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ABSTRACT: To describe a technique for the fixation of intraocular lenses or capsular tension rings through the ciliary sulcus or pars plana.
This alternative technique allows burial of the knot and the free suture ends within the sclera, without using a scleral flap or pocket or even a conjunctival opening.
No suture exposure has occurred with the use of the suture burial technique in approximately 25 eyes in 4 years. Additional benefits include less patient discomfort and an improved anatomic and cosmetic outcome starting from the first postoperative day.
This technique causes minimal tissue damage and scarring with almost no postoperative discomfort.
Journal of refractive surgery (Thorofare, N.J.: 1995) 03/2013; 29(3):220-3. · 2.54 Impact Factor
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ABSTRACT: To compare the visual and refractive results in eyes with advanced keratoconus having deep anterior lamellar keratoplasty (DALK) with those having intrastromal corneal ring segment (ICRS) implantation.
Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
Comparative case series.
Records of advanced keratoconus patients with a clear central cornea and contact lens intolerance who had DALK or ICRS implantation were reviewed. Preoperatively and after 24 months, the uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and Orbscan II keratometry (K) readings in the 2 groups were comparable.
The DALK group comprised 36 eyes and the ICRS group, 30 eyes. Both groups had a statistically significant increase in UDVA and CDVA from preoperatively to 24 months postoperatively (P<.001). The DALK group had a statistically significantly greater improvement in UDVA and CDVA than the ICRS group 24 months postoperatively (P<.001). The improvement in spherical equivalent (SE) refractive error, manifest sphere, and manifest cylinder was statistically significant in both groups (P<.001). The mean reduction in SE and manifest cylinder were significantly greater in the DALK group (P<.05). The postoperative reduction in the maximum and minimum K values was statistically significant in both groups (P<.001); the mean reduction in K values was significantly greater in the DALK group (P<.001).
Although DALK provided greater improvement in visual acuity and refractive errors in advanced keratoconus cases, ICRS implantation may be an alternative treatment with satisfactory outcomes and less visual impact.
Journal of cataract and refractive surgery 02/2012; 38(2):324-32. · 2.75 Impact Factor
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ABSTRACT: To evaluate the safety, efficacy and potential risks of Artiflex foldable iris-fixated phakic intraocular lens (pIOL) implantation for the management of myopia.
Seventy-eight eyes of 40 consecutive patients with a mean spherical refraction of -11.70 ± 3.77 diopters (D; range -5.50 to -17.5 D) were included in this prospective, noncomparative, interventional case series. Main parameters assessed were uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography (Orbscan II, BauchandLomb, Rochester, NY, USA), manifest and cycloplegic refractive errors, endothelial cell density (ECD) and applanation tonometry.
After 2 years, BSCVA was 20/40 or better in 82% of the eyes and UCVA was 20/40 or better in 84% of the eyes. After 1 month, 1 year, and 2 years, 51.3% (37 of 72 eyes), 58.9% (46 of 78 eyes) and 76.0% (38 of 50 eyes) of eyes gained 1 line or more of BSCVA, respectively. Compared to preoperative values, the mean endothelial cell loss was 2.6% at 1 month, 4.9% at 1 year and 7.4% at 2 years. Pigmented or non-pigmented precipitates were observed in 17 eyes (21.7%) which were treated with topical corticosteroids. At the second postoperative year, pigmented precipitates persisted in nine eyes. However, this was not associated with a loss of BSCVA.
The implantation of Artiflex pIOL is an effective surgical option for the management of high myopia. The most common complication observed within 2 years of follow-up was accumulation of pigmented precipitates with no effect on the final BSCVA.
Indian Journal of Ophthalmology 01/2012; 60(1):23-8. · 1.02 Impact Factor
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ABSTRACT: To compare the status of corneal endothelium and central corneal thickness within the first four postoperative years after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus.
Thirty-nine eyes (Group A) which had PK and 44 eyes (Group B) which had DALK for the treatment of keratoconus were included in this retrospective study. The endothelial cell density (ECD), the mean endothelial cell area and the coefficient of variation of cell area were assessed with a non-contact specular microscope, and the central corneal thickness (CCT) was measured with an ultrasound pachymeter.
Mean ECD loss rate at two years was 36.24% in Group A and 18.12% in Group B (P<0.001). Mean ECD loss rate at four years was 47.82% in Group A and 21.62% in Group B (P<0.001). Mean annual ECD loss rate was calculated 14.12% per year in Group A and 5.78% per year in Group B. In the PK group, increase in mean CCT was 15.60% in two years and 15.03% in four years, while in the DALK group, mean CCT increased by 8.05% in two years and 9.31% in four years.
As the majority of ectatic disorders such as keratoconus occur in young people, long-term endothelial cell survival following treatment with keratoplasty is essential for the long-term visual ability. Our finding that corneal endothelial cell loss in the DALK group occurs at a slower rate than in the PK group suggests DALK as a safer alternative to PK in these selected patients.
Indian Journal of Ophthalmology 01/2012; 60(1):35-40. · 1.02 Impact Factor
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ABSTRACT: The aim of this study was to assess changes in macular thickness by means of optical coherence tomography after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) for keratoconus.
This prospective study comprised 60 eyes of 60 patients who had keratoplasty for the treatment of keratoconus. Eyes were divided into 2 groups according to the keratoplastic technique applied: PKP group and DALK group. Measurements of central macular thickness were performed preoperatively and 1, 3, and 6 months after surgery.
The final analysis included 33 eyes in the PKP group and 24 eyes in the DALK group. In the PKP group, the central macula was found to be 6.5%, 6.3%, and 4.5% thicker in the first, third, and sixth month, respectively. Similarly, the central macula was 5.6%, 5.4%, and 2.9% thicker at months 1, 3, and 6 in the DALK group. The 2 groups did not differ significantly in terms of macular thickening. The percentage of eyes showing more than 10% increase in the macular region at any time during the follow-up period was 43.2% in the PKP group and 50.0% in the DALK group (P = 0.614). The percentage of eyes found to have a central macular thickness more than 250 μm at any time during the follow-up period was 10.8% in the PKP group and 18.2% in the DALK group (P = 0.424).
The study showed that DALK, although it is a closed-system technique, has a similar impact on the macula compared with PKP.
Cornea 12/2011; 30(12):1318-21. · 1.73 Impact Factor
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ABSTRACT: To provide an overview of the visual outcomes after pediatric refractive surgery in anisometropic amblyopia and to analyze the relationship of these outcomes with age and type of refractive surgery.
Systematic searches in PubMed, Embase, and Web of Science databases without data restrictions and a search by surveillance of the literature regarding pediatric refractive surgery were performed. Only studies reporting individual data of pediatric cases (age 1 to 17 years) undergoing photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), and LASIK were included. A total of 15 articles including data from a total of 213 amblyopic eyes were considered: LASIK in 95 eyes and surface ablation in 118 eyes. Changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) were investigated as well as their relation with age and ablation type.
A significant increase in logMAR UDVA and CDVA was found in the overall sample of amblyopic eyes after surgery (P<.001). A significant correlation was found between age and preoperative CDVA (r=0.34, P<.001) as well as between age and the change in CDVA after surgery (r=-0.38, P<.001). The change in UDVA was significantly superior for eyes undergoing surface ablation compared to those undergoing LASIK (P=.04). Corneal haze was the predominant complication, which was reported in 5.3% of LASIK cases and 8.5% of surface ablation cases.
Laser refractive surgery is an effective option for improving the visual acuity in children with an amblyopic eye in association with anisometropia.
Journal of refractive surgery (Thorofare, N.J.: 1995) 05/2011; 27(5):364-74. · 2.54 Impact Factor
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ABSTRACT: To compare astigmatic keratotomy (AK) outcomes in high astigmatism after deep anterior lamellar keratoplasty (DALK) and after penetrating keratoplasty (PK) in keratoconus patients.
Prospective, comparative, interventional case series.
This study comprised 20 eyes that underwent DALK and 24 eyes that underwent PK. After suture removal, all eyes had more than 5 diopters (D) of astigmatism and underwent standard manual 1-pair, 90-degree, and 90% corneal thickness AK incisions. The main outcome measures included preoperative and postoperative manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity, surgically induced astigmatism, Orbscan II (Bausch & Lomb) corneal topography results, keratometric astigmatism, and complications.
All eyes completed 6 months of follow-up. The overcorrection rate was 35% and 41.6% in the DALK and PK groups, respectively (P=.75). At 6 months after AK, logarithm of the minimal angle of resolution uncorrected visual acuity improved from 0.88 ± 0.20 to 0.54 ± 0.26 and from 1.0 ± 0.34 to 0.53 ± 0.26 in the DALK and PK groups, respectively (P=.01 to P<.01). Best spectacle-corrected visual acuity improved from 0.16 ± 0.09 to 0.13 ± 0.08 and from 0.16 ± 0.12 to 0.11 ± 0.08 in the DALK and PK groups, respectively (P=.13 to P=.01). The mean refractive cylinder was decreased 2.74 ± 1.44 D in the DALK group and 3.18 ± 2.96 D in the PK group (P=.35). Surgically induced astigmatism was 6.10 ± 3.27 D in the DALK group and 7.15 ± 2.98 D in the PK group (P=.36).
The manual AK for the treatment of postkeratoplasty astigmatism after DALK and PK in keratoconus patients is a safe and effective surgical procedure, allowing similar refractive cylinder reduction and improvement in uncorrected visual acuity and best spectacle-corrected visual acuity.
American journal of ophthalmology 02/2011; 151(4):637-643.e1. · 3.83 Impact Factor
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ABSTRACT: To evaluate the safety and efficacy of intrastromal corneal ring segment implantation using both mechanical and femtosecond-assisted tunnel creation for the treatment of patients with keratoconus.
A retrospective noncomparative interventional study including 96 eyes of 75 patients with keratoconus. All patients had contact lens intolerance and clear central corneas. Corneal tunnels were made using a femtosecond laser in 26 eyes (femtosecond group) and mechanically in 70 eyes (mechanical group). The Keraring (Mediphacos, Belo Horizonte, Brazil) was implanted in each eye, and a complete ophthalmic examination was performed, including visual acuity, refraction, and keratometric readings.
The mean preoperative uncorrected visual acuity for all eyes was 1.40 ± 0.39 logarithm of the minimal angle of resolution (logMAR) (mean ± SD) and improved to 0.60 ± 0.34 logMAR at the sixth month (n = 96, P < 0.001) and 0.50 ± 0.32 (n = 54, P < 0.001) at the 18th month. The mean preoperative best spectacle-corrected visual acuity (BSCVA) for all eyes (n = 96) was 0.68 ± 0.36 logMAR. The mean BSCVA was 0.29 ± 0.21 (n = 96, P < 0.001) at the sixth month and improved to 0.26 ± 0.20 (n = 54, P < 0.001) at the 18th month. There was a significant reduction in spherical equivalent refractive error from -5.88 ± 3.65 diopters (D) (n = 96) to -2.26 ± 1.98 D (n = 54, P < 0.001) at the 18th month. The mean preoperative maximum keratometry (Kmax) was 53.58 ± 5.90 D and decreased to 49.02 ± 4.70 (n = 96, P < 0.001) at 6 months and 48.57 ± 4.36 D (n = 54, P < 0.001) at the 18th month. Sixth month results of the mechanical versus femtosecond groups were as follows: improvement in uncorrected visual acuity (2.08 vs. 1.50 lines), improvement in BSCVA (2.93 vs. 2.19), reduction in spherical equivalent (3.78 vs. 3.75 D), and reduction in maximum keratometry (4.66 vs. 4.62 D). There was no statistically significant difference between both groups for any parameter.
Keraring implantation is effective for the treatment of keratoconus, providing safety and good visual outcomes after both mechanical and femtosecond-assisted tunnel creation.
Cornea 01/2011; 30(1):11-7. · 1.73 Impact Factor
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ABSTRACT: To compare the outcomes of mechanical and femtosecond laser-assisted tunnel creation for intrastromal corneal ring segment (ICRS) implantation in eyes with keratoconus.
Kartal Training and Research Hospital, Istanbul, Turkey.
In this prospective study, consecutive eyes with keratoconus were randomly assigned to have ICRS tunnel creation with a mechanical device or a femtosecond laser. Keraring ICRS with a 5.0 mm diameter and 160-degree arc length were implanted in all cases. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and keratometry (K) readings were measured preoperatively and 1 year postoperatively, and the data in the mechanical group and the femtosecond group were compared statistically.
One year postoperatively, there was significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder in both groups (P<.05). The UDVA improved by 2.4 lines in the mechanical group and 2.0 lines in the femtosecond group and the CDVA by 3.3 lines and 2.7 lines, respectively; the mean reduction in maximum keratometry was 4.50 diopters (D) and 4.70 D, respectively, and the mean reduction in SE, 3.18 D and 3.09 D, respectively. There were no statistically significant differences between the 2 groups in visual or refractive results (P>.05). Anterior corneal perforation, superficial segment placement, and segment extrusion occurred in 1 eye each in the mechanical group. Segment migration occurred in 1 eye in the femtosecond group.
Despite intraoperative complications in the mechanical group, the visual and refractive outcomes were similar to those in the femtosecond group.
Journal of cataract and refractive surgery 09/2010; 36(9):1556-61. · 2.75 Impact Factor
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ABSTRACT: To determine the visual and refractive outcomes of 210-degree arc length intrastromal corneal ring segment (ICRS) implantation in eyes with pellucid marginal corneal degeneration (PMCD).
Retrospective, consecutive case series.
Sixteen consecutive eyes of 10 patients who underwent a single 210-degree ICRS implantation by femtosecond laser for the management of PMCD and completed at least 1 year follow-up were included. A complete ophthalmic examination was performed preoperatively and postoperatively, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest spherical and cylindrical refractions, spherical equivalent, and keratometric readings.
The mean follow-up period was 30.7 months (range 12 to 36 months). No intraoperative complication was observed. White deposits around the segments were noted in 2 of 16 eyes (12.5%) at the first postoperative year. The mean UCVA showed significant improvement, from 1.69 +/- 1.02 logarithm of the minimal angle of resolution (logMAR) preoperatively to 0.64 +/- 0.43 logMAR at the 36th month (n = 11, P < .001). The mean preoperative BSCVA was 0.88 +/- 0.68 logMAR; after 36 months, this improved to 0.35 +/- 0.34 (P < .001). At the 36th month, UCVA was improved in all eyes (n = 11, range: gain of 1 to 6 lines), whereas BSCVA was improved in 9 eyes (81.8%, range: gain of 2 to 7 lines) and remained unchanged in 2 eyes (18.1%); UCVA was 20/40 or better in 3 eyes (27%) and BSCVA was 20/40 or better in 8 eyes (72.7%). There was a significant reduction in the spherical equivalent refractive error, from -4.40 +/- 1.85 diopters (D) preoperatively to -1.86 +/- 0.60 D (P < .001), and the mean maximum keratometric power decreased from 49.70 +/- 4.32 D to 46.08 +/- 2.84 D (P < .001) after 36 months. The mean cylindrical refraction decreased from -4.39 +/- 1.86 D preoperatively to -2.38 +/- 1.35 D at 36 months (P < .001).
A single 210-degree arc length ICRS implantation using a femtosecond laser for patients with PMCD provides good visual and refractive outcomes.
American journal of ophthalmology 08/2010; 150(2):185-192.e1. · 3.83 Impact Factor
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ABSTRACT: To compare the outcomes of implantation of 2 models of intrastromal corneal ring segments (ICRS) to manage keratoconus.
Kartal Training and Research Hospital, Istanbul, Turkey.
This study evaluated eyes with keratoconus that had implantation of Keraring ICRS (Group A) or Intacs ICRS (Group B). The corneal tunnels were created mechanically or with a femtosecond laser. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, keratometry (K) readings (Orbscan II), and complications in the 2 groups were compared.
Group A comprised 100 eyes and Group B, 68 eyes. The postoperative increase in UDVA and CDVA was statistically significant in both groups (P<.05). Group A had greater improvement in CDVA than Group B at 6 months and 1 year (both P<.001). At 1 year, the decrease in the mean maximum K power was statistically significant in Group A (51.27 diopters [D] +/- 4.46 [SD] to 47.87 +/- 3.39 D) and in Group B (51.12 +/- 4.54 D to 47.58 +/- 3.66 D) (P<.05). The mean reduction in maximum K was statistically significantly greater in Group A at 6 months and 1 year (P = .018 and P = .024, respectively). There were no statistically significant differences in visual or refractive results between femtosecond laser and mechanical tunnel creation.
Although both ICRS models were effective and safe in managing keratoconus, the Keraring ICRS led to more improvement in CDVA and UDVA and a greater reduction in the maximum K value.
Journal of cataract and refractive surgery 06/2010; 36(6):978-85. · 2.75 Impact Factor
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ABSTRACT: The aim was to evaluate visual and refractive results and complications of intraocular lens (IOL) exchange through a 3.2 mm corneal incision for opacified IOLs.
This retrospective study comprised 33 eyes of 32 patients with IOL opacification requiring an IOL exchange between July 2003 and March 2007. Exchange surgery was performed through a 3.2-mm temporal clear corneal incision followed by implantation of a new foldable hydrophobic IOL. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), topographical astigmatism, and refractive cylinder were evaluated. Surgically induced astigmatism (SIA) was calculated and complications were recorded.
Opacification was observed in 25 eyes (76%) with Aqua-Sense, 3 eyes (9%) with Hydroview, 3 eyes (9%) with MemoryLens IOLs, and 2 eyes (6%) with DgR. The mean follow-up period was 36.54 months. An uneventful IOL exchange was achieved in 18 eyes (55%). Zonular dehiscence occurred in 9 eyes (27%), and posterior capsule tear developed in 4 eyes (12%). The mean preoperative BSCVA (mean ± standard deviation, decimal scale) was 0.13 ± 0.08 (mean: 20/150, range 20/2000 to 20/60) and improved to 0.63 ± 0.18 (mean: 20/32, range 20/60 to 20/20, P < 0.001). The mean SIA was 0.70 D. Seven eyes (21%) had 0.5 D or lower SIA.
IOL exchange is a technically challenging procedure with potential risks of reversing the advantages of a prior small-incision cataract surgery. The use of a small corneal incision for IOL exchange could preserve the advantages of modern phacoemulsification surgery with acceptable SIA related to the procedure.
Indian Journal of Ophthalmology 59(1):17-21. · 1.02 Impact Factor
