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1.
Vestn Oftalmol ; 137(1): 78-82, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610154

RESUMO

Persistent corneal graft erosion or persistent epithelial corneal defect is a frequent complication of penetrating keratoplasty. Its development can be contributed by the dry eye syndrome, rare blinking, lagophthalmos, symblepharon, viral infection, autoimmune aggression, and the use of epithelial-toxic eye drops. The article presents three clinical observations of patients who developed persistent corneal graft erosion after penetrating keratoplasty. Due to the ineffectiveness of local conservative therapy for more than 3 weeks, anterior stromal corneal micropuncture was performed. After the procedure, there was a gradual epithelial proliferation, complete healing of the corneal surface was observed 10-16 days after the manipulation, the follow-up period was at least 1 year. The mechanism of action of stromal micropuncture is associated with the creation of a porous surface with better adhesion properties, as well as with the activation of the production of extracellular matrix glycoproteins such as fibronectin, type IV collagen and laminin, which are necessary for stable adhesion of the epithelium. The use of stromal micropuncture of the donor flap in the treatment of post-keratoplasty persistent corneal epithelial defect was proposed for the first time.


Assuntos
Doenças da Córnea , Transplante de Córnea , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Doenças da Córnea/cirurgia , Humanos , Ceratoplastia Penetrante/efeitos adversos , Soluções Oftálmicas , Punções
2.
Am J Ophthalmol ; 217: 232-239, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32437671

RESUMO

PURPOSE: To investigate the long-term stability of corneal astigmatism after combined femtosecond (fs)-assisted phacoemulsification and arcuate keratotomy. DESIGN: Retrospective, interventional case series. METHODS: Surgery was performed using a Victus (Bausch & Lomb) platform. A single, 450-µm-deep arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism measurements obtained preoperatively and at 2 and 5 years postoperatively were analyzed using vector analysis. RESULTS: A total of 44 eyes of 44 patients (mean age 66.0 ± 10.1 years) were included. The mean preoperative corneal astigmatism was 1.40 ± 0.66 diopters (D). This was reduced to 0.74 ± 0.54 D at 2 years and 0.70 ± 0.50 at 5 years postoperatively (P < .001). There were no statistically significant differences between postoperative corneal astigmatism at 2 years and at 5 years (P = .609). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .805). At the end of 5 years, 65% of the eyes were within 15 degrees of the preoperative astigmatic meridian. Comparative analysis showed significantly higher surgically induced astigmatism, lower differences in vector and absolute angles of error for the eyes with preoperative with-the-rule (WTR) astigmatism than eyes with against-the-rule (ATR) astigmatism at 5 years (P < .004). CONCLUSIONS: Our study showed the stability of femtosecond (fs)-assisted arcuate keratotomy was well-maintained over 5 years. There was a tendency of increasing overcorrection of preoperative WTR astigmatism and undercorrection of ATR astigmatism over time.


Assuntos
Astigmatismo/etiologia , Córnea/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Terapia a Laser/efeitos adversos , Facoemulsificação/efeitos adversos , Refração Ocular , Idoso , Astigmatismo/diagnóstico , Astigmatismo/fisiopatologia , Córnea/diagnóstico por imagem , Doenças da Córnea/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Facoemulsificação/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual
3.
Rev. cuba. oftalmol ; 33(1): e828, ene.-mar. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126720

RESUMO

RESUMEN Objetivo: Comparar las complicaciones de la queratoplastia lamelar anterior profunda y la queratoplastia penetrante en el tratamiento quirúrgico del queratocono. Métodos: Se realizó un estudio analítico longitudinal prospectivo en 81 pacientes operados de queratoplastia con diagnóstico de queratocono. Las variables analizadas fueron el cilindro, el componente esférico, la densidad celular y las complicaciones en el pre- y en el posoperatorio. Para el análisis estadístico se utilizó la prueba t de Student para la comparación de medias para datos pareados en el caso de dos valores promedios. Resultados: En el paciente operado de queratoplastia lamelar anterior profunda el cilindro fue -3,50 ± 1,50; y en la queratoplastia penetrante el resultado fue de -2,77 ± 0,98. La densidad celular posoperatoria fue de 2 333,6 cel/mm2 en la queratoplastia lamelar anterior profunda y de 2 269,3 cel/mm2 en la queratoplastia penetrante. En la queratoplastia lamelar anterior profunda el 75 por ciento evolucionó sin complicaciones, y el 82,7 por ciento presentó queratoplastia penetrante. Las complicaciones más frecuentes para la queratoplastia lamelar anterior profunda fueron la microperforación, el glaucoma secundario y el síndrome de Urretz-Zavalia (12,5 por ciento cada uno) y en la queratoplastia penetrante el rechazo endotelial (18,2 por ciento) y el defecto epitelial (9,1 por ciento). Conclusiones: En la queratoplastia lamelar anterior profunda la pérdida celular endotelial es más lenta en el primer año y las complicaciones son escasas(AU)


ABSTRACT Objetive: Compare the complications of deep anterior lamellar keratoplasty and penetrating keratoplasty in the surgical treatment of keratoconus. Methods: An analytical prospective longitudinal study was conducted of 81 patients undergoing keratoplasty and diagnosed with keratoconus. The variables analyzed were cylinder, spherical component, cell density, and preoperative and postoperative complications. Statistical analysis was based on Student's t-test for comparison of means for paired data in the event of two average values. Results: Cylinder was -3.50 ± 1.50 for deep anterior lamellar keratoplasty and -2.77 ± 0.98 for penetrating keratoplasty. Postoperative cell density was 2 333.6 cell/mm2 for deep anterior lamellar keratoplasty and 2 269.3 cell/mm2 for penetrating keratoplasty. 75 percent of the patients undergoing deep anterior lamellar keratoplasty and 82.7 percent of those undergoing penetrating keratoplasty evolved without any complication. The most common complications were microperforation, secondary glaucoma and Urretz-Zavalia syndrome (12.5 percent each) for deep anterior lamellar keratoplasty, and endothelial rejection (18.2 percent) and epithelial defect (9.1 percent) for penetrating keratoplasty. Conclusions: In deep anterior lamellar keratoplasty endothelial cell loss is slower in the first year and complications are scant(AU)


Assuntos
Humanos , Complicações Pós-Operatórias/etiologia , Transplante de Córnea/efeitos adversos , Ceratoplastia Penetrante/efeitos adversos , Ceratocone/diagnóstico , Análise Estatística , Estudos Prospectivos , Estudos Longitudinais
4.
Rev. cuba. oftalmol ; 33(1): e837, ene.-mar. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126717

RESUMO

RESUMEN Objetivo: Identificar el resultado óptico o terapéutico de la queratoplastia penetrante en pacientes con queratopatía herpética. Métodos: Se realizó una investigación descriptiva, transversal, donde se expusieron los resultados del alcance de la queratoplastia penetrante por queratopatía herpética, operados en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras", de La Habana. Resultados: La muestra fue de 33 queratoplastias penetrantes. Con fines ópticos sumaron 24 (72,7 por ciento) y tectónicas 9 (27,3 por ciento). En 5 de estas la agudeza visual fue menor o igual a 0,3. En el total de la muestra, 9 opacificaron, 11 sufrieron complicaciones posquirúrgicas, 8 recurrieron en queratoplastias penetrantes ópticas y 6 en queratoplastias penetrantes terapéuticas. Se rechazaron 7 queratoplastias penetrantes ópticas (33,3 por ciento) y 4 queratoplastias penetrantes terapéuticas (4 por ciento). Presentaron complicaciones 5 (25 por ciento) con queratoplastias penetrantes ópticas y 6 (55,6 por ciento) con queratoplastias penetrantes terapéuticas. En el posquirúrgico 22 (66,6 por ciento) tenían agudeza visual mayor o igual a 0,3 (p= 0,0000). Conclusiones: La inactividad de la enfermedad viral corneal beneficia el pronóstico del injerto por queratopatía herpética en las opacidades de las queratoplastias con fines ópticos. Queda demostrado que el uso de antivirales pre y posoperatorios disminuye la recidiva de la enfermedad herpética sobre el injerto y el rechazo, al lograr mejor agudeza visual y mayor viabilidad. La severidad inflamatoria posquirúrgica se asocia con la enfermedad viral activa o afección de origen inmune al realizar el trasplante, conexos a las complicaciones post queratoplastia(AU)


ABSTRACT Objective: Identify the optical or therapeutic outcome of penetrating keratoplasty in patients with herpetic keratopathy. Methods: A descriptive cross-sectional study was conducted in which a presentation was made of the results of the scope of penetrating keratoplasties for herpetic keratopathy performed at Hermanos Ameijeiras Clinical Surgical Hospital in Havana. Results: The sample was 33 penetrating keratoplasties: 24 optical (72.7 percent) and 9 tectonic (27.3 percent). Visual acuity was lower than or equal to 0.3 in 5 of them. Of the total sample, 9 opacified, 11 had postoperative complications, 8 recurred in optical penetrating keratoplasties, and 6 in therapeutic penetrating keratoplasties. Rejection occurred in 7 optical penetrating keratoplasties (33.3 percent) and 4 therapeutic penetrating keratoplasties (4%). Complications were observed in 5 (25 percent) optical penetrating keratoplasties and 6 (55.6 percent) therapeutic penetrating keratoplasties. In the postoperative period 22 (66.6 percent) had a visual acuity greater than or equal to 0.3 (p= 0.0000). Conclusions: Inactivity of corneal viral disease benefits the prognosis of grafting due to herpetic keratopathy in opacities of optical keratoplasties. Pre- and postoperative antivirals were found to reduce the recurrence of herpetic disease on the graft and rejection, achieving better visual acuity and greater viability. Postoperative inflammatory severity is associated to an active viral disease or an immune disorder at the time of the grafting resulting in post keratoplasty complications(AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Antivirais/administração & dosagem , Complicações Pós-Operatórias/terapia , Transplante de Córnea/efeitos adversos , Ceratoplastia Penetrante/efeitos adversos , Epidemiologia Descritiva , Estudos Transversais
5.
J Fr Ophtalmol ; 43(3): 222-227, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31987676

RESUMO

PURPOSE: To compare the visual and refractive outcomes and anterior segment optical coherence tomography (AS-OCT) findings of 2 different deep anterior lamellar keratoplasty (DALK) techniques in the treatment of advanced keratoconus with and without successful big bubble formation. METHODS: In this retrospective comparative case series, data from 79 consecutive eyes of 69 patients who underwent either big bubble (group 1, n: 62) or manual DALK (group 2, n: 17) were analyzed. The visual and refractive results, keratometric values and residual stromal thickness were assessed. Patients were seen at 1, 3, 6 and 12 months after the procedure and 1 month after complete suture removal. RESULTS: A big bubble was successfully obtained in 62 eyes (78.5%; group 1) and manual dissection was performed in the 17 remaining eyes (21.5%; group 2). The final best spectacle-corrected visual acuity (BSCVA) was 0.38 logMAR and 0.55 logMAR in Group 1 and 2, respectively (P<0.05). At the final visit, BSCVA≤0.30 logMAR was achieved in 80% and 60.8% of eyes in Groups 1 and 2, respectively (P<0.001). Groups 1 and 2 were comparable in terms of mean keratometry: 47.80D±2.81D (range, 41.30D to 54.2D) versus 45.90D±3.62D (range, 41.10D to 53.8 D), respectively; (P=0.56) and keratometric astigmatism: 3.81D± 2.1D (range, 1.0D to 6.20D) versus 3.56D±1.92D (range 1.2D to 6.85D), respectively; (P=0.40) at the final follow-up. The mean residual stromal thickness was 36.90±17.80µm in group 2. CONCLUSION: The presence of residual posterior corneal stroma when big bubble formation is not successfully achieved in DALK is correlated with lower postoperative visual acuity.


Assuntos
Transplante de Córnea/métodos , Ceratocone/diagnóstico , Ceratocone/cirurgia , Adulto , Estudos de Casos e Controles , Córnea/cirurgia , Topografia da Córnea , Transplante de Córnea/efeitos adversos , Lâmina Limitante Posterior/cirurgia , Epitélio Posterior/cirurgia , Feminino , Seguimentos , Humanos , Ceratoplastia Penetrante/efeitos adversos , Ceratoplastia Penetrante/métodos , Masculino , Refração Ocular/fisiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Turquia , Acuidade Visual/fisiologia , Adulto Jovem
6.
Cornea ; 39(1): 45-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31517723

RESUMO

PURPOSE: To determine incidence, demographics, management, and outcomes of topical steroid-induced ocular hypertension after penetrating keratoplasty (PKP) and to establish effects on intraocular pressure (IOP) and graft rejection when alternate corticosteroids are used. METHODS: A single-center, retrospective review of 568 consecutive PKPs performed between 1997 and 2010 was conducted. Data were collected on demographics, best-corrected visual acuity, surgical indications, lens status, IOP, postoperative management, and incidence of rejection. RESULTS: Eighty eyes (14.1%) of 74 patients were included. The most common indication was keratoconus (28.8%). Twenty-seven eyes (33.8%) were phakic, 46 (57.4%) had a posterior chamber intraocular lens, and 7 (8.8%) had an anterior chamber intraocular lens. Mean postoperative IOP increase was only significant in the anterior chamber intraocular lens group (18.7 mm Hg, SD 10.4; P = 0.02). The average time for developing hypertension was 9.8 months (SD 14.8) postoperatively, with an average IOP increase of 13.3 mm Hg (SD 5.9). Prednisolone acetate 1% was switched to rimexolone 1% in 64 eyes (80%) and to fluorometholone 0.1% in 16 eyes (20%), which alone achieved IOP normalization in 26 eyes (32.5%) (P < 0.01). Fifty-four eyes (67.5%) required additional antiglaucoma medication. An average IOP reduction of 12.3 mm Hg (SD 6.9) was achieved at an average of 2.3 months (SD 5.2) after the switch. Seventeen eyes (21%) developed glaucoma and 13 eyes (16.3%) developed graft rejection after switching formulations, with no statistically significant differences between rimexolone and fluorometholone (P > 0.05). CONCLUSIONS: The use of alternate topical corticosteroids may be considered in cases of steroid-induced ocular hypertension after PKP because they offer good antiinflammatory prophylaxis with reduced hypertensive response.


Assuntos
Fluormetolona/efeitos adversos , Rejeição de Enxerto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Ceratoplastia Penetrante/efeitos adversos , Hipertensão Ocular/induzido quimicamente , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluormetolona/administração & dosagem , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/epidemiologia , Hipertensão Ocular/fisiopatologia , Soluções Oftálmicas , Estudos Retrospectivos , Fatores de Tempo , Tonometria Ocular , Reino Unido/epidemiologia , Adulto Jovem
7.
Cornea ; 39(1): 71-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31490273

RESUMO

PURPOSE: To report the outcomes of stepwise combined femtosecond astigmatic keratotomy (FSAK) and phacoemulsification with toric intraocular lens (IOL) implantation in the treatment of very high astigmatism after either penetrating keratoplasty or deep anterior lamellar keratoplasty. METHODS: This is a retrospective, interventional case series including 8 eyes of 6 patients with very high astigmatism [≥8.00 diopter (D)] after either penetrating keratoplasty or deep anterior lamellar keratoplasty who underwent FSAK, followed by phacoemulsification and toric IOL implantation. Outcome measures were corneal and manifest astigmatism and uncorrected and best spectacle-corrected visual acuity (UCVA, BSCVA). RESULTS: The average age was 58.9 ± 5.1 years. The average follow-up time was 40.9 ± 43.8 months. Outcome measure changes after both FSAK and toric IOL implantation were: corneal astigmatism improved from 13.56 ± 4.81 D to 4.48 ± 2.83 D (P < 0.001), manifest astigmatism improved from 9.15 ± 3.86 to 1.46 ± 0.88 D (P = 0.011), UCVA improved from 1.69 ± 0.45 LogMAR (Snellen equivalent ∼20/980) to 0.23 ± 0.11 LogMAR (Snellen equivalent ∼20/33, P < 0.001), and BSCVA improved from 1.01 ± 0.71 LogMAR (Snellen equivalent ∼20/200) to 0.19 ± 0.11 LogMAR (Snellen equivalent ∼20/30, P = 0.015). BSCVA and UCVA at the last follow-up were 20/40 or better in all patients. All procedures were uneventful. Two eyes underwent photorefractive keratectomy after FSAK to regularize and further reduce astigmatism before toric IOL implantation. One patient underwent temporary compression suturing because of FSAK overcorrection. CONCLUSIONS: Combined stepwise use of FSAK and phacoemulsification with toric IOL implantation was an effective and apparently safe approach in patients with very high postkeratoplasty astigmatism. Additional treatment using photorefractive keratectomy may be beneficial in some cases.


Assuntos
Astigmatismo/cirurgia , Catarata/complicações , Ceratoplastia Penetrante/efeitos adversos , Ceratotomia Radial/métodos , Terapia a Laser/métodos , Implante de Lente Intraocular/métodos , Facoemulsificação/métodos , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Refração Ocular , Reoperação , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Acuidade Visual
8.
Eur J Ophthalmol ; 30(5): NP62-NP65, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30938185

RESUMO

INTRODUCTION: Suprachoroidal hemorrhage is an unexpected complication after penetrating keratoplasty during childhood. We report the case of delayed suprachoroidal hemorrhage after penetrating keratoplasty in a neonate as the first manifestation of hemophilia. CASE REPORT: A 4-day-old neonate was referred to our hospital because of bilateral corneal opacities present since birth. A diagnosis of bilateral Peter's anomaly type 2 with right eye corneal perforation was made after examination. Appropriate treatment was commenced, and later, right eye therapeutic penetrating keratoplasty combined with lensectomy, and anterior vitrectomy was performed. This was complicated postoperatively with suprachoroidal hemorrhage and retinal detachment. Conservative management was advised due to poor visual prognosis. Three months later, the patient was found to have high intraocular pressure in the left eye and glaucoma surgery was recommended. Proper hematological investigations before glaucoma surgery in the left eye revealed a low level of factor VIII with normal levels of factor IX and von Willebrand's factor antigen. Therefore, a diagnosis of hemophilia type A was established. CONCLUSION: This case serves as a reminder that the occurrence of suprachoroidal hemorrhage, especially in the absence of other predisposing risk factors, should warrant detailed systemic assessment to exclude underlying bleeding disorders.


Assuntos
Cegueira/etiologia , Hemorragia da Coroide/etiologia , Hemofilia A/diagnóstico , Ceratoplastia Penetrante/efeitos adversos , Segmento Anterior do Olho/anormalidades , Segmento Anterior do Olho/cirurgia , Hemorragia da Coroide/diagnóstico por imagem , Opacidade da Córnea/cirurgia , Anormalidades do Olho/cirurgia , Fator VIII/metabolismo , Humanos , Recém-Nascido , Masculino , Descolamento Retiniano/diagnóstico por imagem , Descolamento Retiniano/etiologia , Fatores de Risco , Ultrassonografia , Acuidade Visual , Vitrectomia/efeitos adversos
9.
Cornea ; 39(1): 39-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31259861

RESUMO

PURPOSE: To determine the factors responsible for the recurrence of infection after therapeutic penetrating keratoplasty (TPK) in severe microbial keratitis. METHODS: This is a retrospective interventional case series that reviewed the medical records of 229 consecutive patients (2005-2017) who underwent TPK for microbial keratitis at a tertiary eye care center in Central India. The primary outcome was recurrence of the primary infection. The factors responsible for recurrence were identified by univariate and multivariate regression analysis. RESULTS: The overall outcomes were clear graft in 50 (21.8%) eyes, failed graft in 139 (60.7%) eyes, evisceration in 19 (8.3%) eyes, phthisis bulbi in 14 (6.1%) eyes, repeat TPK in 2 (0.9%) eyes, and anterior staphyloma in 1 (0.4%) eye. Recurrence occurred in 63 (27.5%) eyes within 16.2 ± 13.8 (range: 2-66) days. Univariate analysis identified fungal etiology (P = 0.001), ulcer size > 60 mm (P = 0.001), limbal involvement (P = 0.001), endothelial exudates (P = 0.024), retro-iris exudates (P = 0.001), corneal perforation (P = 0.005), coexisting endophthalmitis (P < 0.001), and graft size ≥ 10 mm (P < 0.001) as significant risk factors. Multiple logistic regression identified fungal etiology (P = 0.013), retro-iris exudates (P = 0.011), coexisting endophthalmitis (P = 0.004), and graft size ≥ 10 mm (P = 0.058) as independent risk factors for recurrence. Presenting visual acuity of 20/200 or better was seen in 49 (21.4%) and 39 (17%) eyes, and no light perception in 11 (4.8%) and 26 (11.4%) eyes at postoperative months 1 and 3, respectively. CONCLUSIONS: Fungal etiology, retro-iris exudates, coexisting endophthalmitis, and larger grafts were susceptible to recurrence. Early surgery may mitigate most of these factors. Despite the risk of recurrence, TPK remains an effective treatment in severe nonresponsive keratitis.


Assuntos
Córnea/cirurgia , Infecções Oculares Fúngicas/cirurgia , Ceratite/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Córnea/microbiologia , Córnea/patologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Lactente , Ceratite/diagnóstico , Ceratite/microbiologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
10.
Eur J Ophthalmol ; 30(5): NP15-NP17, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31148469

RESUMO

BACKGROUND: To describe the successful management of a massive iridoschisis after penetrating keratoplasty for keratoconus, using the nd:YAG punctures. CASE PRESENTATION: A 73-year-old male patient has undergone four penetrating keratoplasties for keratoconus. Nine months after the last surgery, patient presented with massive iridoschisis involving the visual axis. Patient was successfully treated with nd:YAG laser iridopunctures. CONCLUSION: Massive iridoschisis could be a potential complication of keratoconus, especially after penetrating keratoplasty. This condition can be potentially treated with nd:YAG iridopunctures.


Assuntos
Doenças da Íris/etiologia , Ceratocone/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Idoso , Humanos , Doenças da Íris/cirurgia , Masculino , Punções
11.
Cornea ; 39(1): 13-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31299664

RESUMO

PURPOSE: To evaluate the safety and efficacy of the treatment of secondary graft failure in penetrating keratoplasty (PK) by performing Descemet membrane endothelial keratoplasty (DMEK) without host descemetorhexis. METHODS: This is a retrospective case series study of 8 eyes from 8 patients who underwent non host Descemet membrane stripping DMEK surgery under a previously failed PK. The DMEK graft diameter was either matched or 0.25 to 0.5 mm undersized in relation to the PK diameter. Six-month postoperative data are presented. Primary outcome measures were safety and anatomical success. RESULTS: No intraoperative complications were registered. Postoperatively, 1 case developed a PK host-donor junction dehiscence in relation to a previous early suture removal, requiring PK resuturing and DMEK rebubbling. Only 1 additional case required DMEK rebubbling. No primary graft failure was detected, and all cases achieved full PK transparency within 2 weeks. Corrected distance visual acuity improved from a median of counting fingers (CF-0.2) to 0.57 (0.05-0.7). Median central corneal thickness improved from 650.5 (497-897) to 464 (372-597) µm. Median endothelial cell density was 1080 (581-2043) cells/mm. Rebubbling rate (25%) was lower than that previously reported. All patients had extensive preoperative ocular comorbidity. CONCLUSIONS: DMEK under PK without host descemetorhexis is a feasible surgical alternative for the treatment of graft failure after PK. It is associated with equivalent levels of efficacy and safety compared with Descemet membrane stripping DMEK techniques but simplifies the surgical procedure and avoids potential intraoperative complications associated with Descemet stripping. Further studies with a larger sample and a longer follow-up are necessary to confirm our preliminary outcomes.


Assuntos
Doenças da Córnea/cirurgia , Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Ceratoplastia Penetrante/efeitos adversos , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Doenças da Córnea/diagnóstico , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Tomografia de Coerência Óptica , Falha de Tratamento , Resultado do Tratamento
12.
J Fr Ophtalmol ; 43(1): 18-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31831272

RESUMO

PURPOSE: To determine the indications, frequency, influential factors and clinical outcomes of resuturing in an atraumatic setting after penetrating keratoplasty (PK). METHODS: Medical records of all patients who underwent resuturing in the absence of traumatic wound dehiscences after PK between January 1, 2007 and December 31, 2015 were reviewed. The cases were divided into 2 groups: patients with suture-related problems underwent mandatory resuturing (mandatory group), and patients with post-PK ectasia or a progressive increase in K values and surgically induced astigmatism underwent optional resuturing (Optional group). Patient demographics and surgical indications for PK, reasons for and frequency of resuturing, time between PK and resuturing, and clinical outcomes were evaluated. RESULTS: The frequency of resuturing was 9.03% (59 of 633), and the mean age was 39.15±17.80 years. The most common indication for PK was keratoconus (42.4%) and the interval between PK and resuturing ranged from 0.03 to 32 months. The underlying cause leading to resuturing was suture-related problems in 43 eyes (72.9%), development of ectasia or progressive steepening of the K values and surgically induced astigmatism in 16 eyes (27.1%). The mean visual acuity increased, the K value and astigmatism decreased significantly following resuturing in both the mandatory group and the Optional group (P≤0.2). The decrease in astigmatism and K values was more marked in the Optional group, as expected (P≤0.001). CONCLUSION: While resuturing is essential in order to obtain wound integrity in the setting of dehiscence, it is effective in terms of achieving higher visual acuities and lower astigmatism and K values in high astigmatism and post-PK ectasia cases.


Assuntos
Astigmatismo/cirurgia , Ceratoplastia Penetrante , Reoperação , Técnicas de Sutura , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/epidemiologia , Córnea/cirurgia , Dilatação Patológica/epidemiologia , Dilatação Patológica/cirurgia , Feminino , Humanos , Ceratocone/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Ceratoplastia Penetrante/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/estatística & dados numéricos , Suturas , Cicatrização/fisiologia , Adulto Jovem
13.
BMJ Case Rep ; 12(12)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31801779

RESUMO

Sphingomonas paucimobilis is a low-virulence gram-negative bacillus known to cause various ocular infections such as endophthalmitis, panophthalmitis and keratitis that are usually associated with an underlying risk factor such as peri-partum or postpartum phase, cataract surgery, contact lens use, neurotrophic keratopathy or ocular trauma. We report a case of spontaneously occurring perforated corneal ulcer caused by the organism in a young man managed by penetrating keratoplasty. The course was followed by endophthalmitis with graft infection culminating in phthisis bulbi despite aggressive medical and surgical management. Along with reporting this case, we also present a review of literature on ocular infections caused by the same organism.


Assuntos
Úlcera da Córnea/cirurgia , Infecções por Bactérias Gram-Negativas , Ceratoplastia Penetrante/efeitos adversos , Sphingomonas , Adolescente , Antibacterianos/uso terapêutico , Úlcera da Córnea/microbiologia , Quimioterapia Combinada , Endoftalmite/microbiologia , Humanos , Masculino , Complicações Pós-Operatórias/microbiologia , Resultado do Tratamento
14.
Indian J Ophthalmol ; 67(10): 1738-1740, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31546547

RESUMO

A 28-year-old man with a prior history of penetrating keratoplasty in the left eye for total corneal melt presented with a 3-day history of a red, painful left eye. On examination, he was found to have graft infiltrates. Microscopic examination of wet mount preparation of corneal scrapings revealed the presence of embryonated eggs of E. vermicularis. Cellophane (scotch) tape preparation from perianal region also revealed embryonated eggs of E. vermicularis as well as live adult worms. Ocular and adnexal involvement by E. vermicularis is extremely rare. Here, we report the first case of infection of a corneal graft with E. vermicularis.


Assuntos
Enterobíase/diagnóstico , Enterobius/isolamento & purificação , Ceratite/diagnóstico , Ceratoplastia Penetrante/efeitos adversos , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Animais , Córnea/parasitologia , Córnea/cirurgia , Diagnóstico Diferencial , Enterobíase/etiologia , Enterobíase/parasitologia , Humanos , Ceratite/etiologia , Ceratite/parasitologia , Masculino , Infecção da Ferida Cirúrgica/parasitologia
15.
Indian J Ophthalmol ; 67(10): 1742-1744, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31546549

RESUMO

An 84-year-old gentleman underwent uneventful femtolaser-assisted cataract surgery (FLACS) with an arcuate keratotomy (AK) in the left eye. On the 18th post-operative day, a corneal infiltrate developed involving the AK. Staphylococcus epidermidis was the organism isolated on culture. The infiltrate resolved with topical fortified vancomycin and amikacin eyedrops, and the patient regained a visual acuity of 6/6 after 12 weeks. This is the first case from south-east Asia reported in the literature of an infective infiltrate along a femtosecond laser AK. We propose strict peri-operative recommendations to be followed to prevent and treat such infections.


Assuntos
Extração de Catarata/efeitos adversos , Córnea/patologia , Infecções Oculares Bacterianas/etiologia , Ceratite/etiologia , Ceratoplastia Penetrante/efeitos adversos , Terapia a Laser/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Administração Tópica , Idoso de 80 Anos ou mais , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Extração de Catarata/métodos , Córnea/microbiologia , Topografia da Córnea , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Humanos , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Masculino , Soluções Oftálmicas , Refração Ocular , Reoperação , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia , Vancomicina/administração & dosagem , Acuidade Visual
16.
Ophthalmic Res ; 62(3): 150-156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167213

RESUMO

PURPOSE: To study the astigmatic correction of high post-keratoplasty astigmatism using Femtosecond laser (FSL)-assisted Arcuate Keratotomy (FS-AK). METHODS: A prospective interventional cohort study. We enrolled 17 eyes with high degree of irregular astigmatism, scheduled for FS-AK. FSL was used to perform paired arcuate incisions 1.00 mm inside the graft. Patients' uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and astigmatic change were recorded and followed up to 1 year after surgery. Vector analysis using Alpins' method was done to analyze the astigmatic correction. RESULTS: FS-AK reduced the refractive astigmatism at final follow-up visit at 12 months (p = 0.0008, repeated-measures analysis of variance [ANOVA]). The procedure improved the UCVA over the follow-up period (p = 0.007, repeated-measures ANOVA), with a similar effect on the BCVA (p = 0.046, repeated-measures ANOVA). There was a mild correlation between the target-induced astigmatism and the surgically induced astigmatism (R2 = 0.245) with a tendency to overcorrect more than under correct the astigmatism. A constant rotational error in the counterclockwise direction was also detected. CONCLUSIONS: FS-AK improves the visual outcome and reduces the refractive cylinder in post-penetrating keratoplasty astigmatism. The predictability of astigmatism correction was variable in reducing post-keratoplasty astigmatism. Refinement of the treatment nomogram for such cases is highly recommended.


Assuntos
Astigmatismo/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Ceratotomia Radial/métodos , Terapia a Laser/métodos , Adolescente , Adulto , Análise de Variância , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Acuidade Visual
17.
J Glaucoma ; 28(8): 718-726, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31169563

RESUMO

PRECIS: Three-dimensional (3D) spectral domain optical coherence tomography (OCT) volume scans of the optic nerve head (ONH) and the peripapillary area are useful in the management of glaucoma in patients with a type I or II Boston Keratoprosthesis (KPro). PURPOSE: The purpose of this study was to report the use of spectral domain OCT in the management of glaucoma in patients with a type I or II Boston KPro. MATERIALS AND METHODS: This study is an observational case series. Four consecutive patients with KPro implants were referred for glaucoma evaluation. A comprehensive eye examination was performed which included disc photography, visual field testing, and high-density spectral domain OCT volume scans of the ONH and the peripapillary area. 2D and 3D parameters were calculated using custom-designed segmentation algorithms developed for glaucoma management. RESULTS: Spectral domain OCT parameters provided useful information in the diagnosis and management of 4 KPro patients. OCT parameters which can be used in KPro patients included 2D retinal nerve fiber layer (RNFL) thickness, 3D peripapillary RNFL volume, 3D peripapillary retinal thickness and volume, 3D cup volume, and 3D neuroretinal rim thickness and volume. In 3 of 4 cases where the traditional 2D RNFL thickness scan was limited by artifacts, 3D spectral domain OCT volume scans provided useful quantitative objective measurements of the ONH and peripapillary region. Therefore, 3D parameters derived from high-density volume scans as well as radial scans of the ONH can be used to overcome the limitations and artifacts associated with 2D RNFL thickness scans. CONCLUSIONS: Spectral domain OCT volume scans offer the possibility to enhance the evaluation of KPro patients with glaucoma by using both 2D and 3D diagnostic parameters that are easily obtained in a clinic setting.


Assuntos
Doenças da Córnea/complicações , Glaucoma/complicações , Glaucoma/diagnóstico , Ceratoplastia Penetrante/instrumentação , Próteses e Implantes , Tomografia de Coerência Óptica/métodos , Adulto , Doenças da Córnea/diagnóstico , Doenças da Córnea/cirurgia , Progressão da Doença , Feminino , Glaucoma/terapia , Humanos , Imageamento Tridimensional/métodos , Ceratoplastia Penetrante/efeitos adversos , Ceratoplastia Penetrante/classificação , Ceratoplastia Penetrante/métodos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Próteses e Implantes/classificação , Desenho de Prótese/classificação , Testes de Campo Visual
18.
Indian J Ophthalmol ; 67(7): 1193-1194, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238461

RESUMO

We report a rare case of deep anterior lamellar keratoplasty (DALK) neovascularization managed with combination of subconjunctival bevacizumab and argon laser photocoagulation. A 24 year old male underwent Deep anterior lamellar keratoplasty for corneal stromal opacity following presumed viral keratitis. Deep corneal neovascularization was observed postoperatively which was successfully managed using a combination of subconjunctival bevacizumab and argon laser photocoagulation within one week of DALK. The neovascularization resolved by 3 months and at 2 years follow up, patient maintained good visual acuity of 6/12 Snellen's without recurrence of vascularization. A combination of bevacizumab and argon laser may be an effective approach to manage neovascularisation in the immediate postoperative phase (Post DALK) and improve graft survival.


Assuntos
Bevacizumab/administração & dosagem , Neovascularização da Córnea/terapia , Ceratite/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Terapia a Laser/métodos , Lasers de Excimer/uso terapêutico , Inibidores da Angiogênese/administração & dosagem , Túnica Conjuntiva , Neovascularização da Córnea/etiologia , Sobrevivência de Enxerto , Humanos , Injeções , Masculino , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica , Acuidade Visual , Adulto Jovem
19.
Acta Ophthalmol ; 97(7): e987-e992, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31044553

RESUMO

PURPOSE: To describe the ocular findings of 12 subjects with paraproteinemic keratopathy associated with monoclonal gammopathy of undetermined significance (MGUS). METHODS: Ocular examination included corneal spectral domain optical coherence tomography. In three individuals with an initial diagnosis of a lattice or Thiel-Behnke corneal dystrophy, the TGFBI gene was screened by conventional Sanger sequencing. RESULTS: We confirmed a diagnosis of MGUS by systemic examination and serum protein electrophoresis in 12 individuals (9 males and 3 females), with a mean age at presentation of 52.2 years (range 24-63 years) and mean follow-up 6.4 years (range 0-17 years). The best-corrected visual acuity (BCVA) at presentation ranged from 1.25 to 0.32. In all individuals, the corneal opacities were bilateral. The appearances were diverse and included superficial reticular opacities and nummular lesions, diffuse posterior stromal opacity, stromal lattice lines, superficial and stromal crystalline deposits, superficial haze and a superficial ring of hypertrophic tissue. In one individual, with opacities first recorded at 24 years of age, we documented the progression of corneal disease over the subsequent 17 years. In another individual, despite systemic treatment for MGUS, recurrence of deposits was noted following bilateral penetrating keratoplasties. The three individuals initially diagnosed with inherited corneal dystrophy were negative for TGFBI mutations by direct sequencing. CONCLUSION: A diagnosis of MGUS should be considered in patients with bilateral corneal opacities. The appearance can mimic corneal dystrophies or cystinosis. In our experience, systemic treatment of MGUS did not prevent recurrence of paraproteinemic keratopathy following keratoplasty.


Assuntos
Córnea/patologia , Opacidade da Córnea/etiologia , Previsões , Ceratoplastia Penetrante/efeitos adversos , Gamopatia Monoclonal de Significância Indeterminada/complicações , Paraproteinemias/complicações , Adulto , Idoso , Opacidade da Córnea/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Paraproteinemias/diagnóstico , Recidiva , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Acuidade Visual , Adulto Jovem
20.
Rev Lat Am Enfermagem ; 27: e3141, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038635

RESUMO

OBJECTIVE: to identify the main intraoperative complications of patients who underwent keratoplasty and relationship between these complications and clinical and surgical factors. METHOD: cross-sectional observational study. A census of the patients submitted to keratoplasty was carried out, which totaled 258 procedures. RESULTS: twenty-two intraoperative complications were recorded, all in penetrating keratoplasty surgeries, of which 59.09% were performed in male patients with a mean age of 58.5 years. The main intraoperative complication was vitreous loss (36.36%). A statistically significant relationship was found between the variable "intraoperative complication" and the variables "previous surgery", "combined keratoplasty and cataract extraction" and "corneal host button greater than 8.0 mm". CONCLUSION: identifying the main intraoperative complications of keratoplasty enables nurses to understand which factors may interfere with these procedures, point out possible predictors of complications, and seek control measures so that such complications do not occur.


Assuntos
Complicações Intraoperatórias/etiologia , Ceratoplastia Penetrante/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Córnea/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Adulto Jovem
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