known risk factors include an excessively thin postoperative residual stromal bed, a thicker flap, or preoperatively undetected evidence of preexisting subclinical keratoconus. The rate of post-refractive ectasia in eyes without identifiable preoperative risk factors is 20 per 100â000 eyes for photorefractive keratectomy, 90 per 100â000 eyes for laser in situ keratomileusis, and 11 per 100â000 eyes for small incision lenticule extraction. Traditional screening tools for preoperative risk include the ectasia risk score system and percentage of tissue alteration. More recent methods include corneal elastography and epithelial mapping, in addition to Artificial Intelligence methods for data analysis. Therapy includes contact lenses, cross-linking, implantation of intracorneal ring segments, penetrating or lamellar keratoplasty, and, in early studies, implantation of corneal lenticules.
Assuntos
Ceratocone , Ceratomileuse Assistida por Excimer Laser In Situ , Humanos , Dilatação Patológica/etiologia , Inteligência Artificial , Acuidade Visual , Topografia da Córnea , Córnea/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratocone/diagnóstico , Ceratocone/cirurgia , Doença Iatrogênica/prevenção & controleRESUMO
A 22-year-old male presented with complaints of blurred vision in his right eye over the past 2 years following small incision lenticule extraction (SMILE) surgery conducted 4 years ago. Following a thorough ocular examination and evaluation, he was diagnosed with corneal ectasia in the right eye after the SMILE procedure. Subsequently, the patient underwent corneal cross-linking (CXL) treatment in the right eye to prevent the progression of the condition. After 3 months of treatment, the corneal ectasia remained stable. This article outlines the process of diagnosis and treatment, reviews the corneal conditions prior to the SMILE surgery, and analyzes the possible reasons behind the occurrence of postoperative corneal ectasia.
Assuntos
Doenças da Córnea , Cirurgia da Córnea a Laser , Miopia , Humanos , Masculino , Adulto Jovem , Doenças da Córnea/etiologia , Doenças da Córnea/cirurgia , Substância Própria/cirurgia , Cirurgia da Córnea a Laser/efeitos adversos , Topografia da Córnea , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Lasers de Excimer , Miopia/cirurgia , Miopia/diagnóstico , Refração Ocular , Acuidade VisualRESUMO
BACKGROUND: Corneal ectatic diseases are a group of corneal disorder characterized by the steepening and thinning of the cornea. Older people are not a high-risk population for corneal ectatic diseases; due to the lack of typical preoperative topographic manifestations, there is a high possibility that corneal ectasia is undetected. CASE PRESENTATION: Two patients with subclinical corneal ectasia and senile cataracts presented with irregular astigmatism after steep-axis incision during cataract surgery. The two cases presented in this case report are rare because both patients experienced tremendous changes in astigmatism after cataract surgery. CONCLUSION: This case report may shed some light on astigmatism-correcting steep-axis incisions in cataract surgeries.
Assuntos
Astigmatismo , Extração de Catarata , Catarata , Doenças da Córnea , Facoemulsificação , Humanos , Idoso , Astigmatismo/diagnóstico , Astigmatismo/etiologia , Astigmatismo/cirurgia , Dilatação Patológica/etiologia , Facoemulsificação/efeitos adversos , Implante de Lente Intraocular/efeitos adversos , Extração de Catarata/efeitos adversos , Córnea/cirurgia , Catarata/complicações , Catarata/diagnóstico , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Doenças da Córnea/cirurgia , Topografia da CórneaRESUMO
Interface fluid syndrome (IFS) is a complication associated with laser in situ keratomileusis (LASIK) surgery where a fluid pocket in the corneal stroma decreases visual acuity. A systematic review of IFS cases using PRISMA guidelines was performed yielding a total of 33 patients. 2 outcomes were selected for logistic regression analysis: final corrected distance visual acuity (CDVA) and need for surgical management. Results showed 33.3% of patients required surgery, 51.5% had their IFS resolve within 1 month or sooner, and 51.5% had final CDVA 20/25 or better. Higher presenting intraocular pressure (IOP) and duration of IFS ≤1 month was associated with higher odds of final CDVA 20/25 or better (adjusted odds ratio [aOR] 1.12, P = .04; aOR 7.71, P = .02, respectively). Endothelial cell dysfunction led to 17.55 greater odds for requiring surgical compared to medical management (aOR 0.36, P = .04). Presenting IOP and duration of IFS predicted final CDVA, while prior endothelial cell dysfunction predicted need for surgery.
Assuntos
Glaucoma , Ceratomileuse Assistida por Excimer Laser In Situ , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Estudos Retrospectivos , Acuidade Visual , Substância Própria/cirurgia , Dilatação Patológica/etiologia , Síndrome , Glaucoma/cirurgia , Lasers de Excimer/efeitos adversosRESUMO
Post-laser in situ keratomileusis (post-LASIK) ectasia (PLE) is one of the most serious complications after refractive surgery, mainly manifested as progressive thinning and trembling thinning of the cornea, accompanied by increased myopia and astigmatism. The mechanisms behind mainly include genetic risk factors and external environmental factors such as eye rubbing and cornea surgery. In order to achieve the goal of reducing the incidence of ectasia, preoperative screening strategies need to be continuously improved, through the collection and assessment of genetic and environmental risk factors. Although previous preoperative screening methods did not have a uniform standard, the emergence of artificial intelligence (AI) can help us process a large amount of information and make rational use of the data. By using high-fidelity finite element modelling, differences in preoperative and postoperative strain distributions can be observed, which can predict the risk of postoperative ectasia. In this review, we describe the incidence, aetiology, prevention and treatment of PLE for the purpose of comprehensive management. In terms of treatment, corneal collagen cross-linking has been widely used to treat progressive keratoconus and other ectasia disease, either as a preventive measure during surgery or as a therapeutic modality after surgery to prevent progression of corneal dilation. Although the standard Dresden protocol has been identified as the gold standard treatment for corneal dilatation, a series of refinements, investigations and long-term studies have been conducted in recent years. Thus, understanding the factors involved in delaying the onset and slowing progression of cornea ectasia will be key to reducing the incidence worldwide.
Assuntos
Doenças da Córnea , Ceratocone , Ceratomileuse Assistida por Excimer Laser In Situ , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Topografia da Córnea/métodos , Dilatação Patológica/etiologia , Dilatação Patológica/prevenção & controle , Dilatação Patológica/diagnóstico , Inteligência Artificial , Córnea/cirurgia , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Doenças da Córnea/prevenção & controle , Ceratocone/diagnóstico , Ceratocone/etiologia , Ceratocone/prevenção & controle , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
PURPOSE: To report the long-term follow-up of bilateral ectasia after laser-assisted small-incision lenticule extraction (SMILE) with known risk factors. CASE REPORT: We report the case of a 23-year-old woman. Preoperative refraction was - 7.25 -2.00 × 20 in the right eye and -7.25 -1.50 × 155 in the left eye. Maximal keratometry was 47.32 diopters and 48.37 diopters, respectively, which was a contraindication to Laser Assisted In Situ Keratomileusis (LASIK) and a SMILE was proposed in 2015. One year after surgery, ectasia developed in the left eye and crosslinking (CXL) was performed. Two years after surgery, ectasia also developed in the right eye and CXL was also performed, leading to stabilization in both eyes five years after surgery. CONCLUSIONS: Known contraindications for LASIK are also contraindications for the performance of refractive surgery with SMILE. CXL is an efficient treatment of post-SMILE corneal ectasia.
Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Feminino , Humanos , Adulto Jovem , Adulto , Acuidade Visual , Seguimentos , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Miopia/cirurgia , Miopia/complicações , Refração Ocular , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Lasers de Excimer/uso terapêutico , Substância Própria/cirurgia , Topografia da CórneaRESUMO
PURPOSE: The purpose of this study was to determine the safety and outcomes of myopic laser in situ keratomileusis (LASIK) in patients who were secondarily diagnosed with hypermobile Ehlers-Danlos syndrome (EDS). METHODS: We conducted a case series study on patients with hypermobile EDS who underwent myopic LASIK surgery. Visual acuity, manifest refraction, a full dilated eye examination, biometry measurements, and Scheimpflug imaging were performed in the Wilmer outpatient clinic. RESULTS: There were 24 eyes of 12 patients included in this study. All participants were White women with a mean age of 46.58 years (SD 8.91 years). Participants were seen at an average of 13.83 years (SD 4.3 years, range 6-21 years) after undergoing LASIK. None of the patients in the series had a diagnosis of hypermobile EDS before LASIK surgery. Overall, 92% of patients were happy they got LASIK. The uncorrected distance visual acuity was 20/20 or better in 68% of eyes, and the best-corrected visual acuity was 20/20 or better in 92% of eyes. Manifest refraction was within 1 diopter of plano in 79% of patients. Dry eye symptoms were present in 83% of patients, and 46% of eyes had either punctate epithelial erosions or decreased tear break-up time. One of the 12 patients developed corneal ectasia in both eyes. CONCLUSIONS: Patients with hypermobile EDS are generally satisfied with myopic LASIK correction, with good visual acuity outcomes and low rates of myopic regression. However, the risk of corneal ectasia may prevent laser vision correction from being a viable treatment option in these patients. Further studies are needed to make a definitive recommendation.
Assuntos
Doenças da Córnea , Síndrome de Ehlers-Danlos , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Humanos , Feminino , Pessoa de Meia-Idade , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Córnea/cirurgia , Refração Ocular , Dilatação Patológica/etiologia , Doenças da Córnea/cirurgia , Miopia/cirurgia , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Resultado do Tratamento , Lasers de Excimer/uso terapêutico , SeguimentosRESUMO
BACKGROUND: Spinal lesions are a known manifestation of neurofibromatosis type 1 (NF1). The aim of this retrospective review was to analyze and report the prevalence of spinal lesions on imaging in a large NF1 center. METHODS: The data were collected from a period of 62 months from a cohort of 514 patients. Data were collected from multidisciplinary team meeting reports that included radiologic reports of each patient investigating 20 distinct variables. The prevalence of each of these lesions was calculated, and any statistically significant associations were investigated using the χ2 test. RESULTS: Four-hundred forty-seven patients had classic NF1, and 67 patients had spinal NF1. Many of the patients had spinal abnormalities; 25.7% of these patients were found to have dural ectasia, whereas 44.9% of patients had a spinal deformity. A statistically significant association between dural ectasia and spinal neurofibromatosis was established (P < 0.05). An additional statically significant association was established between dural ectasia and spinal deformity (P < 0.00001). The patients with spinal nerve root tumors were identified, and it was found that 49.8% of patients possessed these tumors, whereas 56.3% of these tumors were intraspinal tumors. The most common region affected was the cervical spine, and the most common spinal level was C2. CONCLUSIONS: This high prevalence of spinal tumours in mobile areas of the spine is possibly the result of a combination of genetic predisposition and repeated microtraumas resulting in tumor formation. This is the largest reported study of spinal lesions in NF1 based on imaging and offers insights into the etiology and relationships between lesions.
Assuntos
Neurofibromatoses , Neurofibromatose 1 , Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Humanos , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/epidemiologia , Dilatação Patológica/etiologia , Neurofibromatoses/complicações , Vértebras Cervicais/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/epidemiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Coluna Vertebral/complicaçõesRESUMO
ABSTRACT LASIK is a refractive surgical procedure in which a corneal flap is created to expose the corneal stromal bed. Preoperative estimation of corneal flap thickness is necessary to calculate the percentage tissue altered in LASIK, an important quantitative risk factor for ectasia. The objective of this study was to assess flap thickness and calculate percentage tissue altered to check if unexpectedly thicker flaps and higher percentage tissue altered could pose as risk factors of ectasia. Four subjects (eight eyes) were submitted to mechanical LASIK in 2009 and 2010. Pre and postoperative clinical and tomographic data were reviewed. Mean preoperative estimated percentage tissue altered was 39.18±1.31%, which was borderline for increased ectasia risk when considering the limit of 40%. However, when considering the postoperatively measured flap thickness, the actual mean percentage tissue altered turned out to be 45.17 ± 4.13%, which was significantly higher than predicted preoperatively (p=0.002). Unexpectedly higher postoperative percentage tissue altered may be responsible for corneal ectasia after mechanical LASIK.
RESUMO A LASIK é um procedimento cirúrgico refrativo, no qual um retalho corneano é criado para expor o leito estromal corneano. A estimativa pré-operatória da espessura do retalho corneano é necessária para calcular o percentual de tecido alterado no LASIK, um importante fator de risco quantitativo para ectasia. O objetivo deste estudo foi avaliar a espessura do retalho e calcular o percentual de tecido alterado para verificar se retalhos inesperadamente mais espessos e percentuais de tecido alterado mais altos poderiam representar fatores de risco de ectasia. Quatro indivíduos (oito olhos) foram submetidos à LASIK mecânica em 2009 e 2010. Dados clínicos e tomográficos pré e pós-operatórios foram revisados. A média de percentual de tecido alterado pré-operatória estimada foi de 39,18±1,31%, limítrofe para risco aumentado de ectasia quando considerado o limite de 40%. No entanto, ao considerar a espessura do retalho medida no pós-operatório, o percentual de tecido alterado médio real foi de 45,17±4,13%, ou seja, significativamente maior do que o previsto no pré-operatório (p=0,002). O percentual de tecido alterado pós-operatóriao inesperadamente mais alto pode ser responsável pela ectasia da córnea após LASIK mecânico.
Assuntos
Humanos , Masculino , Feminino , Adulto , Complicações Pós-Operatórias , Retalhos Cirúrgicos/patologia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Dilatação Patológica/etiologia , Lasers de Excimer/efeitos adversos , Erros de Refração , Córnea/cirurgia , Córnea/patologia , Topografia da Córnea/métodos , Tomografia de Coerência Óptica , Dilatação Patológica/diagnóstico , Procedimentos Cirúrgicos Refrativos/métodos , Lasers de Excimer/uso terapêuticoRESUMO
PURPOSE: To investigate the 36-month clinical outcomes of under-flap stromal bed CXL (ufCXL) and report on its ability to stabilize post-laser in situ keratomileusis (LASIK) ectasia. METHODS: This case series included 20 eyes with diagnosed early post-LASIK ectasia treated with ufCXL. Inclusion criteria were early, mild post-LASIK ectasia, defined as new-onset postoperative manifest refraction cylinder of 1.50 diopters (D) or less, with new topographic inferior steepening consistent with ectasia, uncorrected distance visual acuity of 20/40 or better, and corrected distance visual acuity of 20/25 or better. The existing LASIK flap was lifted, 0.25% isotonic riboflavin was applied directly to the stromal bed, the flap was repositioned, and 18 mW/cm2 ultraviolet light was applied for 5 minutes to the corneal flap surface. Post-ufCXL ophthalmic data were compared to pre-ufCXL baseline measurements. RESULTS: Visual outcomes were maintained pre-ufCXL to 36 months post-ufCXL, with preserved safety index (P = .6545), efficacy index (P = .4980), spherical equivalent accuracy (P = .1536), defocus equivalent accuracy (P = .1032), central corneal thickness (P = .5196), and corneal irregularity indices at 3 mm (P = .8548) and 5 mm (P = .3399). Refractive astigmatism significantly decreased from 0.83 to 0.55 D pre-ufCXL to post-ufCXL (P = .0439), as did maximum keratometry from 42.40 to 42.00 D pre-ufCXL to post-ufCXL (P = .0420). The ufCXL demarcation line depth was 336 ± 21 µm post-ufCXL, with normal endothelial cell density (2,574 ± 203 cells/mm2). Only 1 of 20 eyes showed evidence of progression of 1.00 D in maximum keratometry. CONCLUSIONS: The ufCXL procedure shows promise in stabilizing early post-LASIK ectasia. Visual function, refractive astigmatism, maximum keratometry, and corneal irregularity indices were statistically maintained at 36 months postoperatively. [J Refract Surg. 2022;38(8):511-519.].
Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Colágeno/uso terapêutico , Substância Própria , Topografia da Córnea , Reagentes de Ligações Cruzadas/uso terapêutico , Dilatação Patológica/tratamento farmacológico , Dilatação Patológica/etiologia , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Complicações Pós-Operatórias/tratamento farmacológico , Refração Ocular , Resultado do TratamentoRESUMO
BACKGROUND: This study measured the outer media thickness (OMT) at the false lumen by using microscopic images of specimens collected intraoperatively and assessed the impact of OMT on secondary dilatation of the downstream aorta. METHODS: Of 238 patients undergoing surgical procedures for acute type A dissection between 2007 and 2016, 129 patients fulfilled the inclusion criteria for this study: DeBakey type I dissection with a patent false lumen, histopathologic examination of full-thickness aortic wall, and at least 1 follow-up computed tomographic scan at more than 3 months after surgical procedures. On average, 5.1 scans were obtained per patient, and median follow-up was 4.3 years. RESULTS: Considerable variation was observed in OMT (median, 0.21 mm; range, 0.04-0.51 mm). The aortic diameter growth rate was inversely correlated with the OMT, and in the lowest tertile of OMT the aortic diameter dilated significantly faster in the first year than later and faster than in the other tertiles. Multivariable Fine-Gray analysis, with death as the competing risk, identified OMT as an independent variable for aortic-related events. Patients with OMT of 0.04 to 0.15 mm had a 3.54-fold higher risk of aortic-related events and those with 0.16 to 0.31 mm had a 1.56-fold higher risk of aortic-related events than did patients with OMT of 0.32 to 0.51 mm. Multivariable Cox regression analyses revealed OMT of 0.04 to 0.15 mm as an independent variable for all-cause mortality. CONCLUSIONS: In patients with DeBakey type I aortic dissection with a patent false lumen, the growth rate of the distal residual dissecting aorta was inversely correlated with the OMT. The risk of aortic-related events was significantly higher in patients with OMT of 0.04 to 0.15 mm.
Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Aortografia/métodos , Dilatação , Resultado do Tratamento , Estudos Retrospectivos , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Dissecção Aórtica/etiologia , Doenças da Aorta/cirurgia , Dilatação Patológica/etiologia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversosRESUMO
PURPOSE: To evaluate the outcomes of tuck-in deep anterior lamellar keratoplasty (DALK) for the management of post-radial keratotomy (RK) keratectasia. SETTING: Institution. DESIGN: Retrospective. METHODS: Medical records of all cases presenting with post-RK keratectasia from January 2012 to December 2019 were included. Data on corrected distance visual acuity (CDVA), refraction, keratometry, ultrasonic pachymetry, corneal topography, endothelial cell count, applanation tonometry, and dilated fundus examination recorded at all follow-up visits were included. Details of surgical steps, including intraoperative and postoperative complications and any secondary procedures performed subsequently, were also recorded. RESULTS: 7 eyes of 5 patients that developed corneal ectasia after a previous RK procedure underwent DALK with peripheral tuck-in. All eyes had CDVA ≤6/24, preoperatively. The surgical procedure was successfully performed in all eyes without any intraoperative complications. CDVA at the final follow-up ranged between 6/9 and 6/60, with 6 eyes achieving CDVA of 6/18 or better. The median keratometric cylinder reduced from a preoperative value of 7.2 ± 9.27 diopters (D) to 2 ± 1.83 D at the final follow-up. The median central corneal thickness at the final follow-up was 598 ± 40.01 µm, and spherical equivalent ranged between -1.75 D and -3.5 D (median -2 ± 0.57). The percentage of endothelial cell loss ranged between 2.1% and 8.4%. All eyes retained graft clarity, and none showed any evidence of significant interface haze or corneal vascularization. CONCLUSIONS: Tuck-in DALK could successfully address corneal ectasia developing after RK, achieving visual gains. Moreover, it was able to restore the peripheral corneal thickness with a minimal risk for dehiscence of RK incisions.
Assuntos
Doenças da Córnea , Transplante de Córnea , Ceratotomia Radial , Córnea/cirurgia , Doenças da Córnea/complicações , Doenças da Córnea/cirurgia , Topografia da Córnea , Transplante de Córnea/métodos , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Seguimentos , Humanos , Ceratotomia Radial/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
SIGNIFICANCE: This case highlights that hormonal changes during pregnancy could affect the biomechanical stability of the cornea and lead to corneal ectasia during pregnancy after corneal refractive surgery. PURPOSE: We report an unusual case of bilateral corneal ectasia after small-incision lenticule extraction that developed during pregnancy. CASE REPORT: A 27-year-old woman experienced post-small-incision lenticule extraction corneal ectasia. Her pre-operative corneal topography was normal, with a minimum central corneal thickness of 538 µm in the right eye and 530 µm in the left eye. The manifest refraction was -7.75 -0.25 × 180 and -7.50 -0.75 × 10, and the lenticule thickness was 140 and 139 µm in the right and left eyes, respectively. After 11 months, in her first trimester, the patient began to experience gradually deteriorating blurred vision. Two years post-operatively, corneal ectasia was diagnosed based on topographic data. The automatic optometer examination was -7.25 -2.50 × 42 in the right eye and -11.00 -5.00 × 140 in the left eye. Later, the patient underwent corneal collagen cross-linking to control further progression and was recommended to wear rigid gas-permeable contact lenses. CONCLUSIONS: Surgeons should be alert for cornea ectasia after refractive surgery in pregnant patients, as hormonal changes during pregnancy may affect corneal biomechanical stability.
Assuntos
Doenças da Córnea , Cirurgia da Córnea a Laser , Miopia , Adulto , Córnea/cirurgia , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Doenças da Córnea/cirurgia , Substância Própria/cirurgia , Cirurgia da Córnea a Laser/efeitos adversos , Topografia da Córnea , Dilatação Patológica/diagnóstico , Dilatação Patológica/etiologia , Feminino , Humanos , Miopia/diagnóstico , Miopia/cirurgia , Gravidez , Refração Ocular , Acuidade VisualRESUMO
Corneal epithelial thickness (CET) and the regional variations in response to changes in corneal architecture and biomechanics have recently drawn the interest of corneal surgeons. Corneal epithelium possesses the tremendous capability of remodeling and changing its thickness. This remodeling of corneal epithelium takes place in response to underlying stromal irregularities which can result from a variety of corneal disorders including corneal ectasia. Measurement of CET can reveal the underlying stromal abnormalities and supplement in early diagnosis of corneal disorders especially corneal ectasia which has been one of the leading challenges in planning corneal refractive surgery. A significant number of patients ends up in ectasia after refractive surgery and the most common cause of this complication is the presence of preoperative subclinical keratoconus. Furthermore, postoperative complications of corneal refractive surgery are partly masked by epithelial remodeling and make the diagnosis and management difficult and extremely challenging. This leads not only to unpredictable visual and refractive outcome but also the need of multiple interventions to treat these complications. Although corneal tomography is considered as gold standard in the detection and diagnosis of corneal ectasia, a small number of subclinical cases may still go undetected. In this review, we have highlighted the underlying mechanism of epithelial remodeling, the devices and imaging modalities used to measure CET, and application of epithelial mapping in the diagnosis and management of various corneal disorders.