RESUMEN
Purpose: To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods: Forty-two eyes of 42 patients, aged between 11 and 84 years, had a mean follow-up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results: The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre-op, 1.802 at the final follow-up, and 0.52 after excluding preexisting retinal pathologies. At the last follow-up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than -5.00 D and seven needed more than -3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion: Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four-point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow-ups will help understand the technique better.
Asunto(s)
Glaucoma , Lentes Intraoculares , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Queratoplastia Penetrante/métodos , Implantación de Lentes Intraoculares/métodos , Estudios Retrospectivos , Córnea/cirugía , Glaucoma/cirugía , Esclerótica/cirugía , Complicaciones Posoperatorias/cirugíaRESUMEN
During pandemic, eye banks worldwide faced drastic reduction of corneal retrieval. Since precut tissues are uncommon in India, the onus is on corneal surgeons to maximize the donor corneal usage. The stumbling block making the stromal part unusable in the graft preparation of the Descemet membrane endothelial Keratoplasty is the stromal window creation to place the orientation mark on the stromal side of the folded graft. To overcome this, we simply marked directly on the folded Descemet graft, after partly stripping it from the donor cornea. Then, we unfolded, punched, and created two grafts after completely stripping it, retaining the Descemet part for the endothelial Keratoplasty and the stromal part for lamellar Keratoplasty. Initially, we used a special F marker, and later we marked an L using just a spatula. This simple technique needing no extra donor tissue or instrumentation maximizes the tissue utility with proper patient selection.
Asunto(s)
COVID-19 , Queratoplastia Endotelial de la Lámina Limitante Posterior , Córnea/cirugía , Lámina Limitante Posterior/cirugía , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Endotelio Corneal/trasplante , Humanos , SARS-CoV-2 , Donantes de TejidosRESUMEN
To overcome tissue shortage during pandemic, we switched to 100% glycerol preservation of the donor cornea, which is economical and provides longer duration of storage than the short and intermediate storage mediums we normally use like McCAREY Kaufman (MK) or cornisol. During our initial few cases of therapeutic penetrating keratoplasty using glycerol preserved donor cornea, we faced spontaneous Descemet's detachments resistant to air tamponade. We tried reverse graft suturing and successfully reinforced Descemet's attachment along with air tamponade, in one of the cases after multiple failed air injections. In the subsequent two cases of infective keratitis needing therapeutic penetrating Keratoplasty, we took eight reverse sutures in between the eight cardinals, to anchor the Descemet's membrane of the graft. Both the grafts showed attached Descemet's and maintained good graft clarity. The reverse corneal suturing technique has not been described to the best of our knowledge and hope this helps our corneal fraternity.
Asunto(s)
COVID-19 , Queratoplastia Endotelial de la Lámina Limitante Posterior , Obtención de Tejidos y Órganos , Córnea/cirugía , Lámina Limitante Posterior/cirugía , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Endotelio Corneal/cirugía , Glicerol , Humanos , Queratoplastia Penetrante , SARS-CoV-2 , Suturas , Agudeza VisualRESUMEN
PURPOSE: To assess the long-term outcome of graft insertion by taco technique through a 2.8-mm clear corneal incision in patients undergoing Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: This is a retrospective interventional case series of 77 eyes of 75 patients who underwent DSAEK in a tertiary eye hospital. The DSAEK donor grafts were folded to an uneven 70/30 taco and held at a single point using Utrata forceps. All insertions were through a 2.8-mm clear corneal incision except the two aphakic patients requiring combined SFIOL implantation. All patients underwent a comprehensive eye examination preoperatively and were followed up to 6 years postoperatively. Visual outcomes, graft clarity, and complications of all and endothelial cell loss in 22 patients with available postop specular microscopy were analyzed. RESULTS: Overall, 59 (76.6%) had clear grafts until the final follow-up. Visual acuity improved in 48 (62.3%) from an average of 1.3 to 0.8 logMAR (P = 0.0001). Vision was maintained in seven and worsened in four eyes. Grafts failed in 18 (23.3%) eyes: seven (9%) were primary failures, two post rejection, four done for failed PK did not clear, four due to worsening of preexisting glaucoma, and one noncompliant failed eventually. Average endothelial cell density reduction was 26.3% (mean preop donor 2419 to postop 1779 cells/mm2; P = 0.000). CONCLUSION: Our study shows good long-term clinical outcome of DSAEK using Taco technique through a 2.8-mm clear corneal incision in a tertiary hospital.
Asunto(s)
Enfermedades de la Córnea , Queratoplastia Endotelial de la Lámina Limitante Posterior , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/cirugía , Endotelio Corneal , Supervivencia de Injerto , Humanos , Estudios Retrospectivos , Agudeza VisualAsunto(s)
Enfermedades de la Córnea , Queratoplastia Endotelial de la Lámina Limitante Posterior , Obtención de Tejidos y Órganos , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/epidemiología , Enfermedades de la Córnea/cirugía , Lámina Limitante Posterior/cirugía , Endotelio Corneal , Glicerol , Humanos , PandemiasRESUMEN
PURPOSE: To evaluate the efficacy of CXL in treating fungal keratitis as an adjuvant therapy. METHODS: Detailed clinical examination microbiological investigation was performed. Twenty fungal keratitis patients were recruited and randomized into two groups: group 1 (n= 11, standard antifungal), group 2 (n=9, corneal collagen crosslinking with standard antifungal). Corneal scraping and tear samples collected were subjected to real-time PCR targeting ITS, TLR analysis and cytokine analysis. RESULTS: The mean time for complete resolution of ulcer for group 2 was significantly shorter compared to group 1 and the final mean BCVA was better for group 2. Expression of IL-1ß, IL-8, IFN-γ significantly decreased immediately post CXL in group 2 patients. Significant downregulation of TLR 6, TLR-3, TLR-4 was observed 3-days post CXL compared to group 1 patients. CONCLUSION: Adjuvant effect of CXL was significant in treating fungal keratitis compared to standalone antifungal treatment.
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Colágeno/metabolismo , Sustancia Propia/efectos de los fármacos , Úlcera de la Córnea/tratamiento farmacológico , Reactivos de Enlaces Cruzados , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Fármacos Fotosensibilizantes/uso terapéutico , Adulto , Antifúngicos/uso terapéutico , Terapia Combinada , Sustancia Propia/metabolismo , Úlcera de la Córnea/metabolismo , Úlcera de la Córnea/microbiología , Reactivos de Enlaces Cruzados/uso terapéutico , Citocinas/metabolismo , Infecciones Fúngicas del Ojo/metabolismo , Infecciones Fúngicas del Ojo/microbiología , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Oftalmología , Fotoquimioterapia/métodos , Riboflavina/uso terapéutico , Centros de Atención Terciaria , Receptores Toll-Like/metabolismo , Resultado del Tratamiento , Rayos UltravioletaRESUMEN
PURPOSE: To report clinical profile and compare management options for Pythium keratitis. METHOD: Retrospective interventional study of 46 patients diagnosed as Pythium keratitis by PCR DNA sequencing from January 2014 to July 2017. Interventions were categorised into medical management (MM) (topical azithromycin and linezolid with oral azithromycin at presentation), surgery (S) (therapeutic penetrating keratoplasty, TPK), surgical adjunct (SA) (cryotherapy±alcohol with TPK) and medical adjunct (MA) (MM after TPK). RESULTS: Primary treatment included MM (1 eye), SA (3 eyes) and S (42 eyes). Recurrence occurred in 27/43 eyes (MM+S group). Second surgery (S) was required in 11 eyes (TPK-2), with additional procedures (SA) in 10 eyes and evisceration in five eyes. 8/43 eyes received MA after TPK-1. One eye required TPK-3. Recurrence occured in all eyes that received MA (100%) and in 28 of 54 TPKs (51.8%) (TPK 1+2+3) in 42 eyes. Recurrence was noted in 1/14 (7.1%) that underwent SA. CONCLUSION: The currently available and recommended treatment for Pythium keratitis is surgical by means of a TPK and in worse cases evisceration. In our study, MM/MA measures showed no benefit with recurrence or worsening of infection requiring resurgery. Almost 50% of TPKs had a recurrence requiring resurgery. However, adjunctive procedures during TPK appear to have additional benefit with low risk of recurrence and could be included as routine care.
Asunto(s)
Antibacterianos/uso terapéutico , Úlcera de la Córnea , Infecciones Parasitarias del Ojo , Queratoplastia Penetrante/métodos , Pitiosis , Pythium/aislamiento & purificación , Adolescente , Adulto , Anciano , Azitromicina/uso terapéutico , Niño , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/epidemiología , Úlcera de la Córnea/parasitología , Úlcera de la Córnea/terapia , ADN Protozoario/genética , Infecciones Parasitarias del Ojo/diagnóstico , Infecciones Parasitarias del Ojo/epidemiología , Infecciones Parasitarias del Ojo/parasitología , Infecciones Parasitarias del Ojo/terapia , Femenino , Humanos , Linezolid/uso terapéutico , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Pitiosis/diagnóstico , Pitiosis/epidemiología , Pitiosis/parasitología , Pitiosis/terapia , Pythium/genética , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
The purpose of the study was to report a case of ulcerative keratitis caused by an unusual algae Prototheca wickerhamii in a diabetic patient. This study design was a case report. A 46-year-old male, who was a known diabetic for 3 years, had an injury to the left cornea with the sparks of fire from wielding at work that developed into an ulcerative keratitis over a period of next 3 months as the patient was not on any medication. Corneal scraping culture report and Vitek 2 system investigation result confirmed it to be a P. wickerhamii infection. The patient was started on intensive topical 1% voriconazole and 5% natamycin for 1 month and with no improvement subsequently underwent penetrating keratoplasty. No recurrence of infection postoperatively was noted. This opportunistic algae rarely known to cause human eye infections is so far reported in either patients with severe systemic immunosuppression causing posterior segment eye involvement or as postcorneal surgery infections. We report an ulcerative keratitis by P. wickerhamii in a diabetic patient post corneal trauma with no prior ocular surgery.
Asunto(s)
Córnea/microbiología , Úlcera de la Córnea/complicaciones , Diabetes Mellitus , Infecciones Bacterianas del Ojo/complicaciones , Prototheca/aislamiento & purificación , Antifúngicos/administración & dosificación , Córnea/patología , Córnea/cirugía , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/terapia , ADN Bacteriano/análisis , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Humanos , Queratoplastia Penetrante , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas , Prototheca/genética , Voriconazol/administración & dosificaciónRESUMEN
PURPOSE: To report the long-term outcome of corneal collagen cross-linking (CXL) for progressive keratoconus in pediatric patients. METHODS: "Epithelium-off" CXL was performed in pediatric eyes with progressive keratoconus. Spectacle-corrected distance visual acuity (CDVA), retinoscopy, topography, and tomography were documented preoperatively and postoperatively at 3 months, 6 months, 1 year, and annually thereafter. RESULTS: A total of 377 eyes of 336 pediatric patients aged 8 to 18 years with progressive keratoconus underwent CXL. Of these, 194 eyes had a follow-up beyond 2 years and up to 6.7 years. At last follow-up, there was significant improvement in mean CDVA from 0.33 ± 0.22 to 0.27 ± 0.19 logMAR (P ≤ 0.0001), reduction in mean topographic astigmatism from 7.22 ± 3.55 to 6.13 ± 3.28 D (P = 0.0001), mean flattening of 1.20 ± 3.55 diopters in maximum keratometry (Kmax) (P = 0.0002), and mean corneal thinning of 31.1 ± 36.0 µm (P < 0.0001) after CXL. The mean change in Kmax was most significant in moderately advanced keratoconus (average keratometry 48-53 diopters). Central cones showed more corneal flattening than peripheral cones. Stabilization or flattening of Kmax was seen in 85% of eyes at 2 years and in 76% after 4 years. Stabilization or improvement of CDVA was seen in 80.1% of eyes at 2 years and in 69.1% after 4 years. CONCLUSIONS: CXL remains effective in stabilizing keratoconus for longer than 2 years in a majority of pediatric eyes. Flattening of Kmax was greater in moderately advanced keratoconus and central cones. Long-term follow-up beyond 4 years, however, revealed that a few eyes showed features suggestive of reversal of the effect of CXL.