Publications (62)142.83 Total impact
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Article: Femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty.
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ABSTRACT: To review patient outcomes after femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty. Seven eyes of seven patients with a mean age of 30 years underwent femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty from April 2008 to September 2008. Patients had keratoconus, corneal ectasia or scarring. Set for 100 mum of residual cornea, the femtosecond laser was used to create a mushroom-shaped recipient bed and donor button (having a larger anterior than posterior diameter). The posterior central lamella was manually dissected using Melles technique. Mean follow up was 4 months (range, 3-6.5 months). Preoperative mean best-corrected visual acuity was 20/95 (range, 20/40-20/400). Intraoperative complications included two cases (28.6%) of small Descemet membrane perforation. Postoperatively, there was one case of stromal rejection that resolved with topical steroids and two cases of steroid-related intraocular pressure rise that were treated with a prostaglandin analog. At 3 months, mean best-corrected visual acuity was 20/40 (range, 20/25-20/60), mean spherical equivalent refraction was -3.21 D (range, -6.75 D to plano), mean cylindrical refractive error was 3.57 D (range, 1.5-7 D), and mean keratometric cylinder measured 5.56 D (range, 3.79-7.00 D). Selective suture removal occurred in six patients (86%) at a mean of 3.8 months (range, 2-6 months) postoperatively. This preliminary series demonstrates that the use of the femtosecond laser to perform corneal cuts in a mushroom configuration for deep anterior lamellar keratoplasty is feasible. The mechanical stability and wound healing advantages for stepped corneal wounds should be considered in lamellar surgery.Cornea 03/2010; 29(3):290-5. · 1.73 Impact Factor -
Article: IntraLase-enabled astigmatic keratotomy for post-keratoplasty astigmatism: on-axis vector analysis.
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ABSTRACT: To determine the refractive predictability, stability, efficacy, and complication rate of femtosecond laser-enabled astigmatic keratotomy for post-keratoplasty astigmatism. A retrospective case series (pilot study). Thirty-seven eyes of 34 patients. All eyes underwent IntraLase-enabled astigmatic keratotomy for high astigmatism (>5 diopters [D]) after penetrating keratoplasty. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, higher-order aberrations, and complications. Mean follow-up was for 7.2 months. Uncorrected visual acuity improved from a mean of 1.08+/-0.34 logarithm of the minimum angle of resolution preoperatively to a mean of 0.80+/-0.42 postoperatively (P=0.0016). Best-corrected visual acuity improved from a mean of 0.45+/-0.27 preoperatively to 0.37+/-0.27 postoperatively (P=0.018). The defocus equivalent was significantly reduced by more than 1 D (P=0.025). The value of absolute astigmatism was reduced from 7.46+/-2.70 D preoperatively to 4.77+/-3.29 D postoperatively (P=0.0001). Higher-order aberrations were significantly increased. The efficacy index was 0.6+/-0.6. There were no cases of perforation, wound dehiscence, or infectious keratitis. Three eyes (8%) experienced an episode of graft rejection. Overcorrection occurred in 9 eyes (24%). IntraLase-enabled astigmatic keratotomy is an effective treatment for high astigmatism after penetrating keratoplasty with an encouraging refractive predictability. Future studies may help refine the treatment parameters required to achieve reduction of cylinder with greater accuracy.Ophthalmology 02/2010; 117(6):1228-1235.e1. · 5.45 Impact Factor -
Article: Deep lamellar endothelial keratoplasty: up to 5-year follow-up.
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ABSTRACT: To evaluate the outcomes of small-incision deep lamellar endothelial keratoplasty (DLEK) for the treatment of endothelial dysfunction at up to 5 years of follow-up. Prospective, noncomparative case series. Sixty eyes of 55 consecutive patients who had corneal edema as a result of Fuchs' dystrophy, pseudophakic bullous keratopathy, bullous keratopathy secondary to glaucoma tube placement, failed graft, or deep endothelial scar. Patients underwent DLEK surgery at the Toronto Western Hospital. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal endothelial cell density (ECD), and postoperative complications. Data were available for 57, 49, 46, 23, and 7 eyes for examination at 1, 2, 3, 4, and 5 years, respectively. The mean spherical equivalent and refractive astigmatism were -0.18+/-1.62 diopters (D) and 1.67+/-1.36 D, respectively, at 1 year after surgery and remained stable at 2, 3, and 4 years after DLEK. Eliminating eyes with known significant macular or optic nerve disease, BSCVA of 20/188.5 before surgery improved to 20/56.9 at 1 year after surgery (P = 0.0002) and remained stable with BSCVA of 20/52.3, 20/46.2, and 20/56.8 at 2, 3, and 4 years, respectively, (P = 0.59, P = 0.31, P = 0.24, respectively). The number of patients who achieved 20/40 or better visual acuity, increased from a preoperative level of 13.5% to 44.1%, to 40%, to 48.4%, and to 50% at 1, 2, 3, and 4 years after surgery, respectively. The mean donor ECD before surgery was 2762+/-536 cells/mm2 and decreased by 43% at 1 year after surgery (1604+/-787 cells/mm2; P<0.0001), an additional yearly decrease by 14% (1257+/- 684 cells/mm2; P = 0.03), by 4% (1136+/-613 cells/mm2; P = 0.41), and by 1% (1064+/-515 cells/mm2; P = 0.68) was found at 2, 3, and 4 years, respectively. Complications included 4 graft dislocations, 2 primary graft failures, 5 rejections, and 12 secondary failures, with 27.5% graft failure at 4 years. Small-incision DLEK provides good and stable refractive and visual outcomes. The accelerated endothelial cell loss reported during the first 2 years after DLEK was shown to decrease and stabilize at low rates during the longer-term follow-up, which reduces the concern about progressive cell loss and secondary late endothelial failure. The author(s) have no proprietary or commercial interest in any materials discussed in this article.Ophthalmology 02/2010; 117(4):680-6. · 5.45 Impact Factor -
Article: Newer surgical techniques in the management of keratoconus.
International ophthalmology clinics 01/2010; 50(3):77-88. -
Article: Intrastromal corneal ring segment SK implantation for moderate to severe keratoconus.
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ABSTRACT: To report the efficacy and safety of intrastromal corneal ring segment (ICRS) implantation using a femtosecond laser in the management of advanced keratoconus. Private laser center, Toronto, Ontario, Canada. In this retrospective nonrandomized study, Intacs SK ICRS were implanted using an IntraLase femtosecond laser in eyes with moderate to severe keratoconus. Evaluation included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, slitlamp examination, corneal topography, and wavefront analysis of higher-order aberrations. Postoperative visits were at 1, 7, and 30 days and 3 and 6 months. The study evaluated 10 eyes of 8 patients with a mean age of 28 years (range 21 to 42 years). The mean UDVA was significantly better 6 months postoperatively than preoperatively (0.66 logMAR +/- 0.21 [SD] versus 1.19 +/- 0.57 logMAR) (P = .004), as was the mean CDVA (0.25 +/- 0.15 logMAR versus 0.51 +/- 0.20 logMAR) (P = .018). The mean spherical equivalent refractive error was -8.08 diopters (D) preoperatively and -5.03 D at 6 months (P = .65); the mean refractive astigmatism, -5.05 D and -3.90 D, respectively (P = .22); and the mean simulated keratometry value, 57.94 D and 50.07 D, respectively (P = .15). The mean total aberration improved significantly, from 13.48 +/- 4.64 mum preoperatively to 9.42 +/- 1.80 mum postoperatively (P = .007). There were no complications. Implantation of ICRS for advanced keratoconus was safe and effective, leading to significant improvement in UDVA, CDVA, and total aberrations. No author has a financial or proprietary interest in any material or method mentioned.Journal of cataract and refractive surgery 01/2010; 36(1):110-3. · 2.75 Impact Factor -
Article: Reply:.
Cornea 01/2009; 27(10):1217. · 1.73 Impact Factor -
Article: Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial.
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ABSTRACT: To compare the degree of conjunctival autograft inflammation, subconjunctival haemorrhage (SCH) and graft stability following the use of sutures or fibrin glue (FG) during pterygium surgery. Prospective, observer masked, clinical trial. 40 eyes of 40 patients undergoing primary pterygium surgery with conjunctival autograft were allocated into two groups. Group 1 (n = 20) had FG (Tisseel) for attaching the conjunctival autograft, whereas group 2 (n = 20) had sutures. Standardised digital slit-lamp photographs were taken at 1 week, 1 month and 3 months postoperatively. Sutures were masked using commercially available photo-editing software. Two masked observers objectively graded the digital photographs for degree of inflammation, SCH and graft stability. 34 of the 40 patients completed the study. When using FG, the degree of inflammation was significantly less than with sutures at 1 month (p = 0.019) and 3 months (p = 0.001) postoperatively. No significant difference was found for inflammation at 1 week postoperatively (p = 0.518). Conjunctival grafts secured with FG were as stable as those secured with sutures (p = 0.258, p = 0.076 and p = 0.624, at 1 week, 1 month and 3 months, respectively). No significant difference was found in degree of postoperative SCH between the groups (p = 0.417, p = 1 and p = 1, at 1 week, 1 month and 3 months, respectively). This is the first prospective clinical trial confirming that conjunctival grafts secured with FG during pterygium surgery not only are as stable as those secured with sutures, but also produce significantly less inflammation.The British journal of ophthalmology 12/2008; 93(2):215-8. · 2.92 Impact Factor -
Article: Busin Guide vs Forceps for the Insertion of the Donor Lenticule in Descemet Stripping Automated Endothelial Keratoplasty.
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ABSTRACT: To compare two insertion methods in Descemet stripping automated endothelial keratoplasty (DSAEK): Busin guide-assisted vs Forceps-assisted insertion of the corneal lenticule graft. Prospective, consecutive, comparative, nonrandomized study. setting: Cornea clinic at the Toronto Western Hospital. study population: Sixty-three eyes of 63 consecutive patients were included. All patients underwent DSAEK for Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, failed graft, or iridocorneo endothelial syndrome. Twenty-six consecutive donor discs were inserted with the Busin guide and 37 consecutive eyes underwent forceps assisted insertion of the donor. main outcome measures: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal endothelial cell loss, and postoperative complications. Busin guide-assisted DSAEK group had significantly worse UCVA and lower donor endothelial cell counts preoperatively. No significant differences were noted in the intraoperative or postoperative complications. Six months following surgery, BCVA was not significantly different between groups: 20/37 in the Busin guide-assisted DASEK group vs 20/42 in the Forceps-assisted group (P = .39). Mean spherical equivalent was -0.02 diopters (D) and 0.82 D (P = .06), and mean refractive cylinder was 2.2 D and 1.31 D (P = .0006), respectively. Endothelial cell loss was significantly lower in the Busin guide-assisted DASEK group: 25% loss vs 34.3% loss in the Forceps-assisted DSAEK group. (P = .04). Although visual outcomes were not different between the groups studied, Busin guide-assisted DSAEK resulted in lower percentage of endothelial cell loss compared with forceps insertion, six months following surgery.American journal of ophthalmology 11/2008; 147(2):220-226.e1. · 3.83 Impact Factor -
Article: Femtosecond laser versus manual dissection for top hat penetrating keratoplasty.
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ABSTRACT: To compare the outcomes of IntraLase-enabled top hat penetrating keratoplasty (IEK) versus retrospective results of manual top hat penetrating keratoplasty (TH-PKP) and conventional PKP. Patients/methods: This non-randomised prospective study included 94 eyes: 23 eyes underwent IEK, 36 TH-PKP and 35 conventional PKP. Preoperative and postoperative manifest refraction, uncorrected and best-spectacle corrected visual acuity (BSCVA), high-order ocular aberrations (HOA), endothelial cell counts and complications were analysed. At 12 months of follow-up, the mean log MAR BSCVA was 0.32 (SD 0.31) in the IEK group, 0.53 (0.36) in the TH PKP group (p = 0.03) and 0.39 (0.30) in the conventional PKP group (p = 0.4). The mean spherical equivalent was similar between the groups and was less than -2.2 dioptres. The mean cylinder was similar in the IEK and conventional PKP group (3.6 (1.9) dioptres and 4.1 (1.8) dioptres, respectively), and was significantly lower than the TH-PKP group (5.1 (3.2) dioptres, p = 0.04). The complications rate and high-order ocular aberrations were similar between the three groups studied. The mean endothelial cell loss was significantly lower at 12 months of follow-up in the IEK and the TH-PKP groups versus conventional PKP (32.4% and 22.3% vs 40.8%, respectively) (p = 0.05). The mean time to suture removal was 4.1 (1.2) months in the IEK group and 3.9 (1.5) months in the TH-PKP group versus 9.7 (1.1) months in the conventional PKP group (p<0.0001). IEK is a safe and stable procedure. It results in higher endothelial counts and faster suture removal in comparison with the conventional PKP, and has less astigmatism and better BSCVA in comparison with the manual TH-PKP.The British journal of ophthalmology 10/2008; 93(1):73-8. · 2.92 Impact Factor -
Article: Comparison of three different techniques of corneal transplantation for keratoconus.
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ABSTRACT: To compare the visual outcomes following deep anterior lamellar keratoplasty (DALK), penetrating keratoplasty (PK), and manual top-hat PK (TH-PK) in subjects undergoing corneal transplantation for keratoconus (KC). A retrospective comparative case series. settings: Cornea clinic at the Toronto Western Hospital. study population: Fifty patients who underwent corneal transplantation for KC: 17 eyes underwent DALK, 20 eyes underwent traditional PK, and 13 had TH-PK. main outcome measures: Preoperative and postoperative uncorrected and best spectacle-corrected visual acuity (UCVA, BSCVA), high-order aberrations (HOA), complication rate, and endothelial cell counts. The median BSCVA at 12 months follow-up was 20/40 in the DALK eyes and 20/30 in the traditional PK and TH-PK eyes. The mean final spherical equivalent power in the three groups was less than -1 diopter (D). The median astigmatism was less than 3.5 D in the three groups. Complication rates were similar for three groups, although the DALK group tended toward more complications. Although DALK and TH-PK procedure results in significantly shorter time to suture removal (P < .01), they caused increased levels of HOAs (P = .02). Endothelial cell counts at 12 months were significantly higher in DALK and TH-PK eyes when compared to the traditional PK eyes (P < .001). DALK, PK, and TH-PK provide comparable visual outcomes in keratoconus patients. Although DALK and TH-PK induce more HOA, they speed up the time to suture removal and provide higher endothelial cell density at one year of follow-up.American journal of ophthalmology 09/2008; 146(6):905-12.e1. · 3.83 Impact Factor -
Article: IntraLase-enabled astigmatic keratotomy for postkeratoplasty astigmatism.
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ABSTRACT: To report on the outcomes of IntraLase-enabled astigmatic keratotomy (IEAK) and to compare it with manual astigmatic keratotomy (AK) for the management of postkeratoplasty astigmatism. Retrospective, comparative case series. Forty eyes of 39 patients treated at a cornea clinic at the Toronto Western Hospital were included. Twenty eyes underwent manual AK and 20 eyes underwent IEAK. The main outcome measures included preoperative and postoperative manifest refraction, uncorrected and best-corrected visual acuity (UCVA, BCVA), corneal topography, high-order ocular aberrations, and complications. In the manual AK group, UCVA (logarithm of the minimum angle of resolution) improved from 1.08 +/- 0.29 before surgery to 0.93 +/- 0.45 after surgery (P = .09), and in the IEAK group, UCVA improved from 1.14 +/- 0.42 before surgery to 0.82 +/- 0.44 after the procedure (P = .004). BCVA improved from 0.63 +/- 0.40 to 0.44 +/- 0.38 (manual AK; P = .16) and from 0.52 +/- 0.38 to 0.29 +/- 0.26 (IEAK; P = .01), respectively. Mean cylinder reduction was 3.23 +/- 4.69 diopters in the manual AK group and 4.26 +/- 1.72 diopters in the IEAK group (P = .36). Two eyes in each group lost one line of BCVA. Three patients (15%) in the manual AK group had corneal perforation and required resuturing of the AK wound (P = .23) Overcorrection occurred at a similar rate in the two groups. Treatment of postkeratoplasty astigmatism with IntraLase is a safe and effective surgical procedure and resulted in a significant improvement in UCVA and BCVA compared with manual AK. A larger sample series is needed to refine further this new technique of AK and to compare it with accepted manual techniques.American journal of ophthalmology 09/2008; 146(6):897-904.e1. · 3.83 Impact Factor -
Article: Suture-assisted vs forceps-assisted insertion of the donor lenticula during Descemet stripping automated endothelial keratoplasty.
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ABSTRACT: To compare a new insertion method using a suture with the standard forceps-assisted insertion of the lamellar corneal graft in Descemet stripping automated endothelial keratoplasty (DSAEK). Interventional, comparative case series. DSAEK was performed on 28 consecutive eyes of 28 patients (mean age +/- standard deviation, 72.5 +/- 9.7 years; 12 males). The donor tissue was prepared using the Moria automated lamellar therapeutic keratectomy microkeratome head with a 300-mm blade depth on a Moria artificial anterior chamber (Moria, Antony, France). The central 9 mm of the recipient's Descemet membrane were stripped through a superior limbal incision. In eight consecutive unselected patients, a 10-0 monofilament suture on a long straight needle was used to insert the folded donor lenticula into the recipient's eye, whereas in the other 20 patients, a standard insertion forceps was used. During the suture insertion, an anterior chamber maintainer was used to fill the anterior chamber continuously with balanced salt solution to prevent its collapse. Suture-assisted DSAEK did not differ significantly from forceps-assisted DSAEK in any of the preoperative parameters. No significant differences were noted in the intraoperative or postoperative complications. Six months after surgery, there were no significant differences in endothelial cell counts (1804 vs 1935 cells/mm(2), respectively), visual acuity (20/40 vs 20/36, respectively), or refraction (spherical equivalent, 0.93 vs 1.05 diopters, respectively). Suture-assisted DSAEK is a valid alternative to forceps insertion; however, it does not seem to offer a significant advantage.American Journal of Ophthalmology 07/2008; 145(6):986-990. · 4.22 Impact Factor -
Article: Prospective randomized comparison of one- versus two-site Phacotrabeculectomy two-year results.
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ABSTRACT: Previous studies have failed to find a significant difference in intraocular pressure (IOP) between one- and two-site phacotrabeculectomy. A possible explanation has been relatively small samples and short follow-up. We prospectively observed 80 patients for 2 years randomized to one- versus two-site phacotrabeculectomy with the primary outcome measure being IOP. Prospective randomized controlled study. Eighty eyes were randomized and 79 underwent phacotrabeculectomy; 76 completed 24 months' follow-up. Eligible patients scheduled for phacotrabeculectomy were randomized to one- or two-site phacotrabeculectomy after giving informed consent. A sample size of 54 was calculated to detect a difference of 2 mmHg between the groups with a power of 80%. Data recorded included demographics, visual acuity, IOP, endothelial cell counts, glaucoma medications, phacoemulsification settings, iris manipulation, suture lysis, needling, and complications. Follow-up data were obtained at 3, 6, 12, and 24 months. Mean IOP at 24 months. There were no significant differences between the groups preoperatively. Mean IOPs were 17.6 versus 17.6, 12.6 versus 12.5, 13.1 versus 11.7, 13.1 versus 12.7, and 12.5 versus 12.9 mmHg for one- versus two-site at baseline and 3, 6, 12, and 24 months. There was a significant lowering of IOP compared with baseline at all time points (P<0.05). There was no significant difference in mean IOP between the groups at any time. The mean number of glaucoma medications decreased from 3.0 in each group to 0.2 and 0.4 for one- and two-site, respectively, at 24 months (P = 0.20). At 3 and 12 months, the endothelial counts (cells/mm(2)) were significantly lower in the two-site group: 2333 versus 2207 (P = 0.17), 2239 versus 1938 (P = 0.01), 2180 versus 1934 (P = 0.04), and 2147 versus 1947 (P = 0.08) at baseline and 3, 12, and 24 months, respectively. The surgical time was significantly longer for two-site (48.1+/-7.8 minutes) compared with one-site (39.2+/-6.4 minutes; P<0.001). At 2 years after phacotrabeculectomy, there was no statistically significant difference in IOP between groups. Corneal endothelial cell counts were significantly lower in the two-site group at 3 and 12 months. Two-site surgery took significantly more time.Ophthalmology 07/2008; 115(7):1130-1133.e1. · 5.45 Impact Factor -
Article: Optical coherence tomography provides insight into the effect of intacs in keratoconus.
Archives of ophthalmology 05/2008; 126(4):571-2. · 3.86 Impact Factor -
Article: Incidence, possible risk factors, and potential effects of an opaque bubble layer created by a femtosecond laser.
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ABSTRACT: To describe the incidence, characteristics, risk factors, and sequelae of an opaque bubble layer created by the IntraLase (15 Khz) femtosecond laser (IntraLase, Corp.). Private laser center and the Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. This study comprised 79 consecutive patients (149 eyes) who had laser in situ keratomileusis for myopic astigmatism. The preoperative visual acuity, refraction, keratometry, pachymetry, and intraoperative data including flap size and thickness were documented. A computerized system was used to calculate the total area of the opaque bubble layer. Eighty-four eyes (56.4%) developed an opaque bubble layer. The layer pattern was diffuse in 32.2% of eyes and hard in 24.2%. The diffuse opaque bubble layer covered a mean of 13.4%+/-10% of the corneal flap and the hard opaque bubble layer, a mean of 21.6%+/-10% (P= .0004). A significant correlation was noted between the corneal steep curvature and central corneal thickness (CCT) and the area of opaque bubble layer. Multivariate logistic regression found that flap diameter (P= .04) and CCT (P = .045) affected the occurrence and area of the opaque bubble layer (P= .04 and P= .05, respectively). Postoperative diffuse lamellar keratitis was not associated with an opaque bubble layer. Three months postoperatively, visual acuity and refraction were not affected by the bubble layer. There was an increase in trefoil aberrations in eyes with a hard opaque bubble layer (P= .01). Thicker corneas and smaller flaps were associated with a more opaque bubble layer. The presence of an opaque bubble layer did not seem to have detrimental long-term sequelae, although a small harmful effect could not be ruled out.Journal of Cataract [?] Refractive Surgery 04/2008; 34(3):417-23. · 2.26 Impact Factor -
Article: Optical coherence tomography of Descemet membrane separation by the big bubble technique.
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ABSTRACT: To image Descemet membrane separation by the big bubble technique in human corneas by using anterior segment optical coherence tomography (OCT). Five human corneoscleral rims were placed on an artificial anterior chamber and partially trephinated. A 23-gauge needle was inserted into the stroma under slit-lamp control and air was injected. The procedure was continuously imaged by anterior segment OCT. In all corneoscleral rims, a big bubble was created. The spread of air seemed to follow the interlamellar spaces without crossing lamellae. It involved mainly the inner layers of the stroma while sparing the outer 212 +/- 41 microm of the cornea (range, 168-271 microm). Intrastromal pressure build-up forced air above the Descemet membrane, creating tiny air bubbles of approximately 355 +/- 111 microm (range, 210-560 microm). When the pressure inside those bubbles reached a certain level, the bubbles spontaneously coalesced to form a big bubble. OCT is useful in imaging intracorneal air spread. The main obstacle to creating a big bubble is the impermeability to air of the imperforated posterior stromal lamellae.Cornea 11/2007; 26(9):1115-7. · 1.73 Impact Factor -
Article: Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK.
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ABSTRACT: To report anterior chamber gas bubble formation during corneal flap creation in a myopic patient who underwent LASIK using a femtosecond laser (IntraLase). A 30-year-old man underwent customized wavefront-guided LASIK for myopia. The IntraLase FS15 was used to create the corneal flap. During flap creation, gas bubble formation was noted in the anterior chamber, in addition to cavitation bubbles under the flap. Flap creation was successful and myopic ablation was uneventful. One day postoperatively, the flap was well apposed, and no air bubbles were present in the anterior chamber. Gas bubbles in the anterior chamber can be an infrequent occurrence during the use of femtosecond laser for corneal flap creation. Although gas bubbles do not hinder flap creation, their presence may interfere with eye-tracking mechanisms.Journal of refractive surgery (Thorofare, N.J.: 1995) 11/2007; 23(8):828-30. · 2.54 Impact Factor -
Article: Slit-lamp technique of draining interface fluid following Descemet's stripping endothelial keratoplasty.
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ABSTRACT: To describe a new slit-lamp technique for draining interface fluid to manage complete donor disc detachments following Descemet's stripping (automated) endothelial keratoplasty (DSEK/DSAEK). Interventional case series. Five DSEK/DSAEK patients presented on the first postoperative day with complete detachment of the donor lenticule. Slit-lamp biomicroscopy showed interface fluid preventing attachment of the donor disc to the host stromal bed. A new slit-lamp technique is described to drain the interface fluid. This technique involved completely filling the anterior chamber with an air bubble using a 30-gauge needle on a 3 ml syringe. Following this, a 0.12 forceps was used to open the inferior mid-peripheral corneal drainage slit to drain the interface fluid. This technique was successful in draining the interface fluid in all five patients, leading to immediate complete reattachment of the donor disc. Donor disc detachments following DSEK/DSAEK can be successfully managed by this slit-lamp technique of draining the interface fluid.British Journal of Ophthalmology 10/2007; 91(9):1202-5. · 2.90 Impact Factor -
Article: Early postoperative complications of deep lamellar endothelial keratoplasty.
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ABSTRACT: To report and discuss the early postoperative complications of deep lamellar endothelial keratoplasty (DLEK). The records of the first 44 patients who underwent DLEK by 1 surgeon were reviewed. Complications occurring between the first day and eighth week after surgery were recorded. In 6 patients (13.6%), the donor disc was floating in the anterior chamber on the first postoperative day and was repositioned with a 30-gauge needle. Fluid was present between the cornea and the disc in 8 patients (18.2%); in 6 of them, the fluid absorbed spontaneously. In 2 patients, the fluid was aspirated 1 month after surgery, but fibrosis developed in the interface. Two patients (4.5%) had persistent corneal edema. In 1 of them, the edema resolved after 2 months, but the other needed penetrating keratoplasty. One patient (2.3%) developed endothelial graft rejection when steroid treatment was discontinued because of exacerbation of preexisting glaucoma. Ten patients (22.7%) had elevated intraocular pressure (IOP) before surgery. The pressure was controlled with topical medication after surgery in 7 patients, 1 patient (mentioned above) suffered graft rejection, 1 patient underwent repeat trabeculectomy, and 1 patient needed insertion of a glaucoma valve. Three patients (6.8%) who did not have glaucoma before surgery developed elevated IOP postoperatively, which was controlled with topical medication. Non-adhesion of the disc and elevated IOP were the most common complications after DLEK. The mechanical preparation of a thinner donor disc and more experience may lead to fewer postoperative complications and their more efficient management.Cornea 08/2007; 26(6):650-3. · 1.73 Impact Factor -
Article: Five-millimeter-incision deep lamellar endothelial keratoplasty: one-year results.
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ABSTRACT: To evaluate visual acuity, topography, and endothelial cell density 1 year after deep lamellar endothelial keratoplasty (DLEK) for endothelial dysfunction. This is a prospective, comparative, interventional case series. Thirty-five eyes of 35 patients who had undergone DLEK with a 5-mm incision and had a minimum of 1-year follow-up were included. Main outcome measures were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), astigmatism, topographic regularity and symmetry, and endothelial cell density. : One year postoperatively, BSCVA was 0.33 +/- 0.12 (mean, 20/60; range, 20/40-20/400) compared with 0.15 +/- 0.15 preoperatively (mean, 20/200; range, 20/70-20/800). Six patients did not reach an acceptable visual acuity and were not included in the mean BSCVA, 2 had a primary failure, and the others had preexisting glaucoma or macular disease. Spherical equivalent was -0.04 +/- 1.2 D, refractive astigmatism was 1.76 +/- 1.69 D, surface regularity index was 0.97 +/- 0.54, and surface asymmetry index was 1.25 +/- 0.78 1 year after surgery. Mean endothelial cell count from the donor was 2904 +/- 559 (range, 4694-2111) and 1 year after surgery was 1595 +/- 662 (range, 702-3040), equating to 45% cell loss (range, 15%-77%). DLEK is a newer method to replace the endothelium in patients with Fuchs dystrophy. Results showed minimal astigmatism, good topographic parameters, and acceptable visual acuity. Endothelial cell loss at 1 year was significant.Cornea 07/2007; 26(5):530-3. · 1.73 Impact Factor
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2007–2013
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University Health Network
- Department of Ophthalmology
Toronto, Ontario, Canada
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1995–2012
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University of Toronto
- Department of Ophthalmology and Vision Sciences
Toronto, Ontario, Canada
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