AIM: To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty(DSAEK) performed in phakic eyes. METHODS: A ...AIM: To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty(DSAEK) performed in phakic eyes. METHODS: A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o'clock positions, superiorly to the 10 and 2 o'clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.RESULTS: The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4 mo or less postoperatively was identified in 2 of 49(4%) eyes in the study group and 7 of 35(20%) eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group(P=0.03, RR=4.9, 95%CI 1.08-22.1).CONCLUSION: Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.展开更多
AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty(DSAEK) combined with artisan aphakia intraocular lens(IOL) implantation in severely damaged eyes without ca...AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty(DSAEK) combined with artisan aphakia intraocular lens(IOL) implantation in severely damaged eyes without capsular support.METHODS: DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure(IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity(BCVA), IOP and mean central endothelial cell density(ECD) were recorded.RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5(17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes(6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6 mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm^2 at 6 mo, and the rate of the donor cell loss was 34.7%.CONCLUSION: DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.展开更多
AIM: To determine the incidence of cystoid macular edema(CME) after Descemet's stripping automated endothelial keratoplasty(DSAEK).METHODS: This study included all consecutive patients operated in a Spanish ter...AIM: To determine the incidence of cystoid macular edema(CME) after Descemet's stripping automated endothelial keratoplasty(DSAEK).METHODS: This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS: Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone(7%; 3/41) and the other three, DSAEK combined with phacoemulsification(21%; 3/14). Five out of six patients with CME responded to standard therapy.CONCLUSION: CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber(PC) intraocular lens(IOL) implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.展开更多
Background:To compare the visual outcome and patients’satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty(UT-DSAEK)and Descemet membrane endothelial keratoplasty(DMEK)performed on fello...Background:To compare the visual outcome and patients’satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty(UT-DSAEK)and Descemet membrane endothelial keratoplasty(DMEK)performed on fellow eyes of the same patients.Methods:In this retrospective study,the records of 18 pseudophakic patients affected by Fuchs endothelial dystrophy who underwent DMEK in one eye and UT-DSAEK in the fellow eye were reviewed.Best corrected visual acuity(BCVA),corneal pachymetry,keratometry,corneal aberrations,photopic and mesopic contrast sensitivity,and endothelial cell counts measured 12 months after surgery in either eye were analyzed and compared.The results of a satisfaction questionnaire were also reviewed.Results:Twelve months after surgery,BCVA was not significantly different in UT-DSAEK and DMEK eyes(0.10±0.04 and 0.07±0.07 logMAR,respectively);at both 4-and 6 mm optical zones total and posterior corneal higher order aberrations(HOAs),posterior astigmatism and total coma were significantly lower after DMEK;BCVA in both groups was significantly correlated mainly with anterior corneal aberrations;contrast sensitivity was higher after DMEK especially in mesopic conditions and at medium spatial frequencies;the endothelial cell density was similar,although slightly higher in the UT-DSAEK group(p=0.10).The satisfaction questionnaire showed that although patients were highly satisfied from both procedures,more than half of them preferred DMEK and reported a more comfortable and quicker postoperative recovery.Conclusions:DMEK and UT-DSAEK showed no evidence of difference in terms of postoperative BCVA,although DMEK had a better performance in terms of contrast sensitivity,posterior corneal aberrations and overall patient satisfaction.展开更多
文摘AIM: To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty(DSAEK) performed in phakic eyes. METHODS: A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o'clock positions, superiorly to the 10 and 2 o'clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.RESULTS: The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4 mo or less postoperatively was identified in 2 of 49(4%) eyes in the study group and 7 of 35(20%) eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group(P=0.03, RR=4.9, 95%CI 1.08-22.1).CONCLUSION: Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.
基金Supported by the National Natural Science Foundation of China(No.30871315No.31140025No.31271045)
文摘AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty(DSAEK) combined with artisan aphakia intraocular lens(IOL) implantation in severely damaged eyes without capsular support.METHODS: DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure(IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity(BCVA), IOP and mean central endothelial cell density(ECD) were recorded.RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5(17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes(6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6 mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm^2 at 6 mo, and the rate of the donor cell loss was 34.7%.CONCLUSION: DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.
文摘AIM: To determine the incidence of cystoid macular edema(CME) after Descemet's stripping automated endothelial keratoplasty(DSAEK).METHODS: This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS: Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone(7%; 3/41) and the other three, DSAEK combined with phacoemulsification(21%; 3/14). Five out of six patients with CME responded to standard therapy.CONCLUSION: CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber(PC) intraocular lens(IOL) implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.
文摘Background:To compare the visual outcome and patients’satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty(UT-DSAEK)and Descemet membrane endothelial keratoplasty(DMEK)performed on fellow eyes of the same patients.Methods:In this retrospective study,the records of 18 pseudophakic patients affected by Fuchs endothelial dystrophy who underwent DMEK in one eye and UT-DSAEK in the fellow eye were reviewed.Best corrected visual acuity(BCVA),corneal pachymetry,keratometry,corneal aberrations,photopic and mesopic contrast sensitivity,and endothelial cell counts measured 12 months after surgery in either eye were analyzed and compared.The results of a satisfaction questionnaire were also reviewed.Results:Twelve months after surgery,BCVA was not significantly different in UT-DSAEK and DMEK eyes(0.10±0.04 and 0.07±0.07 logMAR,respectively);at both 4-and 6 mm optical zones total and posterior corneal higher order aberrations(HOAs),posterior astigmatism and total coma were significantly lower after DMEK;BCVA in both groups was significantly correlated mainly with anterior corneal aberrations;contrast sensitivity was higher after DMEK especially in mesopic conditions and at medium spatial frequencies;the endothelial cell density was similar,although slightly higher in the UT-DSAEK group(p=0.10).The satisfaction questionnaire showed that although patients were highly satisfied from both procedures,more than half of them preferred DMEK and reported a more comfortable and quicker postoperative recovery.Conclusions:DMEK and UT-DSAEK showed no evidence of difference in terms of postoperative BCVA,although DMEK had a better performance in terms of contrast sensitivity,posterior corneal aberrations and overall patient satisfaction.