Sorcha Ní Dhubhghaill

University Hospital Brussels | UZ Brussel · Department of Eye surgery

Introduction Modern intraocular lens (IOL) designs for cataract treatment can be broadly classified into three focal range categories; monofocal, extended depth-of-focus (EDOF) and multifocal IOLs. Monofocal IOLs allow spectacle independence for one focus, typically distance. In contrast, EDOF IOLs provide a greater range of vision, extending spect...

Purpose To report the clinical course and compare the utility of Scheimpflug tomography (ST) and anterior segment optical coherence tomography (AS-OCT) for central corneal thickness (CCT) and corneal densitometry (CD) assessment in patients with corneal crystals owing to nephropathic cystinosis. Methods A retrospective chart analysis of three pati...

Objectives To present three cases of serious corneal complications after seemingly minor and uncomplicated eyelid surgery. Methods These cases emphasize the real-world risk of corneal damage after oculoplastic surgery. Results The first case is a 46-year-old man referred to our department with a corneal perforation after bilateral blepharoplasty...

This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search. The definition can be related to a number of special phenotypes. In the more challenging cases of complex microphthalmos, relative anterior microphthalmos, and nanophthalmos, the surgeon can approach these cases more safely if they have a deep unde...

This research uses mathematical modelling to evaluate the influence of the ligament of Wieger on the crystalline lens shape at rest, and during accommodation. An axisymmetric model of the anterior segment, including the ligament of Wieger, was created using the finite element method. Different conditions including variations of stiffness and positi...

Purpose Presenting the first case of noncellular corneal endothelial substitute after multiple failed penetrating keratoplasty and lamellar endothelial keratoplasty. Methods Our case presented with pseudophakic bullous keratopathy after a history of 2 rejected PKs and 1 rejected Descemet stripping automated endothelial keratoplasty. We implanted a...

This study investigated patient satisfaction levels in five premium intraocular lenses (IOLs). A secondary aim was to determine whether patient satisfaction was associated with the cataract grade before lens surgery. In this multicenter prospective comparative study, 164 patients from diverse backgrounds underwent cataract surgery and were assigned...

Purpose There is currently no consensus on which keratoconus need cross-linking nor on how to establish progression. This study assessed the performance of diverse progression criteria and compared them with our clinical knowledge of keratoconus evolution. Methods This was a retrospective, longitudinal, observational study. Habitual progression cr...

Objectives Corneal blindness is the third most frequent cause of blindness globally. Damage to the corneal endothelium is a leading indication for corneal transplantation, which is typically performed by lamellar endothelial keratoplasty. There are two conventional surgical techniques: Ultra-Thin Descemet Stripping Automated Endothelial Keratoplast...

Die modernste Therapie zur Behandlung von Hornhautendothel­erkrankungen ist die Transplantation. Fortschritte in der Reproduzierbarkeit und Zugänglichkeit chirurgischer Techniken erhöhen die Zahl der Hornhauttransplantationen, was zu einem weltweiten Mangel an Spenderhornhäuten führt und 12,7 Millionen Patienten mit behandelbarer Sehbehinderung zur...

Introduction The success of keratoplasty strongly depends on the health status of the transplanted endothelial cells. Donor corneal tissues are routinely screened for endothelial damage before shipment; however, surgical teams have currently no means of assessing the overall viability of corneal endothelium immediately prior to transplantation. The...

Objectives: The aim of this prospective study is to examine the effects of 5 hours of well-fitted, mini-scleral contact lens (mini-SL) wear on the tear film cytokine expression in healthy eyes. Methods: Twenty-three healthy participants were included in the study. One eye of each participant was selected at random, and a mini-SL measuring 16.5 m...

Purpose To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. Setting Countries affiliated to the European Board of Ophthalmology (EBO). Design Cross-sectional study of anonymous survey results. Methods A 23-question online survey was emailed to candidates who sat the EBO Diploma Examinat...

Purpose: To establish a numerical spectral-domain optical coherence tomography (SD-OCT)-based keratoconus (KC) staging system and compare it with existing KC staging systems. Setting: Eye Hospital of Wenzhou Medical University, Wenzhou, China. Designs: Retrospective case-control study. Methods: Scheimpflug tomography, air-puff tonometry, and...

Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplantation procedure that involves selective transplantation of Descemet membrane and endothelium. DMEK offers significant advantages over other keratoplasty techniques such as faster visual rehabilitation, better final visual acuity due to minimal optical interfa...

The exchange of intraocular lenses is often indicated in cases of intraocular lens opacification, subluxated, and luxated lenses where other approaches are not likely to be successful. However, it may also be necessary after implantation of artificial lenses with incorrect refractive power, lenses that damage the corneal endothelium or elicit iris...

Scleral fixation of intraocular implants has increased significantly in recent years. Newer techniques allow minimally invasive fixation of common intraocular implants originally intended for the capsular bag. In addition, a new artificial lens implant developed specifically for scleral fixation using a small incision technique has also made it to...

Surgery on a particularly soft lens may differ from that of a standard cataract. In this chapter we will discuss these particularities.KeywordsSoft lensRefractive lens exchangeCataract surgery

This chapter reflects the author’s experience using the bag-in-the-lens (BIL) intraocular implant (IOL) in children. Pseudophakia in children using the BIL implantation gives excellent results under the age of two but is currently not recommend in children under 2 months of age. Examination including biometric measurements under anaesthesia immedia...

Posterior capsular rupture is the most common serious complication in lens surgery. With appropriate management however, posterior capsular rupture is not necessarily a contradiction to a successful lens surgery and a good result for the patient can still be achieved. However, if the surgeon does not know enough about the necessary maneuvers in man...

In this study we describe peripheral corneal endothelial cell migration in vitro in the absence and presence of a ROCK-inhibitor. For this study, 21 corneal endothelial graft rims, with attached trabecular meshwork (TM), were prepared from Descemet membrane-endothelial cell sheets by 6.5 mm trepanation. For the initial proof-of-concept, 7 outer gra...

To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature rev...

Approximately 80 million people globally are affected by glaucoma, with a projected increase to over 110 million by 2040. Substantial issues surrounding patient compliance remain with topical eye drops, and up to 10% of patients become treatment resistant, putting them at risk of permanent vision loss. The major risk factor for glaucoma is elevated...

Purpose: To determine whether combinations of devices with different measuring principles, supported by artificial intelligence (AI), can improve the diagnosis of keratoconus (KC). Methods: Scheimpflug tomography, spectral-domain optical coherence tomography (SD-OCT), and air-puff tonometry were performed in all eyes. The most relevant machine-d...

Corneal neurotization is a promising surgical approach for the treatment of moderate to severe neurotrophic keratopathy. This technique aims to restore corneal sensation by transferring healthy nerves, either directly or via a conduit, to the anesthetic cornea. This review provides a report on the current state of development, evidence, and experie...

A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. Th...

Purpose To determine the incidence of clinically significant pseudophakic cystoid macular edema (CSPME) after phacoemulsification using the ‘bag-in-the-lens’ lens (BIL) implantation technique and to examine the influence of associated risk factors for clinically significant pseudophakic macular edema (CSPME), both ocular and systemic. Methods This...

Chemosis is a common, though typically temporary complication of both upper and lower blepharoplasty surgery, though it is much more common after the latter. It occurs due to extravasation of fluid into the subconjunctival space precipitated by dessication, inflammation and manipulation of the conjunctiva and associated lymphatic drainage. Intraope...

Purpose To report secondary opacification of a hydrophilic bag-in-the-lens (BIL) which is a rare manifestation that can happen years after initial surgery. Observations We describe a case of a prominent wave-like, rippled opacification on the posterior surface of the BIL. The opacification was composed of calcium deposits and seems to start in the...

Currently, there are very few well-established treatments to stimulate corneal endothelial cell regeneration in vivo as a cure for corneal endothelial dysfunctions. The most frequently performed intervention for a damaged or dysfunctional corneal endothelium nowadays is corneal endothelial keratoplasty (EK), also known as lamellar corneal transplan...

PURPOSE To report three cases with Acanthamoeba keratitis after laser vision correction and their treatment course and outcomes, and to compare these with the existing literature. METHODS Case series and literature review. RESULTS Three eyes of three patients presented with Acanthamoeba keratitis after laser vision correction and were treated wit...

The aim of this study was to provide a concise review of international standards in the initial management of facial palsy. This culminates in guidelines and indications for referral to a tertiary facial nerve center. Facial nerve palsy is a relatively rare condition, and most practitioners outside specialized centers will only see a few cases per...

Purpose : To investigate the gender gap in first/last authors in vision science and whether gender affects manuscript review times. Design : Observational retrospective database study. Methods : First/last author's gender and country were assigned to 30438 PubMed records (data derived from Q1-Q2 ‘Ophthalmology’ journals for 2016–2020). Using mixe...

Purpose To present two patients with recent onset iris cysts where two different treatments were applied. Methods While generally benign, stromal iris cysts can increase in size very rapidly and if treatment is not prompt, can result in enucleation,as in traumatic related induced epithelial cysts. To avoid this, two different treatment modalities...

One key element to the health of the ocular surface encompasses the presence of gel-forming mucins in the pre-ocular tear film. Conjunctival goblet cells are specialized epithelial cells that secrete mucins necessary for tear film stability and general homeostasis. Their dysfunction can be linked to a range of ocular surface inflammation disorders...

Purpose: To report the indications, outcomes, and complications regarding the Bag-in-the-lens (BIL) intraocular lens (IOL) exchanges over a period of 13 years in a tertiary ophthalmologic centre. Setting: Department of Ophthalmology of the University Hospital of Antwerp (UZA). Design: Observational retrospective study. Patients and methods:...

Abstract: Early and accurate detection of keratoconus progression is particularly important for the prudent, cost-effective use of corneal cross-linking and judicious timing of clinical follow-up visits. The aim of this study was to verify whether a progression could be predicted based on two prior tomography measurements and to verify the accuracy...

The state of the art therapy for treating corneal endothelial disease is transplantation. Advances in the reproducibility and accessibility of surgical techniques are increasing the number of corneal transplants, thereby causing a global deficit of donor corneas and leaving 12.7 million patients with addressable visual impairment. Approaches to reg...

The corneal endothelium is the inner layer of the cornea. Despite comprising only a monolayer of cells, dysfunction of this layer renders millions of people visually impaired worldwide. Currently, corneal endothelial transplantation is the only viable means of restoring vision for these patients. However, because the supply of corneal endothelial g...

Pterygium is a multifaceted pathology that displays apparent conflicting characteristics: benign (e.g., self-limiting and superficial), bad (e.g., proliferative and potentially recurrent) and ugly (e.g., signs of preneoplastic transformation). The natural successive question is: why are we lacking reports showing that pterygium lesions become life-...

Objectives: To identify the most suitable parameters to describe keratoconus progression. Methods: Longitudinal retrospective cohort study. Monotonicity and consistency of over 250 parameters extracted from the Pentacam tomographies (Oculus, Germany) of 743 patients was analyzed. Repeatability was calculated for 69 patients (published elsewhere)...

Purpose: To assess the efficacy and safety of human leukocyte antigen-matched allogeneic cultivated limbal epithelial stem cell grafts in the treatment of aniridia-associated keratopathy (AAK). Methods: Six eyes of 6 patients with severe AAK received an allogeneic stem cell graft between January 2010 and March 2017. Anatomical and functional res...

The cornea is an important barrier to consider when developing ophthalmic formulations, but proper modelling of this multi-layered tissue remains a challenge. This due to the varying properties associated with each layer in addition to the dynamics of the tear film. Hence, the most representative models to date rely on animals. Animal models, howev...

Purpose To present a descriptive system for the elliptic demarcation area seen in keratoconus densitometry maps (obtained with a Scheimpflug tomographer) and to evaluate its suitability for clinical practice. Methods The subjects were 30 keratoconus patients at different stages and 20 healthy subjects. The averaged densitometry maps (‘two‐layers’...

Anterior megalophthalmos is characterized by both an extremely large corneal diameter and a very deep anterior chamber. Cataract surgery in these patients is particularly challenging because of the enlarged sulcus and capsular bag, which means that it is impossible to accommodate a conventional intraocular lens (IOL). Iris-fixated IOLs can be consi...

In this study, we describe a process of preparing, surgically manipulating, and validating a novel “small diameter” 4mm circular Descemet membrane endothelial keratoplasty (DMEK) graft in vitro. Three small diameter DMEK grafts can be prepared from a single donor endothelium and could, therefore, potentially expand the donor pool. Prior to clinical...

Purpose: To analyze the incidence of cataract extraction after Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes and to evaluate the effect of phacoemulsification after DMEK on the donor endothelial cell density (ECD). Methods: The clinical data of phakic patients with DMEK were examined. From this cohort, all patients who subsequ...

Corneal transplantation is currently the most effective treatment to restore corneal clarity in patients with endothelial disorders. Endothelial transplantation, either by Descemet membrane endothelial keratoplasty (DMEK) or by Descemet stripping (automated) endothelial keratoplasty (DS(A)EK), is a surgical approach that replaces diseased Descemet...

Purpose: To assess the postoperative outcome and patient-reported satisfaction, spectacle independence and dysphotopsia after implantation with the Rayner Sulcoflex supplementary IOL (sIOL). Methods: We analysed the outcome of all patients implanted with a multifocal sIOL between 2009 and 2011. In all cases the sIOL was the Rayner Sulcoflex IOL...

Quarter–Descemet membrane endothelial keratoplasty (Quarter-DMEK) has been introduced as a modification of the standard DMEK technique to increase the pool of endothelial grafts. In this study, we evaluated in vitro changes in endothelial cell distribution, viability and morphology of Quarter–DMEK grafts when stored in organ-culture medium. Quarter...

Purpose: To report the indications, frequency, and outcomes regarding intraocular lens (IOL) exchange in 2 university hospital tertiary referral settings over a period of 15 years. Setting: Ophthalmology departments of the University Hospital Antwerp and the University Hospital Leuven, Belgium. Design: Retrospective cross-sectional study. Met...

Abstract Purpose: To report an observation made while performing Scheimpflug densitometry analysis on the corneal region affected in keratoconus (KC) that seems to delineate the base of the cone. Methods: Scheimpflug densitometries of 20 healthy subjects and 90 patients with KC were examined. Corneal densitometry was analyzed using both “1-layer...

Purpose To investigate the origins of age‐related decreases in axial length in the literature. Methods A literature review was performed, including all articles regarding axial length changes with age. These data were combined with mean body length and education level for the countries of each study to assess their influence in a multivariate anal...

Aim Studying cell migration of corneal endothelial cells in vitro is challenging because the capacity for cell migration needs to be maintained while at the same time the tissue must remain fixed on a rigid substrate. In this study, we report a thermoresponsive culture technique designed to maintain cellular viability, and to reduce tissue handling...

Purpose: To present the baseline data for a large cohort of patients with keratoconus enrolled in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) study. Methods: Eight centers contributed the Scheimpflug tomographical data for 906 patients with keratoconus, 743 measured with a Pentacam and 163 with a Galilei. The s...

Corneal transplantation is currently the only effective treatment option for dysfunctional corneal endothelial cells (CEC). In this study, we test in vitro the surgical potential of cultivated human corneal endothelial cells (hCEC) on human anterior lens capsule (HALC), LinkCell™ bioengineered collagen sheets of 20-µm thickness (LK20), and denuded...

Purpose: To determine the incidence of clinically significant pseudophakic cystoid macular edema (CSPME) after phacoemulsification using the bag-in-the-lens intraocular lens (BIL IOL) implantation technique and to examine the influence of associated risk factors, both ocular and systemic. Setting: Monocentric, Antwerp University Hospital, Belgiu...

Purpose: To analyze whether endothelial cell density (ECD) differs between central and paracentral areas after Descemet membrane endothelial keratoplasty (DMEK) and to identify the locations of the highest and lowest ECD. Methods: In this retrospective cohort study, central and paracentral ECDs of 30 eyes of 30 patients who underwent DMEK for Fu...

Purpose: To design a grading system and validate an open-source tool to improve objective quantification and follow-up of limbal stem cell deficiency (LSCD) after treatment. Methods: A custom-made web-based grading system was developed for grading stem cell deficient eyes, termed the "Vascularisation, Haze, and Integrity" tool. For validation pu...

Ex vivo grown human corneal endothelial cells (HCEnC) are a new emerging treatment option to treat visually impaired patients aimed at alleviating the current global donor shortage. Expanding HCEnC is still challenging, and obtaining cells in sufficient quantities is a limiting factor. It is already known that conditioned medium obtained from bone...

Purpose: To introduce the concept of using a Bowman layer (BL) onlay graft to manage superficial herpetic corneal scarring and to describe the clinical outcomes of the first 2 cases undergoing this procedure. Methods: Two patients with a quiescent superficial corneal scar after herpes (varicella zoster virus [n = 1] and herpes simplex virus [n =...

Purpose To test in vitro the surgical potential of cultivated human corneal endothelial cells (hCEC) on human anterior lens capsule (HALC), bioengineered collagen sheets and denuded Descemet membrane (dDM) as tissue‐engineered grafts for Descemet membrane endothelial keratoplasty (DMEK). Methods Primary hCEC were seeded onto HALC, LinkCell™ bioeng...

Limbal stem cell deficiency (LSCD) is a condition that results from a loss of limbal stem cells or a dysfunctional limbal microenvironment. The term refers to a highly heterogeneous group of pathologies ranging from acquired diseases such as chemical burns to severe autoimmune conditions, iatrogenic trauma and genetic abnormalities such as aniridia...

Purpose Studying in vitro cell migration of endothelial sheets is challenging since capacity for cell migration needs to be maintained while the tissue must remain fixed on a rigid substrate. Here, a 3D culture technique is designed to maintain cellular viability and reduce tissue handling in order to analyze in vitro endothelial cell migration fro...

Endothelial cell migration plays a crucial role in achieving corneal clearance after corneal transplantation when using smaller-sized endothelial grafts to increase the donor pool. In this study we investigated how different strategies of Quarter-Descemet Membrane Endothelial Keratoplasty (Quarter-DMEK) limbal graft edge modification influence peri...

Corneal endothelial dysfunction is one of the leading causes of corneal edema and visual impairment, requiring corneal endothelial transplantation. The treatments are limited, however, by both logistics and a global donor shortage. As a result, corneal researchers are striving to develop tissue-engineered constructs as an alternative. Recently, the...