[Preliminary study of Boston keratoprosthesis in treatment of severe late stage ocular chemical burns].

OBJECTIVE: To evaluate preliminary clinical outcome of Boston type I keratoprosthesis in ocular chemical burn patients. METHODS: Six keratoprosthesis were implanted into 6 patients of bilateral blindness. Visual acuity in these patients before the operation was light perception and all of them were unsuitable for standard penetrating corneal transplantation. The causes for corneal opacity were alkali burn in 2, sulfate acid burn in 3 and ethanol injury in 1 patient. Shirmer's test revealed severe dry eye in 3 patients, only one eye had normal lacrimal secretion. All patients were male, with follow-up period ranged from 17 to 26 months (mean 24 months). RESULTS: The postoperative visual acuity ranged from 0.05 to 0.5, 5 of them was better than 0.1. The retention rate within the follow-up period was 100%. Intraocular pressure was in normal limit, no retinal detachment was detected by type B ultrasonic examination. Postoperatively, retro-keratoprosthestic membrane occurred in 2 cases and was treated with YAG laser membranectomy, one eye complicated with elevated intraocular pressure and treated with shunt implantation. CONCLUSION: The Boston type 1 keratoprosthesis is a viable option for patients with obsolete chemical burns.

[The effects of transplantation of compound keratoprosthesis in clinical practice and managements of complications after operation].

OBJECTIVE: To explore the clinical value and management of complications of the transplantation of Titanium skirt compounded keratoprosthesis for severe corneal blindness eyes. METHODS: It was a retrospective case series study. Nine eyes from 9 male patients, aged 28 to 52 years old, accepted permanent keratoprosthesis transplantation in Zhongshan Ophthalmic Center from March 2002 to June 2005. All patients had corneal lesion in both eyes for 1.5 to 5.0 years. Among the 9 treated eyes, 6 eyes was severe vascularization after alkali burns, 3 eyes explosive injuries. Light perception was remained in all patients before surgery, however, 2 eyes only had a questionable orientation of light perception among them. Surgical management was divided into two stages. In the first stage, transplantation of Titanium skirt compound keratoprosthesis was performed, and the explant was reinforced by the self auricular cartilage and Tendons capsule. The second stage of surgery was performed in 5 to 6 months later, in which the membrane in the front of keratoprosthesis was cut. After the surgery, visual acuity, visual field, intraocular pressure and retina were examined. The complications were noticed and managed. RESULTS: All treated eyes were followed up for 1 to 3 years. After the treatment, 7 eyes divorced from blindness with uncorrected visual acuity 20/200 (0.1), and 2 eyes among them got corrected visual acuity 20/30 (0.6). Two eyes with the questionable orientation of light perception before treatment gained uncorrected visual acuity 4/200 (0.02) and 8/200 (0.04) after treatment respectively. Complications were found to include 5 recurrent frontal membrane of keratoprosthesis, one back membrane of keratoprosthesis, and one limited corneal melting. Complications were controlled by the corresponding treatments, such as membrane resection for the recurrent frontal membrane of keratoprosthesis, courage under microscope for back membrane of keratoprosthesis, and reinforcement of acellular dermis for corneal melting. All keratoprosthesis were maintained in situ, and no rejection and leakage of aqueous humor happened. CONCLUSIONS: It is effective to use transplantation of keratoprosthesis for the severe corneal blindness eyes. Combination with self auricular cartilage and Tendons capsular reinforcement may reduce the complications and improve the biocompatibility of keratoprosthesis.

[Preliminary outcome of large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty for whole cornea destruction].

OBJECTIVE: To understand the indication, surgical principle, outcome and complications of large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty for whole cornea destruction. METHODS: Eleven hospitalized patients with whole cornea destruction in Zhongshan Ophthalmic Center, Sun Yat-Sen University from May, 2005 to March, 2006 were involved in this study. Five left eyes and six right eyes underwent large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty. The patients were followed up for 12 to 18 months and their pinhole postoperative visual acuity, intraocular pressure, pachymetry of the central cornea and corneal endothelial cell density was recorded. RESULTS: The pinhole postoperative visual acuity of all patients improved and averaged separately 4.4 +/- 0.3, 4.5 +/- 0.3 and 4.5 +/- 0.3 at the 3rd, 6th and 12th postoperative month. There was a temporary increase of the postoperative intraocular pressure within one postoperative week which can be controlled by medication and released soon. And the postoperative intraocular pressure averaged (19.8 +/- 2.7), (19.2 +/- 1.7) and (19.5 +/- 2.0) mm Hg respectively at the 3rd, 6th and 12th month postoperatively. At the same following up times, the pachymetry of the central cornea averaged (538.9 +/- 8.9), (536.3 +/- 6.3) and (537.2 +/- 6.9) microm respectively and the corneal endothelial cell density averaged (2519.8 +/- 110.7), (2244.4 +/- 137.9) and (2093.3 +/- 141.9) cells/mm2 respectively. The main complication was the interspace between the two lamellar grafts and it would disappear automatically within one postoperative month. CONCLUSIONS: Large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty can avoid postoperative glaucoma. It may offer further advantages over traditional surgery to treat whole cornea destruction.

[Preliminary clinical study of sutureless, small-incision deep lamellar endothelial keratoplasty surgery].

OBJECTIVE: To investigate the surgical procedure, clinical efficacy, and the prevention and management of complications of sutureless, small-incision deep lamellar endothelial keratoplasty (DLEK). METHODS: Nine patients (nine eyes) with bullous keratopathy underwent sutureless, small-incision DLEK surgery, six of them was combined with anterior vitrectomy. Visual acuity, graft clearance, corneal curvature, astigmatism and endothelial cell density (ECD) were observed over a 3 - 5 month follow-up period. RESULTS: All grafts remained transparent, and six eyes had improved visual acuity. After the surgery, mean corneal curvature was (43.96 +/- 3.38) D. Mean corneal astigmatism was (3.32 +/- 1.20) diopter (D). Mean ECD was (2124 +/- 278) cells/mm(2). No severe complications occurred. CONCLUSION: Sutureless, small-incision DLEK, as compared with penetrating keratoplasty (PKP) and microkeratome-associated deep lamellar endothelial keratoplasty, has more advantages and is expected to be the initial surgical treatment for bullous keratopathy.

[Microkeratome-assisted deep lamellar endothelial keratoplasty].

OBJECTIVE: To observe the indication, surgical principle, clinical results and complications of microkeratome-assisted deep lamellar endothelial keratoplasty (DLEK). METHODS: DLEK was performed in six patients with bullous keratopathy. One of the six patients underwent DLEK combined with vitrectomy under temporary artificial corneal and intraocular foreign-body removal. Another underwent DLEK combined with vitrectomy and posterior chamber intraocular lens implantation. The patients were followed up for 6 approximately 9 months. RESULTS: The postoperative best-corrected visual acuity showed clear improvement in 5 cases. Endothelial cell density averaged (2481 +/- 212) cells/mm(2). Pachymetry averaged (549 +/- 61) micro m. Astigmatism averaged (2.04 +/- 1.19) D. No serious complication was found. CONCLUSION: DLEK is an alternative choice for PKP. It may offer further advantages over conventional PKP surgery, and could serve as a surgical technique in endothelial keratoplasty. A long-term follow-up in a larger patient population is needed to confirm our initial results.

Method of bubble under water capsulorhexis in small incision used in mature cataract operation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe application of underwater bubble method capsulorhexis overmature period to improve the small incision cataract surgery, so as to explore the clinical value of the surgical method. ● METHODS: From Jul. 2012 to Mar. 2016 at the grassroots of blindness 58 people fail in the 66 eyes overmature period of cataract were randomly divided into underwent capsulorhexis by underwater bubble method to improve the small incision cataract surgery group ( 36 eyes of 30 cases ) and conventional viscoelastic agent underwent capsulorhexis small incision cataract surgery group (30 eyes of 28 cases). ● RESULTS: A total of 66 eyes in success rate of continuous circular capsulorhexis: 92% ( 33/36 eyes ) of underwater bubble method, method of viscoelastic agent only 40% ( 12/30 eyes ) . Two groups of cases of postoperative corneal endothelial cell density are compared with preoperative significantly reduced, no significant statistical difference between the two groups(P>0. 05). ● CONCLUSION: Underwater bubble method capsulorhexis difficult to overmature period of cataract surgery capsulorhexis solution is a better way.

Out-of-the-bag intraocular lens dislocation: outcomes of posterior chamber intraocular lens exchange, risk factors, and prevention.

BACKGROUND: Dislocation of posterior chamber intraocular lens is one of the most common complications of intraocular lens implantation. Lens exchange is an effective solution to this unsatisfactory status. This study was conducted to analyze the possible predisposing factors for out-of-the-bag posterior chamber intraocular lens dislocation and to study the outcomes of lens exchange surgery. METHODS: Thirty-six consecutive patients (36 eyes) with out-of-the-bag intraocular lens dislocation who underwent posterior chamber intraocular lens exchange in Zhongshan Ophthalmic Center of Sun Yat-sen University (Guangdong, China) from January 2003 to October 2009 were included. A 6-month follow-up was completed. The causes for out-of-the-bag intraocular lens dislocation and visual outcomes of posterior chamber intraocular lens exchange were analyzed. The out-of-the-bag intraocular lens dislocation was diagnosed on the basis of the findings from slit-lamp microscope and B-ultrasound. The dislocated intraocular lens was explanted. Reimplantation of a new posterior chamber intraocular lens was performed in each case using standardized surgical procedures. RESULTS: In this study, a total of thirty-six consecutive patients (36 eyes) with out-of-the-bag intraocular lens dislocation underwent posterior chamber intraocular lens exchange surgery. Causes for out-of-the-bag intraocular lens dislocation included posterior capsule rupture during the initial cataract extraction procedure (23 eyes, 63.8%), trauma (5 eyes, 13.9%),neodymium-doped yttrium aluminium garnet (Nd:YAG) laser-induced dislocation (2 eyes, 5.6%), the status after vitrectomy (2 eyes, 5.6%) and unidentifiable etiology (4 eyes, 11.1%). Symptoms of these patients mainly included decrease in visual acuity (17 cases, 47.2%), blurred vision (16 cases, 44.4%), glare (1 case, 2.8%), diplopia (1 case, 2.8%), and halo (1 case, 2.8%). Intraocular lens dislocation into the posterior vitreous cavity (29 eyes, 80.5%), anterior chamber (1 eye, 2.8%) and anterior vitreous cavity (6 eyes, 16.7%) was found in this series. The foldable intraocular lenses (acrylic or silicone) were explanted from 27 eyes (75%) and rigid intraocular lenses (poly methyl methacrylate, PMMA) from 9 eyes (25%). The most common explanted intraocular lens material was single-piece acrylic (13 pieces, 36.1%), followed by 3-piece acrylic (9 pieces, 25%), single-piece PMMA (9 pieces, 25%), and 3-piece silicone (5 pieces, 13.9%). Uncorrected visual acuity postoperatively improved in 29 eyes (81%), unchanged in 4 eyes (11%), and worsened in 3 eyes (8%) in comparison to that before exchange operation (P = 0.006). Best corrected visual acuity tended to improve, but the improvement was not significant (P = 0.206). Complications related to lens exchange surgery were mainly intraocular lens redislocation (1 eye), retinal detachment (1 eye), vitreous hemorrhage (1 eye), and cystoid macular edema (1 eye). CONCLUSIONS: Out-of-the-bag intraocular lens dislocation was mainly caused by posterior capsule rupture during the initial cataract extraction procedure and the foldable lens was the most common dislocated intraocular lens. In most cases, posterior chamber intraocular lens exchange surgery could provide satisfied final visual outcomes.